In the United States, nearly 2 million adults live with opioid use disorder. Compared with opioid naïve patients, individuals with opioid use disorder experience greater challenges in managing acute pain and a greater risk for opioid-related harms. For example, individuals with opioid use disorder may have tolerance to commonly used analgesics, and opioid use disorder has been shown to increase the risk of inadequate pain control after surgery. Surgical care is one of the most common reasons for opioid prescribing for acute pain, but there is little evidence to guide postoperative pain management and reduce opioid-related harms for individuals with opioid use disorder. Specifically, important knowledge gaps exist regarding variation in perioperative outcomes including patient-reported pain and opioid use after surgery, the best practices in preventing overdose and coordinating pain management during the perioperative period, and the implementation of care pathways to address the unique needs of individuals with opioid use disorder. To address these gaps, we will prospectively capture patient-reported pain and opioid use among individuals with opioid use disorder undergoing common elective and non-elective surgical procedures and develop a clinical care pathway to optimize perioperative outcomes across a large network of hospitals in the state of Michigan that are diverse with respect to geography and case mix. In 2016, we established the Opioid Prescribing Engagement Network (OPEN), a federal and state funded quality improvement program focused on developing and disseminating best practices in surgical opioid prescribing and pain management for opioid-naïve patients. In this proposal, we will extend this work to examine patient-reported pain, opioid use, opioid prescribing, and inadequate pain management after surgery, and overdose among patients with opioid use disorder in order to adapt current prescribing guidelines for common elective and non-elective surgical procedures (Aim 1). We will qualitatively assess the perioperative experiences of individuals with opioid use disorder undergoing surgical care; their providers; and healthcare leaders. This data will inform the development of a clinical care pathway for perioperative pain management for patients with opioid use disorder (Aim 2). Finally, we will examine the implementation of the care pathway that includes care coordination, overdose prevention, peer recovery coaching, and pain management recommendations after surgery (Aim 3). We hypothesize that implementation of the care pathway will increase alignment with guideline-concordant prescribing and reduce opioid-related harms without adversely impacting patient-centered outcomes including pain and satisfaction with care. Given the growing prevalence of individuals with opioid use disorder undergoing surgery each year in the United States, interventions to reduce high-risk prescribing practices, adverse postoperative events, and optimize postoperative pain management will lead to safer perioperative care.

PROJECT NARRATIVE Over 2 million individuals in the United States live with opioid use disorder. Opioid use disorder is correlated with poor postoperative pain and an increased risk of opioid-related harms, but strategies to improve surgical care for individuals with opioid use disorder are lacking. In this prospective study, we will examine the perioperative experiences of patients with opioid use disorder in order to develop and test a clinical care pathway that integrates care coordination, overdose prevention, peer coaching, and best practices in postoperative pain management to generate the necessary evidence to optimize surgical recovery for patients with opioid use disorder.