Despite quite revealing, several of which make evident

Despite having a legitimate and important role in the
treatment of pain, opioid use poses a significant health burden in the United
States. Potential adverse outcomes of prescription opioid therapy have been well
established, and include bowel impaction, substance abuse disorders, and fatal
respiratory depression. There has been a fourfold increase in drug overdose
deaths over the past fifteen years, largely attributed to prescription opioid abuse
and/or misuse.1-2 Opioid-related emergency room department visits and
admissions for substance abuse treatment have also been on the rise since 2002.3
Consequent to the ever-increasing societal problems imposed by this powerful
class of medicines, the U.S. Department of Health and Human Services declared the
national opioid crisis a public health emergency.4 Today, there is a
greater need than ever to explore the causes and conditions that contribute to
the opioid epidemic to promote safe use of narcotics.


Determinants of the opioid epidemic are manifold, and include
an array of socioeconomic, political, structural, and individual factors.5
Importantly, a recent review has underscored how misperceptions about the risks
of opioids and a lack of evidence to corroborate clinician decision-making can
lead to prescribing practices that result in poor outcomes.6 To
address these concerns, many researchers have scrutinized opioid prescribing
patterns and consumption in various clinical settings (e.g., emergency room
visits, urological procedures, dermatological procedures, and oncology-related
surgery).7-9 These investigations have been quite revealing, several
of which make evident a gross overprescribing of narcotics following surgical
procedures. Additionally, two retrospective cohort studies evinced prolonged
refilling (i.e., > 3 months) of perioperative opioid prescriptions in patients
that underwent relatively modest surgical procedures.9-10 Establishing
the determinants of prolonged opioid use following surgery can provide evidence
to facilitate safe and effective use of these medicines.


Notwithstanding the strong evidence of opioid overprescribing
in the aforementioned settings, there remains a paucity of data on opioid
utilization following many plastic surgical procedures. Characterizing the
predictors of continued opioid use following common plastic surgical procedures
is needed to inform current prescribing practices. More informed prescribing
has the potential to mitigate conversion of non-opioid users to chronic opioid
users following surgery, and, in turn, the numerous unintended consequences of chronic
opioid use.12-14


The primary objective of our study was to identify factors associated
with refilling of a perioperative prescription opioid in the four months following
Surgical Reduction Mammoplasty (SRM) in previously opioid-naïve patients. In
addition, we sought to establish whether a particular degree of perioperative
opioid exposure (i.e., daily morphine milligram equivalents) was associated
with a lower or higher risk of opioid refills in our cohort.