Adolescent outcomes of Post-operative opioid EXposure (APEX): Protocol for a multisite observational study

Adolescents accounted for 5% of fatal overdoses in the United States in 2023 (Centers for Disease Control and Prevention, 2024), yet existing research on the risk factors for non-medical opioid use (not prescribed, more frequent, or in a greater quantity than intended) among adolescent patients remains limited. Surgical procedures serve as a first exposure to opioids for many adolescents and may lead to an increased likelihood of non-medical opioid use or future opioid use disorder (OUD). Although the prevalence of OUD in adolescents ages 12-17 is low-1.2% (Center for Behavioral Health Statistics S, 2024)-- identifying risk of opioid use disorder (ROUD) in adolescence could present an opportunity to intervene and support vulnerable individuals. Preventive interventions for adolescents undergoing surgical procedures could interrupt the trajectory from non-medical use to OUD, minimizing negative health effects and reducing the risk for fatal overdose.

Using a biopsychosocial model of the development of OUD, the Adolescent outcomes of Post-operative opioid EXposure (APEX) study gathers medical record and survey data from adolescent-parent dyads to better understand the relationship between pain, pain management, prescription opioid use and recovery from surgical procedures.

In this paper, we describe objectives and design of the APEX study, which aims to develop and validate systematic tools that are designed to detect ROUD in adolescent surgical patients in the 12 months following surgery.

Results of this study could provide insight into predictors of ROUD, which may inform prescribing practices in the future, help update protocols for managing pain in young people and guide future research efforts.