Date of Award

January 2020

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

William Becker

Second Advisor

Joseph Goulet

Abstract

The opioid epidemic has claimed hundreds of thousands of lives and many more remain at risk. As there is little to no evidence supporting the use of long-term opioid therapy, we aim to quantify risk of progression to long-term opioid therapy in the perioperative and outpatient settings. For patients with no preoperative opioid use, we found a low incidence of long-term opioid use one year post-operatively. However, patients who were on opioids intermittently or chronically prior to surgery exhibited a large risk of remaining on opioid therapy one year post- surgery. We also found that duration of the first opioid prescription in a patient without prior opioid prescription was a larger predictor of progression to long-term use than dose with odd ratios rising exponentially after 14 days. Only doses higher than 90 mg morphine equivalent daily dose conveyed similar risk of long-term opioid use. On the other hand, larger initial doses were more predictive of longer total time on opioid therapy than initial prescription duration.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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