Individual and Family-Level Risk Factors of Daily Opioid Use in Adolescents Following Spinal Fusion Surgery

OBJECTIVE: Exposure to prescribed opioids during adolescence increases risk of future misuse. Opioid use following major musculoskeletal surgery varies substantially, yet predictors of daily use remain unclear in adolescents. This study examined associations between pre-existing individual and family factors and postoperative clinical risk factors with daily opioid use among adolescents undergoing spinal fusion surgery. METHODS: Data were from a prospective longitudinal cohort study in youth following spinal fusion surgery. Preoperative factors included age, sex, parent education, income, pain intensity, anxiety, depression, pain self-efficacy, and family functioning. Postoperative factors (post-discharge day, sleep quality, pain interference, and pain severity) and daily opioid use (yes/no) were assessed for 30 days following surgery. Multilevel logistic regression models examined between- and within-person associations between pre- and post-operative factors with daily opioid use. RESULTS: During the 30-day postoperative period, 83% of participants (N=146; Mage:14.6±2.01 y; 79% female; 58% White) reported opioid use. Analyses demonstrated that less healthy family functioning was associated with greater odds of opioid use each day (OR=1.27, 95% CI: 1.05-1.54). On days with higher pain severity, adolescents had increased odds of concurrent opioid use (OR=1.85, 95% CI: 1.47-2.36). Each subsequent postoperative day was associated with lower odds of opioid use (OR=0.40, 95% CI: 0.33-0.49). DISCUSSION: Family functioning was a key preoperative predictor of opioid use, while daily pain severity was a strong within-person postoperative risk factor. Screening for unhealthy family functioning may help identify adolescents and parents who may benefit from targeted education and guidance on opioid prescriptions.