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

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.