Work

Risk of Opioid Use Disorder in Surgical Patients with Medicaid and Associations with Prescription Opioid Dose and Duration

Year: 2025

Type: article

Abstract: Introduction: Opioids are commonly used to treat postoperative pain. Risk of opioid use disorder (OUD) in opioid-naive Medicaid patients undergoing surgery is not well studied. We investigated the incidence of OUD after opioid prescription in opioid-naïve patients undergoing surgery and estimated the association between reducing prescription duration and/or dose on risk of OUD. Methods: We analyzed data from Medicaid T-MSIS Analytic Files from 25 states of opioid-naïve adults who underwent surgery and received perioperative opioid prescription from 2016 to 2019. Associations between reducing opioid prescription on risk of OUD were estimated using a non-parametric, doubly robust estimator. Results: This study included 178,133 people who underwent a non-cesarean section surgery and 164,936 who underwent a cesarean section. OUD incidence, excluding cesarean section, was 0.84% and 1.47% at 1 and 2 years postoperatively, and OUD incidence after cesarean section was 0.77% and 1.44% at 1 and 2 years. For non-cesarean section patients, reducing opioid prescription duration by 20% as well as dose and duration by 20% were associated with a relative risk reduction of OUD at 2 years of 15% (95% CI 11%, 18%) and 27% (95% CI 23%, 30%), respectively. For cesarean section, the same reductions were associated with a relative risk reduction of OUD at 2 years of 18% (95% CI 14%, 22%) and 26% (95% CI 22%, 30%). Reducing dose alone did not significantly reduce risk of OUD. Discussion: In opioid-naïve Medicaid patients undergoing surgery, reduction in opioid prescription duration and daily dose was estimated to reduce risk of incident OUD. Plain Language Summary: In opioid-naïve Medicaid patients undergoing surgery and filling opioid prescription, the incidence of opioid use disorder (OUD) at 1 year was 0.84% in the non-cesarean section group and 0.77% in the cesarean section group. Reducing opioid prescription duration alone and duration and dose together were estimated to significantly reduce risk of OUD. Keywords: analgesics, opioids, postoperative pain management

Source: Journal of Pain Research

DOI: 10.2147/jpr.s543280

Authors: Lisa Doan, Anton Hung, Nicholas Williams, Mark Olfson, Kara Rudolph

Institutions: New York University, Columbia University, Columbia University Irving Medical Center

Language: English

Topic: Opioid Use Disorder Treatment

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836