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. 2024 Jul 1;7(7):e2420370.
doi: 10.1001/jamanetworkopen.2024.20370.

Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths

Tori N Sutherland  1   2   3 , Jennifer A Rabbitts  4 , Gregory E Tasian  5   6 , Mark D Neuman  2   3   7 , Craig Newcomb  8 , Scott E Hadland  9   10
Affiliations

Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths

Tori N Sutherland et al. JAMA Netw Open. .

Abstract

Importance: High-risk practices, including dispensing an opioid prescription before surgery when not recommended, remain poorly characterized among US youths and may contribute to new persistent opioid use.

Objective: To characterize changes in preoperative, postoperative, and refill opioid prescriptions up to 180 days after surgery.

Design, setting, and participants: This retrospective cohort study was performed using national claims data to determine opioid prescribing practices among a cohort of opioid-naive youths aged 11 to 20 years undergoing 22 inpatient and outpatient surgical procedures between 2015 and 2020. Statistical analysis was performed from June 2023 to April 2024.

Main outcomes and measures: The primary outcome was the percentage of initial opioid prescriptions filled up to 14 days prior to vs 7 days after a procedure. Secondary outcomes included the likelihood of a refill up to 180 days after surgery, including refills at 91 to 180 days, as a proxy for new persistent opioid use, and the opioid quantity dispensed in the initial and refill prescriptions in morphine milligram equivalents (MME). Exposures included patient and prescriber characteristics. Multivariable logistic regression models were used to estimate the association between prescription timing and prolonged refills.

Results: Among 100 026 opioid-naive youths (median [IQR] age, 16.0 [14.0-18.0] years) undergoing a surgical procedure, 46 951 (46.9%) filled an initial prescription, of which 7587 (16.2%) were dispensed 1 to 14 days before surgery. The mean quantity dispensed was 227 (95% CI, 225-229) MME; 6467 youths (13.8%) filled a second prescription (mean MME, 239 [95% CI, 231-246]) up to 30 days after surgery, and 1216 (3.0%) refilled a prescription 91 to 180 days after surgery. Preoperative prescriptions, increasing age, and procedures not typically associated with severe pain were most strongly associated with new persistent opioid use.

Conclusions and relevance: In this retrospective study of youths undergoing surgical procedures, of which, many are typically not painful enough to require opioid use, opioid dispensing declined, but approximately 1 in 6 prescriptions were filled before surgery, and 1 in 33 adolescents filled prescriptions 91 to 180 days after surgery, consistent with new persistent opioid use. These findings should be addressed by policymakers and communicated by professional societies to clinicians who prescribe opioids.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sutherland reported that her spouse is employed by Optum HealthCare. Dr Tasian reported personal fees from Alnylam Pharmaceuticals Scientific Advisory Board and personal fees from Novo Nordisk Scientific Advisory Board outside the submitted work. Dr Hadland reported honoraria related to speaking on substance use from the American Academy of Pediatrics and grants from National Institute on Drug Abuse (R01DA057566, K18DA059913) outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Characteristics of Initial Preoperative and Postoperative Opioid Prescriptions, 2015-2020
By year, each figure displays characteristics of initial opioid prescriptions filled between 14 days prior to and up to 7 days after surgery among opioid-naive youths undergoing study procedures. Procedures are grouped by higher, medium, and lower overall opioid-prescribing categories. Panels show initial prescription likelihood (A), total amount of opioid in MME dispensed in the first prescription (B), and percentage of initial prescriptions dispensed up to 14 days prior to surgery (C). MME indicates morphine milligram equivalents.
Figure 2.
Figure 2.. Percentage of Opioid-Naive Youths Who Obtained an Opioid Prescription Refill Up to 60 Days After Surgery, by Timing of First Opioid Prescription Fill
By year, each panel displays the percentage of opioid-naive youths with continuous enrollment 90 days prior to and 60 days after a given surgery who were dispensed a refill opioid prescription within 30 days after surgery, by timing of first opioid prescription fill. A, The percentage of youths aged 11 to 17 years who filled a refill within 30 days after surgery. B, The percentage of youths aged 18 to 20 years who filled a refill within 30 days after surgery. C, The percentage of youths aged 11 to 17 years who filled a refill prescription 31 to 60 days after surgery. D, The percentage of youths aged 18 to 20 years who filled a refill prescription 31 to 60 days after surgery. The 3 lines in each panel refer to the time of the first opioid prescription with regard to surgery: 14 to 8 days prior, 7 to 1 days prior, and within 1 week of surgery.
See this image and copyright information in PMC

References

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