High-risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults : Annals of Surgery

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High-risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults

Vargas, Gracia M. BA*,†; Gunaseelan, Vidhya MBA, MS, MHA; Upp, Lily BS; Deans, Katherine J. MD, MHSc; Minneci, Peter C. MD, MHSc; Gadepalli, Samir K. MD*; Englesbe, Michael J. MD*,†; Waljee, Jennifer F. MD, MPH, MS*,†; Harbaugh, Calista M. MD, MS*,†

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Annals of Surgery 277(5):p 761-766, May 2023. | DOI: 10.1097/SLA.0000000000005193



In this study, we explored which postoperative opioid prescribing practices were associated with persistent opioid use among adolescents and young adults.


Approximately 5% of adolescents and young adults develop postoperative new persistent opioid use. The impact of physician prescribing practices on persistent use among young patients is unknown.


We identified opioid-naïve patients aged 13 to 21 who underwent 1 of 13 procedures (2008–2016) and filled a perioperative opioid prescription using commercial insurance claims (Optum Deidentified Clinformatics Data Mart Database). Persistent use was defined as ≥ 1 opioid prescription fill 91 to 180 days after surgery. High-risk opioid prescribing included overlapping opioid prescriptions, co-prescribed benzodiazepines, high daily prescribed dosage, long-acting formulations, and multiple prescribers. Logistic regression modeled persistent use as a function of exposure to high-risk prescribing, adjusted for patient demographics, procedure, and comorbidities.


High-risk opioid prescribing practices increased from 34.9% to 43.5% over the study period; the largest increase was in co-prescribed benzodiazepines (24.1%–33.4%). High-risk opioid prescribing was associated with persistent use (aOR 1.235 [1.12,1.36]). Receipt of prescriptions from multiple opioid prescribers was individually associated with persistent use (aOR 1.288 [1.16,1.44]). The majority of opioid prescriptions to patients with persistent use beyond the postoperative period were from nonsurgical prescribers (79.6%).


High-risk opioid prescribing practices, particularly receiving prescriptions from multiple prescribers across specialties, were associated with a significant increase in adolescent and young adult patients’ risk of persistent opioid use. Prescription drug monitoring programs may help identify young patients at risk of persistent opioid use.

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