Trends in Opioid Prescribing and New Persistent Opioid Use After Surgery in the United States

Abstract

Objective: To define recent trends in opioid prescribing after surgery and new persistent opioid use in the United States.

Background: New persistent opioid use after surgery among opioid-naive individuals has emerged as an important postoperative complication. In response, initiatives to promote more appropriate postoperative opioid prescribing have been adopted in recent years. However, current estimates of opioid prescribing and new persistent opioid use following surgery remain unknown.

Methods: A retrospective cohort study of opioid-naive privately insured adult patients undergoing 17 common surgical procedures between 2013 and 2021 was conducted utilizing multi-payer claims data from the Health Care Cost Institute (HCCI). Initial opioid prescription size in oral morphine equivalents (OMEs) and new persistent opioid use were the outcomes of interest. Trends in opioid prescribing and rates of new persistent opioid use were evaluated across the study period. Mixed effects logistic regression was performed to evaluate independent predictors of new persistent opioid use while adjusting for patient-level factors and year.

Results: Among 989,354 opioid-naive individuals, the adjusted initial opioid prescription size decreased from 282 mg OME to 164 mg OME, a reduction of 118 mg OME (95% CI: 116-120). The adjusted incidence of new persistent opioid use decreased from 2.7% in 2013 (95% CI: 2.6%-2.8%) to 1.1% in 2021 (95% CI: 1.0%-1.2%). For every 30 OME increase in initial opioid prescription size, new persistent opioid use increased by 3.1%. Other predictors of new persistent opioid use included preoperative nonopioid controlled substances fills [31-365 days: adjusted odds ratio (aOR)=1.78, 95% CI: 1.70-1.86; 0-30 days: aOR=2.71, 95% CI: 2.59-2.84] and undergoing orthopedic procedures [total knee arthroplasty (aOR=3.43, 95% CI: 3.15-3.72); shoulder arthroscopy (aOR=2.39, 95% CI: 2.24-2.56)].

Conclusions: Both opioid prescription size after surgery and new persistent opioid use decreased over the last decade, suggesting that opioid stewardship practices had favorable effects on the risk of long-term opioid use.

FIGURE 1

Trends in postoperative opioid prescribing, 2013–2021. The adjusted rate of an initial opioid prescription fills following surgery decreased by 3.5% over the study period [78.9% (95% CI: 78.7%–79.2%) to 75.4% (95% CI: 74.9%–75.3%)], while the adjusted initial opioid prescription size decreased from 282 mg OME (95% CI: 280–284) to 164 mg OME (95% CI: 162–165), a reduction of 118 mg OMEs (95% CI: 116–120). The rate of opioid prescription refills within 30 days of the index procedure also decreased by 11.0% over the study period [24.6% (95% CI: 24.3%–24.9%) to 13.6% (95% CI: 13.3%–14.0%)].

FIGURE 2

Trends in rates of new persistent opioid use after surgery, 2013–2021. The adjusted incidence of new persistent opioid use decreased from 2.7% in 2013 (95% CI: 2.6%–2.8%) to 1.1% in 2021 (95% CI: 1.0%–1.2%), which represents a 1.6% absolute risk reduction over the study period.

FIGURE 3

Adjusted probability of new persistent opioid use by initial opioid prescription size. The probability of new persistent opioid use increased as the initial opioid prescription size increased across all study years.