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

Lisa V Doan¹, Anton M Hung², Nicholas T Williams²

¹Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA.

Journal of Pain Research

|December 11, 2025

Abstract

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.

Keywords:

analgesics opioids postoperative pain management

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