{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:52:22Z","timestamp":1786978342839,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL166337"],"award-info":[{"award-number":["R01HL166337"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K24AR080786"],"award-info":[{"award-number":["K24AR080786"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High\u2010risk substance use is a public health concern among adolescents placing them at increased likelihood for opioid misuse and overdose. However, whether high\u2010risk substance use is associated with increased postoperative opioid use remains poorly described. This study aimed to determine whether preoperative high\u2010risk substance use is associated with increased postoperative opioid use in adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This longitudinal study included opioid\u2010naive adolescents undergoing ambulatory orthopedic surgery. Preoperative high\u2010risk substance use was stratified using the Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD). Postoperative opioid dose use was recorded with an objective electronic medication adherence device. Postoperative pain was reported every 4\u2009h using a smartphone diary. Multivariable regression analyses for cross\u2010sectional data and multivariable mixed modeling for longitudinal data were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants (\n                      <jats:italic>n<\/jats:italic>\n                      121) aged 15\u2009years (mean; range 11\u201319) (49% females) had mostly knee, some shoulder and elbow surgery. Only 13\/121 (10.7%) reported high substance use risk, none reported low risk, with the majority (89.3%) reporting no substance intake in the prior 12\u2009months. Patients with high\u2010risk preoperative substance use took twice the postoperative opioid doses compared to those with no use 12.2 (2.7) versus 5.6 (0.6) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Multivariate negative binomial regression analysis, controlling for sociodemographic and clinical factors, confirmed high\u2010risk preoperative substance use was associated with increased postoperative opioid dose use (incidence rate ratio 1.96, 95% CI: 1.12\u20133.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018). Longitudinal analysis over 14\u2009days revealed that while adolescents with high\u2010risk substance use overall used more opioids for their pain, they were also less likely to vary their opioid use in response to lower levels of pain intensity as compared to adolescents without substance use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High\u2010risk preoperative substance use was associated with increased postoperative opioid use in opioid\u2010na\u00efve adolescents following elective ambulatory orthopedic surgery. These findings, although limited by small sample size, highlight the need for presurgery substance use screening to guide personalized strategies, potentially reduce opioid use, improve pain management, and lower misuse risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70190","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T14:49:32Z","timestamp":1776869372000},"page":"832-840","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association Between High\u2010Risk Preexisting Substance Use and Increased Postoperative Opioid Dose Use Among Adolescents Undergoing Ambulatory Orthopedic Surgery"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7601-0270","authenticated-orcid":false,"given":"Cornelius B.","family":"Groenewald","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Rabbitts","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber N.","family":"Borucki","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Sabatti","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Science Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonya M.","family":"Palermo","sequence":"additional","affiliation":[{"name":"Center for Child Health, Behavior &amp; Development Seattle Children's Research Institute  Seattle Washington USA"},{"name":"Department of Anesthesiology &amp; Pain Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0755-8659","authenticated-orcid":false,"given":"Andrew H.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Behavioral Medicine, Department of Medicine University at Buffalo, State University of New York  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"\u201c2023 National Survey on Drug Use and Health (NSDUH) Releases \u201daccessed February 11 2025 https:\/\/www.samhsa.gov\/data\/release\/2023\u2010national\u2010survey\u2010drug\u2010use\u2010and\u2010health\u2010nsduh\u2010releases."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14728"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13993"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14753"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2022.04.019"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004109"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630\u2010025\u201002921\u20107"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001958"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2020.06.024"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0504"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013\u20102346"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleepadvances\/zpae039"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010\u20100852"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136\u2010010\u20109619\u20103"},{"key":"e_1_2_10_16_1","unstructured":"\u201cR: The R Project for Statistical Computing \u201daccessed January 22 2026 https:\/\/www.r\u2010project.org\/."},{"key":"e_1_2_10_17_1","unstructured":"CDC \u201cYRBS Data Summary & Trends Report. Youth Risk Behavior Surveillance System (YRBSS) \u201daccessed March 27 2025 https:\/\/www.cdc.gov\/yrbs\/dstr\/index.html."},{"key":"e_1_2_10_18_1","unstructured":"\u201c2025\u201001\u201002 05:49 | Archive of HHS.gov \u201daccessed March 27 2025 https:\/\/www.hhs.gov\/about\/news\/2024\/07\/30\/samhsa\u2010releases\u2010annual\u2010national\u2010survey\u2010drug\u2010use\u2010and\u2010health.html."},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.7367"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2024.01.010"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003956"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542\u2010200605000\u201000021"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013\u20102346"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2020.1803180"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.156.6.607"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006623"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5790"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pan.70190","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pan.70190","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pan.70190","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T06:51:33Z","timestamp":1780987893000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pan.70190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/pan.70190"],"URL":"https:\/\/doi.org\/10.1002\/pan.70190","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"assertion":[{"value":"2025-07-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}