Importance Morbidity and mortality associated with prescription opioid use is escalating in the United States. The extent to which chronic opioid use influences postoperative outcomes following elective surgery is not well understood. Objective To examine the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures. Design Truven Health Marketscan® Databases were used to identify patients. Setting Outpatient services claims from patients who underwent elective procedure requiring an inpatient stay. Participants Patients ages 18 and older who underwent elective hysterectomy, bariatric surgery, reflux procedures, and ventral hernia repair between 2009 and 2013 (n=184,053). Exposure Receipt of prescription opioid analgesic within 30 days of and 30 to 90 days prior to procedure. Preoperative opioid use was drawn from insurance claims and converted into oral morphine equivalents (OMEs). Main Outcomes and Measures Outcomes included postoperative healthcare utilization (length of stay, 30-day readmission rate, discharge destination) and cost (hospital stay, 90-, 180-, and 365-day). We used generalized linear regression to determine the effect of preoperative opioid use on healthcare utilization and cost outcomes after adjusting for number of comorbidities, psychological conditions, and demographic characteristics. Results In this cohort, 10.0% of patients used opioids preoperatively. Compared with non-users, patients using opioids preoperatively were more likely to have a longer and more expensive hospital stay (2.8 days vs. 2.5 days, p<0.001; $21,919.00 vs. $21,241.80, p = 0.02, respectively) and were more likely to be discharged to a rehabilitation facility (3.5% vs. 2.4%, p<0.001), adjusting for covariates. Preoperative opioid use was also correlated with a greater rate of 30-day readmission (3.7% vs. 3.1%, p<0.001) and overall greater expenditures at 90- ($5,405.40 vs. $3,681.70, p<0.001), 180- ($10,148.20 vs. $6,469.80, p<0.001), and 365-($19,695.60 vs. $11,419.40, p<0.001) days following surgery, adjusted for covariates. Conclusions and Relevance Preoperative opioid use is an independent risk factor for longer length of stay, higher 30-day readmission rates and probability of being discharged to a rehabilitation facility, and greater costs in the postoperative period. Preoperative interventions focused on opioid cessation and alternative analgesics may improve the safety and efficiency of elective surgery among chronic opioid users.

for the surgery cost center. Therefore, the use of hospital CCRs may overestimate costs for surgical patients. For example, an $8000 charge for an outpatient cholecystectomy procedure would be estimated as a $2000 cost using a hospital CCR when the actual cost is closer to $1500 using the surgery CCR. This bias would be exaggerated for patients with short or negligible inpatient stays and may be especially problematic when comparing medical and surgical therapies. There may be an additional bias of using hospital CCRs when comparing hospitals by ownership, overestimating surgical costs for not-forprofit hospitals more than for government-owned facilities and for-profit facilities.This study has several limitations. First, use of cost-center CCRs improved the accuracy of cost estimates compared with hospital CCRs; however, alternative approaches, such as timedriven activity-based costing are more accurate and actionable. 4 Second, our data came from a single state, which limited generalizability; however, California is a large and diverse state with per capita health care spending near the nation's mean. 5 Conclusions | Clinicians and payers will increasingly rely on accurate measures of cost to make value-based treatment decisions and to ensure financial solvency. Cost-center specific CCRs can be generated 6 and our findings suggest they should be used to provide more accurate measures of the cost of surgical care.

Changing hydrocodone from schedule III to schedule II was associated with an increase in the amount of opioids filled in the initial prescription following surgery. Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors.

Introduction How adolescents think about their future (i.e., future orientation) impacts their risk-taking behavior. The purpose of the present analysis was to explore whether future orientation (future planning, perceived risk to future goals, and positive future expectations) was associated with nonmedical use of stimulants and analgesics in a sample of high school students. Methods Information on future orientation and nonmedical use of prescription drugs (NMUPD) were collected using a paper-and-pencil survey from a sample of 9th-12th grade students in a Midwestern school. Results Higher perceived risk to future goals and positive future expectations were associated with a lower likelihood of self-reported nonmedical use of stimulants (n = 250; OR = 0.46, 95% CI: 0.26, 0.83; OR = 0.15, 95% CI: 0.05, 0.47, respectively). Only higher perceived risk to future goals was associated with a lower likelihood of self-reported nonmedical use of analgesics (n = 250; OR = 0.40, 95% CI: 0.24, 0.68). In a follow-up analysis limited to students who endorsed alcohol or marijuana use, perceived risk to future goals remained associated with a lower likelihood of nonmedical use of stimulants and analgesics. Conclusions Results suggest that risk perception might be a salient protective factor against both nonmedical use of stimulants and analgesics. Overall, the differential impact of conceptualizations of future orientation might depend on the class of prescription drug used, demonstrating a need to consider prescription drugs individually in the development of future studies and interventions.

Statement of PurposeThe majority of opioids prescribed following procedural care remain unused, and are a common source of nonmedical opioid misuse and accidental poisonings. Due to the importance of removing unused opioids from the home, we sought to describe access to permanent opioid disposal sites in the state of Michigan.Methods/ApproachWe identified and surveyed all sites currently authorised by the Drug Enforcement Administration (DEA) to collect opioids. The distance between the population-weighted centroid of each census block group in Michigan and the nearest opioid collection site was calculated using ArcGISÂ Network Analyst. These distances were then aggregated to the census tract level. Each census tract was categorised as urban or rural, low-income, or low-access (average distance to disposal site >1 mile for urban tracts and >10 miles for rural tracts).ResultsWe identified 819 DEA-authorised opioid disposal sites: 84% law enforcement agencies, 15%, pharmacies, and 1% other. Of these, 92% of sites responded, and 58% reported accepting opioids. The majority of individuals reside in areas with low-access (78%) to opioid disposal sites, including 94% of urban residents and 39% of rural residents. Overall, 31% reside in both low-income and low-access census tracts. The average distance to the nearest opioid disposal site was 4.0 miles, but ranged from 2.5 to 13.0 miles depending on census tract characteristic. Even after considering how access would change if all DEA-authorised sites collected opioids, distances changed minimally.ConclusionsIn Michigan, opioid disposal sites are primarily law enforcement agencies, and only 58% of DEA-authorised sites report accepting opioids. Expanded DEA registration and authorisation to create safe and convenient opioid disposal options is paramount to curb the opioid crisis.Significance and Contributions to Injury and Violence Prevention ScienceTo our knowledge, our study is the first to quantify the state-wide accessibility of opioid disposal locations.