{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:12:52Z","timestamp":1780978372731,"version":"3.54.1"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>On August 31, 2017, the state of Ohio implemented legislation limiting the dosage and duration of opioid prescriptions. Despite the widespread adoption of such restrictions, few studies have investigated the effects of these reforms on opioid prescribing and patient outcomes. In the present study, the authors aimed to evaluate the effect of recent state-level reform on opioid prescribing, patient-reported outcomes (PROs), and postoperative emergency department (ED) visits and hospital readmissions after elective lumbar decompression surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study was a retrospective cohort study of patients who underwent elective lumbar laminectomy for degenerative disease at one of 5 hospitals within a single health system in the years prior to and after the implementation of the statewide reform (September 1, 2016\u2013August 31, 2018). Patients were classified according to the timing of their surgery relative to implementation of the prescribing reform: before reform (September 1, 2016\u2013August 31, 2017) or after reform (September 1, 2017\u2013 August 31, 2018). The outcomes of interest included total outpatient opioids prescribed in the 90 days following discharge from surgery as measured in morphine-equivalent doses (MEDs), total number of opioid refill prescriptions written, patient-reported pain at the first postoperative outpatient visit as measured by the Numeric Pain Rating Scale, improvement in patient-reported health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System\u2013Global Health (PROMIS-GH) questionnaire, and ED visits or hospital readmissions within 90 days of surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 1031 patients met the inclusion criteria for the study, with 469 and 562 in the before- and after-reform groups, respectively. After-reform patients received 26% (95% CI 19%\u201332%) fewer MEDs in the 90 days following discharge compared with the before-reform patients. No significant differences were observed in the overall number of opioid prescriptions written, PROs, or postoperative ED or hospital readmissions within 90 days in the year after the implementation of the prescribing reform.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Patients undergoing surgery in the year after the implementation of a state-level opioid prescribing reform received significantly fewer MEDs while reporting no change in the total number of opioid prescriptions, PROs, or postoperative ED visits or hospital readmissions. These results demonstrate that state-level reforms placing reasonable limits on opioid prescriptions written for acute pain may decrease patient opioid exposure without negatively impacting patient outcomes after lumbar decompression surgery.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2020.11.spine201046","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T07:23:47Z","timestamp":1625815427000},"page":"275-283","source":"Crossref","is-referenced-by-count":6,"title":["The change in postoperative opioid prescribing after lumbar decompression surgery following state-level opioid prescribing reform"],"prefix":"10.3171","volume":"35","author":[{"given":"Robert D.","family":"Winkelman","sequence":"first","affiliation":[{"name":"Center for Spine Health, Neurological Institute, and"},{"name":"Case Western Reserve University School of Medicine; and"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Neurological Institute, and"},{"name":"Case Western Reserve University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Tanenbaum","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Neurological Institute, and"},{"name":"Case Western Reserve University School of Medicine; and"},{"name":"Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic W.","family":"Pelle","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Neurological Institute, and"},{"name":"Orthopaedic Surgery, Cleveland Clinic;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward C.","family":"Benzel","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Neurological Institute, and"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Mroz","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Neurological Institute, and"},{"name":"Orthopaedic Surgery, Cleveland Clinic;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Neurological Institute, and"},{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","article-title":"Drug overdose deaths. Centers for Disease Control and Prevention","unstructured":"Drug overdose deaths. Centers for Disease Control and Prevention. Accessed January 21, 2021.https:\/\/www.cdc.gov\/drugoverdose\/data\/statedeaths.html"},{"key":"b2","article-title":"Prescription opioid data. Centers for Disease Control and Prevention","unstructured":"Prescription opioid data. Centers for Disease Control and Prevention. Accessed January 21, 2021.https:\/\/www.cdc.gov\/drugoverdose\/data\/prescribing.html"},{"issue":"No RR-1","key":"b3","series-title":"MMWR Recomm Rep","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr6501e1","article-title":"CDC guideline for prescribing opioids for chronic pain \u2014 United States, 2016","volume":"65","author":"Dowell D","year":"2016","unstructured":"Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain \u2014 United States, 2016. MMWR Recomm Rep. 2016;65(No RR-1):1\u201349.10.15585\/mmwr.rr6501e126987082"},{"issue":"6","key":"b4","series-title":"J Med","first-page":"504","article-title":"Opioid prescribing limits for acute pain - striking the right balance. N Engl","volume":"379","author":"Lowenstein M","year":"2018","unstructured":"Lowenstein M, Grande D, Delgado MK. Opioid prescribing limits for acute pain - striking the right balance. N Engl. J Med. 2018;379(6):504\u2013506."},{"key":"b5","series-title":"Pharmacy Times","article-title":"Opioid prescribing limits across the states","author":"Bulloch M","year":"2021","unstructured":"Bulloch M. Opioid prescribing limits across the states. Pharmacy Times. February 5, 2021.Accessed January 21, 2021.https:\/\/www.pharmacytimes.com\/contributor\/marilyn-bulloch-pharmd-bcps\/2019\/02\/opioid-prescribing-limits-across-the-states"},{"key":"b6","series-title":"Centers for Medicare and Medicaid Services","article-title":"A prescriber\u2019s guide to the new Medicare Part D opioid overutilization policies for 2019","year":"2018","unstructured":"A prescriber\u2019s guide to the new Medicare Part D opioid overutilization policies for 2019. Centers for Medicare and Medicaid Services. November 1, 2018.Accessed January 21, 2021.https:\/\/www.cms.gov\/Outreach-and-Education\/Medicare-Learning-Network-MLN\/MLNMattersArticles\/downloads\/SE18016.pdf"},{"issue":"February","key":"b7","series-title":"BMJ","doi-asserted-by":"publisher","first-page":"g1251","DOI":"10.1136\/bmj.g1251","article-title":"Rates and risk factors for prolonged opioid use after major surgery: population based cohort study","volume":"348","author":"Clarke H","year":"2014","unstructured":"Clarke H, Soneji N, Ko DT,  Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348(February):g1251.10.1136\/bmj.g125124519537"},{"issue":"4","key":"b8","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1097\/SLA.0000000000001993","article-title":"Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures","volume":"265","author":"Hill MV","year":"2017","unstructured":"Hill MV, McMahon ML, Stucke RS, Barth RJ Jr. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709\u2013714.2763177110.1097\/SLA.0000000000001993"},{"issue":"1","key":"b9","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1001\/jamasurg.2017.3132","article-title":"Defining optimal length of opioid pain medication prescription after common surgical procedures","volume":"153","author":"Scully RE","year":"2018","unstructured":"Scully RE, Schoenfeld AJ, Jiang W,  Defining optimal length of opioid pain medication prescription after common surgical procedures. JAMA Surg. 2018;153(1):37\u201343.10.1001\/jamasurg.2017.313228973092"},{"issue":"4","key":"b10","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1097\/SLA.0000000000002365","article-title":"Wide variation and overprescription of opioids after elective surgery","volume":"266","author":"Thiels CA","year":"2017","unstructured":"Thiels CA, Anderson SS, Ubl DS,  Wide variation and overprescription of opioids after elective surgery. Ann Surg. 2017;266(4):564\u2013573.10.1097\/SLA.000000000000236528697049"},{"issue":"4","key":"b11","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.amjsurg.2018.11.047","article-title":"Temporal trends in opioid prescribing for common general surgical procedures in the opioid crisis era","volume":"217","author":"Nobel TB","year":"2019","unstructured":"Nobel TB, Zaveri S, Khetan P, Divino CM. Temporal trends in opioid prescribing for common general surgical procedures in the opioid crisis era. Am J Surg. 2019;217(4):613\u2013617.10.1016\/j.amjsurg.2018.11.04730554665"},{"issue":"5","key":"b12","series-title":"Surgery","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1016\/j.surg.2018.05.047","article-title":"Variation of opioid prescribing patterns among patients undergoing similar surgery on the same acute care surgery service of the same institution: time for standardization?","volume":"164","author":"Eid AI","year":"2018","unstructured":"Eid AI, DePesa C, Nordestgaard AT,  Variation of opioid prescribing patterns among patients undergoing similar surgery on the same acute care surgery service of the same institution: time for standardization?. Surgery. 2018;164(5):926\u2013930.10.1016\/j.surg.2018.05.04730049481"},{"issue":"10","key":"b13","series-title":"J Pain","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1016\/j.jpain.2012.07.007","article-title":"Geographic variation in opioid prescribing in the U.S","volume":"13","author":"McDonald DC","year":"2012","unstructured":"McDonald DC, Carlson K, Izrael D. Geographic variation in opioid prescribing in the U.S. J Pain. 2012;13(10):988\u2013996.2303139810.1016\/j.jpain.2012.07.007"},{"issue":"1","key":"b14","series-title":"Pain Rep","doi-asserted-by":"publisher","first-page":"e637","DOI":"10.1097\/PR9.0000000000000637","article-title":"Discharge prescription patterns of opioid and nonopioid analgesics after common surgical procedures","volume":"3","author":"Nooromid MJ","year":"2018","unstructured":"Nooromid MJ, Blay E Jr, Holl JL,  Discharge prescription patterns of opioid and nonopioid analgesics after common surgical procedures. Pain Rep. 2018;3(1):e637.10.1097\/PR9.000000000000063729430565"},{"key":"b15","series-title":"BMJ","doi-asserted-by":"publisher","first-page":"j4792","DOI":"10.1136\/bmj.j4792","article-title":"Overprescribing is major contributor to opioid crisis","volume":"359","author":"Makary MA","year":"2017","unstructured":"Makary MA, Overton HN, Wang P. Overprescribing is major contributor to opioid crisis. BMJ. 2017;359:j4792.10.1136\/bmj.j479229051174"},{"issue":"15","key":"b16","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.1001\/jama.2016.0130","article-title":"Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012","volume":"315","author":"Wunsch H","year":"2016","unstructured":"Wunsch H, Wijeysundera DN, Passarella MA, Neuman MD. Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012. JAMA. 2016;315(15):1654\u20131657.10.1001\/jama.2016.013026978756"},{"issue":"1","key":"b17","series-title":"Anesth Analg","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1213\/ANE.0000000000003338","article-title":"Incidence and risk factors for chronic postoperative opioid use after major spine surgery: a cross-sectional study with longitudinal outcome","volume":"127","author":"Dunn LK","year":"2018","unstructured":"Dunn LK, Yerra S, Fang S,  Incidence and risk factors for chronic postoperative opioid use after major spine surgery: a cross-sectional study with longitudinal outcome. Anesth Analg. 2018;127(1):247\u2013254.10.1213\/ANE.000000000000333829570151"},{"issue":"15","key":"b18","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.2106\/JBJS.16.01075","article-title":"Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients","volume":"99","author":"Schoenfeld AJ","year":"2017","unstructured":"Schoenfeld AJ, Nwosu K, Jiang W,  Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients. J Bone Joint Surg Am. 2017;99(15):1247\u20131252.10.2106\/JBJS.16.0107528763410"},{"issue":"25","key":"b19","series-title":"Spine(Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E1524","DOI":"10.1097\/BRS.0000000000000622","article-title":"Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery","volume":"39","author":"Armaghani SJ","year":"2014","unstructured":"Armaghani SJ, Lee DS, Bible JE,  Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine(Phila Pa 1976). 2014;39(25):E1524\u2013E1530.10.1097\/BRS.000000000000062225417827"},{"issue":"11","key":"b20","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1974","DOI":"10.1016\/j.spinee.2018.03.018","article-title":"Opioid use following cervical spine surgery: trends and factors associated with long-term use","volume":"18","author":"Pugely AJ","year":"2018","unstructured":"Pugely AJ, Bedard NA, Kalakoti P,  Opioid use following cervical spine surgery: trends and factors associated with long-term use. Spine J. 2018;18(11):1974\u20131981.2965324410.1016\/j.spinee.2018.03.018"},{"key":"b21","series-title":"Cleveland.com","article-title":"New Ohio rules limit some opioid prescriptions to 7-day supplies","author":"Borchardt J","year":"2017","unstructured":"Borchardt J. New Ohio rules limit some opioid prescriptions to 7-day supplies. Cleveland.com. March 30, 2017.Accessed January 21, 2021.https:\/\/www.cleveland.com\/metro\/2017\/03\/pain_prescription_limits_set.html"},{"key":"b22","series-title":"August","article-title":"For prescribers - New limits on prescription opioids for acute pain. State Medical Board of Ohio","volume":"18,","year":"2017","unstructured":"For prescribers - New limits on prescription opioids for acute pain. State Medical Board of Ohio. August 18,2017.Accessed January 21, 2021.http:\/\/med.ohio.gov\/Publications\/RecentNews\/TabId\/246\/ArticleId\/50\/new-limits-on-prescription-opioids-for-acute-pain.aspx"},{"key":"b23","article-title":"Rule 4731-11-13: Prescribing of opioid analgesics for acute pain. State Medical Board of Ohio","unstructured":"Rule 4731-11-13: Prescribing of opioid analgesics for acute pain. State Medical Board of Ohio. Accessed January 21, 2021.https:\/\/med.ohio.gov\/Portals\/0\/DNN\/PDF-FOLDERS\/Laws-Rules\/Newly-Adopted-Rules\/4731-11-13%2Ceff8-31-17.pdf"},{"key":"b24","series-title":"Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing","author":"McPherson ML","year":"2009","unstructured":"McPherson ML. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. ASHP; 2009."},{"key":"b25","article-title":"A brief guide to the PROMIS Global Health Instruments","unstructured":"A brief guide to the PROMIS Global Health Instruments. HealthMeasures.Accessed January 21, 2021.http:\/\/www.healthmeasures.net\/images\/PROMIS\/manuals\/PROMIS_Global_Scoring_Manual.pdf"},{"key":"b26","article-title":"simputation: Simple imputation","author":"van der Loo M","unstructured":"van der Loo M. simputation: Simple imputation. Accessed January 21, 2021.https:\/\/cran.r-project.org\/package=simputation"},{"issue":"12","key":"b27","series-title":"Eur Heart J","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1093\/eurheartj\/ehi890","article-title":"Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods","volume":"27","author":"Ahmed A","year":"2006","unstructured":"Ahmed A, Husain A, Love TE,  Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J. 2006;27(12):1431\u20131439.10.1093\/eurheartj\/ehi89016709595"},{"issue":"19","key":"b28","series-title":"Stat Med","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.1002\/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B","article-title":"Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group","volume":"17","author":"D\u2019Agostino RB Jr","year":"1998","unstructured":"D\u2019Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17(19):2265\u20132281.980218310.1002\/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B"},{"key":"b29","article-title":"Observation and Experiment: An Introduction to Causal Inference","author":"Rosenbaum PR","year":"2017","unstructured":"Rosenbaum PR. Observation and Experiment: An Introduction to Causal Inference. Harvard University Press;2017."},{"issue":"1","key":"b30","series-title":"Stat Sci","first-page":"54","article-title":"Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy","volume":"1","author":"Efron B","year":"1986","unstructured":"Efron B, Tibshirani R. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat Sci. 1986;1(1):54\u201375."},{"key":"b31","series-title":"R Foundation","article-title":"R: A language and environment for statistical computing","year":"2020","unstructured":"R: A language and environment for statistical computing. R Foundation; 2020.Accessed January 21, 2021.https:\/\/www.r-project.org\/"},{"key":"b32","article-title":"RStudio: Integrated Development for R","year":"2020","unstructured":"RStudio: Integrated Development for R. RStudio, Inc; 2020.Accessed January 21, 2021.http:\/\/www.rstudio.com\/"},{"issue":"4","key":"b33","series-title":"Surgery","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1016\/j.surg.2019.05.040","article-title":"Opioid prescribing in minimally injured trauma patients: effect of a state prescribing limit","volume":"166","author":"Zolin SJ","year":"2019","unstructured":"Zolin SJ, Ho VP, Young BT,  Opioid prescribing in minimally injured trauma patients: effect of a state prescribing limit. Surgery. 2019;166(4):593\u2013600.10.1016\/j.surg.2019.05.04031326187"},{"issue":"4","key":"b34","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/j.spinee.2018.09.007","article-title":"Effect of narcotic prescription limiting legislation on opioid utilization following lumbar spine surgery","volume":"19","author":"Reid DBC","year":"2019","unstructured":"Reid DBC, Shah KN, Ruddell JH,  Effect of narcotic prescription limiting legislation on opioid utilization following lumbar spine surgery. Spine J. 2019;19(4):717\u2013725.10.1016\/j.spinee.2018.09.00730223089"},{"issue":"3","key":"b35","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1001\/jamasurg.2019.4913","article-title":"Association of Florida House Bill 21 with postoperative opioid prescribing for acute pain at a single institution","volume":"155","author":"Porter SB","year":"2020","unstructured":"Porter SB, Glasgow AE, Yao X, Habermann EB. Association of Florida House Bill 21 with postoperative opioid prescribing for acute pain at a single institution. JAMA Surg. 2020;155(3):263\u2013264.10.1001\/jamasurg.2019.4913"},{"issue":"7","key":"b36","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1056\/NEJMc1905045","article-title":"Statewide implementation of postoperative opioid prescribing guidelines","volume":"381","author":"Vu JV","year":"2019","unstructured":"Vu JV, Howard RA, Gunaseelan V,  Statewide implementation of postoperative opioid prescribing guidelines. N Engl J Med. 2019;381(7):680\u2013682.3141218410.1056\/NEJMc1905045"},{"issue":"76","key":"b37","series-title":"Addict Behav","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/j.addbeh.2017.08.032","article-title":"Associations between statewide prescription drug monitoring program (PDMP) requirement and physician patterns of prescribing opioid analgesics for patients with non-cancer chronic pain","volume":"76","author":"Lin HC","year":"2018","unstructured":"Lin HC, Wang Z, Boyd C,  Associations between statewide prescription drug monitoring program (PDMP) requirement and physician patterns of prescribing opioid analgesics for patients with non-cancer chronic pain. Addict Behav. 2018;76(76):348\u2013354.2889880810.1016\/j.addbeh.2017.08.032"},{"issue":"7","key":"b38","series-title":"Health Aff (Millwood)","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1377\/hlthaff.2015.1496","article-title":"Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates","volume":"35","author":"Patrick SW","year":"2016","unstructured":"Patrick SW, Fry CE, Jones TF, Buntin MB. Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Aff (Millwood). 2016;35(7):1324\u20131332.10.1377\/hlthaff.2015.149627335101"},{"issue":"12","key":"b39","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1001\/jamasurg.2018.2666","article-title":"Association of the use of a mandatory prescription drug monitoring program with prescribing practices for patients undergoing elective surgery","volume":"153","author":"Stucke RS","year":"2018","unstructured":"Stucke RS, Kelly JL, Mathis KA,  Association of the use of a mandatory prescription drug monitoring program with prescribing practices for patients undergoing elective surgery. JAMA Surg. 2018;153(12):1105\u20131110.10.1001\/jamasurg.2018.266630140927"},{"issue":"3","key":"b40","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1097\/SLA.0000000000002198","article-title":"An educational intervention decreases opioid prescribing after general surgical operations","volume":"267","author":"Hill MV","year":"2018","unstructured":"Hill MV, Stucke RS, McMahon ML,  An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg. 2018;267(3):468\u2013472.2826768910.1097\/SLA.0000000000002198"},{"issue":"2","key":"b41","series-title":"J Hand Surg Am","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.jhsa.2014.10.054","article-title":"The effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program","volume":"40","author":"Stanek JJ","year":"2015","unstructured":"Stanek JJ, Renslow MA, Kalliainen LK. The effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program. J Hand Surg Am. 2015;40(2):341\u2013346.2554243510.1016\/j.jhsa.2014.10.054"},{"issue":"11","key":"b42","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1001\/jamasurg.2018.2083","article-title":"Association of lowering default pill counts in electronic medical record systems with postoperative opioid prescribing","volume":"153","author":"Chiu AS","year":"2018","unstructured":"Chiu AS, Jean RA, Hoag JR,  Association of lowering default pill counts in electronic medical record systems with postoperative opioid prescribing. JAMA Surg. 2018;153(11):1012\u20131019.3002728910.1001\/jamasurg.2018.2083"},{"issue":"4","key":"b43","series-title":"J Gen Intern Med","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s11606-017-4286-5","article-title":"Association between electronic medical record implementation of default opioid prescription quantities and prescribing behavior in two emergency departments","volume":"33","author":"Delgado MK","year":"2018","unstructured":"Delgado MK, Shofer FS, Patel MS,  Association between electronic medical record implementation of default opioid prescription quantities and prescribing behavior in two emergency departments. J Gen Intern Med. 2018;33(4):409\u2013411.2934093710.1007\/s11606-017-4286-5"},{"issue":"11","key":"b44","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1001\/jamasurg.2017.0831","article-title":"Prescription opioid analgesics commonly unused after surgery: a systematic review","volume":"152","author":"Bicket MC","year":"2017","unstructured":"Bicket MC, Long JJ, Pronovost PJ,  Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg. 2017;152(11):1066\u20131071.2876832810.1001\/jamasurg.2017.0831"},{"issue":"10","key":"b45","series-title":"MMWR Morb Mortal Wkly Rep","doi-asserted-by":"publisher","first-page":"265","DOI":"10.15585\/mmwr.mm6610a1","article-title":"Characteristics of initial prescription episodes and likelihood of long-term opioid use - United States, 2006-2015","volume":"66","author":"Shah A","year":"2017","unstructured":"Shah A, Hayes CJMB, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use - United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(10):265\u2013269.10.15585\/mmwr.mm6610a128301454"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/35\/3\/article-p275.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/35\/3\/article-p275.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/35\/3\/article-p275.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T01:07:26Z","timestamp":1751072846000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/35\/3\/article-p275.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":45,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2020.11.spine201046","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}