{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T03:23:46Z","timestamp":1766805826589,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015770","name":"Prisma Health Transformative Seed Grant","doi-asserted-by":"publisher","award":["0745-239-2013780"],"award-info":[{"award-number":["0745-239-2013780"]}],"id":[{"id":"10.13039\/100015770","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>There is growing concern about the over-prescription of opioids and the risks of long-term use. This study examined the relationship between initial need (pre-operative, post-operative, and discharge pain) and dosage of opioids in the first prescription after surgery with continued opioid use through opioid refills over 12 months, while considering patient-level characteristics. A total of 9262 opioid-na\u00efve patients underwent elective surgery, 7219 of whom were prescribed opioids following surgery. The results showed that 17% of patients received at least one opioid refill within one year post-surgery. Higher initial opioid doses, measured in morphine milligram equivalent (MME), were associated with a greater likelihood of continued use. Patients receiving a dose greater than 90 MME were 1.57 times more likely to receive a refill compared to those receiving less than 90 MME (95% confidence interval: 1.30\u20131.90, p &lt; 0.001). Additionally, patients who experienced pain before or after surgery were more likely to receive opioid refills. Those experiencing moderate or severe pain were 1.66 times more likely to receive a refill (95% confidence interval: 1.45\u20131.91, p &lt; 0.001). The findings highlight the need to consider surgery-related factors when prescribing opioids and the importance of developing strategies to balance the optimization of pain management with the risk of opioid-related harms.<\/jats:p>","DOI":"10.3390\/ijerph20105766","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T01:57:51Z","timestamp":1683683871000},"page":"5766","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association between Initial Opioid Prescription and Patient Pain with Continued Opioid Use among Opioid-Na\u00efve Patients Undergoing Elective Surgery in a Large American Health System"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6463-4094","authenticated-orcid":false,"given":"Abass","family":"Babatunde","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA"},{"name":"Center for Public Health Modeling and Response, Clemson University, Clemson, SC 29634, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5275-7273","authenticated-orcid":false,"given":"Lior","family":"Rennert","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA"},{"name":"Center for Public Health Modeling and Response, Clemson University, Clemson, SC 29634, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin B.","family":"Walker","sequence":"additional","affiliation":[{"name":"Prisma Health, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas L.","family":"Furmanek","sequence":"additional","affiliation":[{"name":"Prisma Health, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn W.","family":"Blackhurst","sequence":"additional","affiliation":[{"name":"Prisma Health, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vito A.","family":"Cancellaro","sequence":"additional","affiliation":[{"name":"Prisma Health, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alain H.","family":"Litwin","sequence":"additional","affiliation":[{"name":"Prisma Health, Greenville, SC 29605, USA"},{"name":"School of Health Research, Clemson University, Clemson, SC 29634, USA"},{"name":"School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0107-5202","authenticated-orcid":false,"given":"Kerry A.","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA"},{"name":"Center for Public Health Modeling and Response, Clemson University, Clemson, SC 29634, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S63","DOI":"10.36076\/ppj.2008\/11\/S63","article-title":"Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids","volume":"11","author":"Manchikanti","year":"2008","journal-title":"Pain Physician"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e76","DOI":"10.1097\/PTS.0000000000000566","article-title":"The Burden of Opioid-Related Adverse Drug Events on Hospitalized Previously Opioid-Free Surgical Patients","volume":"17","author":"Urman","year":"2021","journal-title":"J. Patient Saf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/SLA.0000000000002969","article-title":"Patterns of Initial Opioid Prescribing to Opioid-Naive Patients","volume":"271","author":"Larach","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1097\/PTS.0000000000001088","article-title":"Evaluation of policies limiting opioid exposure on opioid prescribing and patient pain in opioid-naive patients undergoing elective surgery in a large American health system","volume":"19","author":"Rennert","year":"2023","journal-title":"J. Patient Saf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1002\/cncr.33199","article-title":"Surgeons and perioperative opioid prescribing: An underappreciated contributor to the opioid epidemic","volume":"127","author":"Serrell","year":"2021","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e170504","DOI":"10.1001\/jamasurg.2017.0504","article-title":"New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults","volume":"152","author":"Brummett","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.jpain.2017.06.010","article-title":"Factors Influencing Long-Term Opioid Use Among Opioid Naive Patients: An Examination of Initial Prescription Characteristics and Pain Etiologies","volume":"18","author":"Shah","year":"2017","journal-title":"J. Pain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1001\/jama.2017.14567","article-title":"Ten Steps the Federal Government Should Take Now to Reverse the Opioid Addiction Epidemic","volume":"318","author":"Kolodny","year":"2017","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1056\/NEJMra1807054","article-title":"Prevention of Opioid Overdose","volume":"380","author":"Babu","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"85","DOI":"10.7326\/0003-4819-152-2-201001190-00006","article-title":"Opioid Prescriptions for Chronic Pain and Overdose: A Cohort Study","volume":"152","author":"Dunn","year":"2010","journal-title":"Ann. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s40263-018-0499-3","article-title":"Prescribed Dose of Opioids and Overdose: A Systematic Review and Meta-Analysis of Unintentional Prescription Opioid Overdose","volume":"32","author":"Adewumi","year":"2018","journal-title":"CNS Drugs"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/j.jpain.2019.01.011","article-title":"Development of the Revised Opioid Risk Tool to Predict Opioid Use Disorder in Patients with Chronic Nonmalignant Pain","volume":"20","author":"Cheatle","year":"2019","journal-title":"J. Pain"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1213\/ANE.0000000000002496","article-title":"Risk Factors for Opioid-Use Disorder and Overdose","volume":"125","author":"Webster","year":"2017","journal-title":"Anesth. Analg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/SLA.0000000000001945","article-title":"Predictors of In-hospital Post-operative Opioid Overdose After Major Elective Operations: A Nationally Representative Cohort Study","volume":"265","author":"Cauley","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e207367","DOI":"10.1001\/jamanetworkopen.2020.7367","article-title":"Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis","volume":"3","author":"Lawal","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1177\/0098858820933500","article-title":"Opioid Prescribing and the Ethical Duty to Do No Harm","volume":"46","author":"Nicholson","year":"2020","journal-title":"Am. J. Law Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC Clinical Practice Guideline for Prescribing Opioids for Pain\u2014United States, 2022","volume":"71","author":"Dowell","year":"2022","journal-title":"MMWR Recomm. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"j5790","DOI":"10.1136\/bmj.j5790","article-title":"Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: Retrospective cohort study","volume":"360","author":"Brat","year":"2018","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"265","DOI":"10.15585\/mmwr.mm6610a1","article-title":"Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use\u2014United States, 2006\u20132015","volume":"66","author":"Shah","year":"2017","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"697","DOI":"10.15585\/mmwr.mm6626a4","article-title":"Vital Signs: Changes in Opioid Prescribing in the United States, 2006\u20132015","volume":"66","author":"Guy","year":"2017","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC Guideline for Prescribing Opioids for Chronic Pain\u2014United States, 2016","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/SLA.0000000000002308","article-title":"Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter?","volume":"268","author":"Sekhri","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.spinee.2021.01.016","article-title":"Relationship between initial opioid prescription size and likelihood of refill after spine surgery","volume":"21","author":"Massie","year":"2021","journal-title":"Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","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","year":"2018","journal-title":"JAMA Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1001\/archinternmed.2011.1827","article-title":"Long-term Analgesic Use After Low-Risk Surgery: A Retrospective Cohort Study","volume":"172","author":"Alam","year":"2012","journal-title":"Arch. Intern. Med."},{"key":"ref_26","first-page":"18","article-title":"Association of Prescription Opioid Exposure and Patient Factors With Prolonged Post-operative Opioid Use in Opioid-Na\u00efve Patients","volume":"88","author":"Clark","year":"2020","journal-title":"AANA J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.drugpo.2017.05.023","article-title":"Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study","volume":"46","author":"Carroll","year":"2017","journal-title":"Int. J. Drug Policy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.annemergmed.2014.11.015","article-title":"Association of Emergency Department Opioid Initiation With Recurrent Opioid Use","volume":"65","author":"Hoppe","year":"2015","journal-title":"Ann. Emerg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e2221316","DOI":"10.1001\/jamanetworkopen.2022.21316","article-title":"Association of Postsurgical Opioid Refills for Patients With Risk of Opioid Misuse and Chronic Opioid Use Among Family Members","volume":"5","author":"Agniel","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s40122-018-0097-6","article-title":"A Brief History of the Opioid Epidemic and Strategies for Pain Medicine","volume":"7","author":"Jones","year":"2018","journal-title":"Pain Ther."},{"key":"ref_31","doi-asserted-by":"crossref","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","year":"2017","journal-title":"JAMA Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/10\/5766\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:32:26Z","timestamp":1760124746000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/10\/5766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,9]]},"references-count":31,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["ijerph20105766"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20105766","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2023,5,9]]}}}