Copyright © 2018 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited. Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2018 1 Purpose: To assess opioid prescribing patterns among American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members. Methods: An observational, retrospective, cohort study of ASOPRS members’ prescribing patterns in the 2013–2016 Medicare Part D Prescriber database. These prescribers were stratified by years in practice, sex, and geography. The ASOPRS member cohort was compared with all ophthalmologists, as a group, and other surgeons. Results: The authors identified 617 surgeons in the 2017 ASOPRS directory. Members wrote an average of 45 opioid prescriptions/year. Almost half (45%) wrote <10 prescriptions. Those with >10 prescriptions averaged 78 annually. A minority wrote >100 prescriptions per year (14.8%). Overall, opioids comprised 16.5% of all prescriptions written by ASOPRS members. Despite seeing a similar number of beneficiaries (p = 0.20), male members prescribed a greater number (p < 0.05) and a higher rate (p < 0.05) of opioids than female members. Older members had a lower opioid prescription rate (p < 0.0001). Many heavy opioid prescribers practiced in states with high opioid overdose deaths. Conclusions: American Society of Ophthalmic Plastic and Reconstructive Surgery members prescribe moderate amounts of opioids at a rate (16.5%) higher than all of ophthalmology (4%), 1 above the national mean (6.8%), but lower than other surgical services (36.5%). 2 Male gender, younger age, and practice in states with high opioid-related deaths were correlated to number of prescriptions. Prescribing patterns may naturally relate to the type of surgical intervention and population. Further research is warranted to understand opioid prescriptions and their role in the opioid epidemic. (Ophthal Plast Reconstr Surg XXX;XX:00–00) T he United States is experiencing an epidemic of opioid overdose deaths. In 2016, 116 people died daily from opi- oid-related overdoses with over 11 million total and 2 million new people misusing prescription opioids. 3 This epidemic has occurred in 3 distinct waves starting with increased prescribing of opioids in the 1990s, then transitioning to heroin as a cheaper more accessible alternative, and most recently to illicitly-manu- factured high-potency fentanyl. 3 In recent times, the majority of people who eventually become addicted to opioids are first exposed to prescription medications. A survey of heroin users in 150 treatment facilities across the United States over the past 50 years found that the most addicts had used prescription opioids (not heroin) as their first opioid of abuse. 4 This transition occurred in the 1990s and has been linked to the widespread availability and marketing of Oxycodone. 5,6 Physician’s prescriptions are a significant source of opi- oids in the community. The majority of people who abuse pre- scription opioids get them for free from a prescription intended for a friend or relative. 3 Many abusers at high risk of overdose obtain opioids from both a prescription in their name as well as from friends or other illegal sales. 7 With these trends in mind, many have scrutinized opi- oid prescribing practices. Treating pain was as an integral part of patient-centered care and often linked to patient satisfaction with healthcare. 8 Pain is measured and quantified, metrics that are tracked with goals set to improve a patient’s experience in part by adequately addressing pain. 9 Not surprisingly, pain man- agement specialists and surgeons controlling postoperative pain are among the highest prescribers of opioids. 2 Compared with other surgical specialists, ophthalmolo- gists prescribe low rates of opioids. In contrast to the national average of 6.8%, ophthalmology’s median prescriber rate is only 4% with the large majority (89%) writing for 10 or fewer opioids annually. 1 This is well below estimates for all surgery in general (36.5%) as well as pain medicine (48.6%), physi- cal medicine and rehabilitation (35.5%), and dentistry (29%). 2 With the widespread adoption of small incision surgery such as phacoemulsification and other minimally invasive interven- tions, as well as the use of topical anesthetic agents and local blocks, pain after general ophthalmic surgeries may be minimal and may account for the lower opioid prescription rates. 10 It remains unknown if these prescription trends vary within ophthalmic subspecialties. The American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) is the primary group of oculoplastic surgeons in the United States. These surgeons treat functional and aesthetic conditions affect- ing the eyelids, orbits, lacrimal system, and face, interventions that may be associated with postoperative pain. 11 Opioid pre- scription patterns within ASOPRS or any other ophthalmic subspecialty has not previously been described, to the authors’ knowledge. DOI: 10.1097/IOP.0000000000001266 Accepted for publication September 21, 2018. The authors have no financial or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.op-rs.com.). Presented at the ASOPRS Spring Meeting, Austin, TX, June 1, 2018. Address correspondence and reprint requests to Emily S. Charlson, M.D., Ph.D., Gavin Herbert Eye Institute, University of California, Irvine, 850 Health Sciences Road, Irvine, CA 92697. E-mail: Emily.charlson@gmail.com Opioid Prescribing Patterns Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members in the Medicare Part D Database Emily S. Charlson, M.D., Ph.D.*, Paula Wu Feng, M.D.†, Anh Bui, B.A.*, Seanna Grob, M.D.*, and Jeremiah P. Tao, M.D., F.A.C.S.* *Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California; and †Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, U.S.A. ORIGINAL INVESTIGATION