Research Article Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery Jennifer M. Hah, 1 Yasamin Sharifzadeh, 2 Bing M. Wang, 2 Matthew J. Gillespie, 2 Stuart B. Goodman, 3 Sean C. Mackey, 1 and Ian R. Carroll 1 1 Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA 2 Stanford Systems Neuroscience and Pain Lab (SNAPL), Stanford University, Palo Alto, CA, USA 3 Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA, USA Correspondence should be addressed to Jennifer M. Hah; jhah@stanford.edu Received 28 August 2015; Accepted 15 December 2015 Academic Editor: Anna Maria Aloisi Copyright © 2015 Jennifer M. Hah et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid na¨ ıve counterparts to identify diferences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain) with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) score was associated with 2.37 (95% CI 1.29–4.32) increased odds of preoperative opioid use ( = 0.0005). Te SOAPP-R score was also associated with 3.02 (95% CI 1.36–6.70) increased odds of illicit preoperative opioid use ( = 0.007). Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12–7.27) increased odds of legitimate preoperative opioid use ( = 0.03). Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse afer surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain. 1. Introduction Previous research has reported prolonged postoperative opi- oid use in patients already taking opioids prior to surgery [1– 3]. A small retrospective study of patients undergoing ortho- pedic surgery for trauma reported that positive toxicology results at the time of injury predicted an extended duration of postoperative prescription opioid use [1]. Similarly, 30% of women taking preoperative opioids were taking them 6 months afer gynecologic surgery compared to 2.2% of women not taking preoperative opioids [2]. Tese fndings extend to patients with preoperative chronic opioid use. 77% of chronic opioid users undergoing bariatric surgery contin- ued to use opioids in the year afer surgery [4]. Likewise, a higher proportion of chronic opioid users compared to nonusers continued to take opioids 58 months afer total hip arthroplasty [5]. Furthermore, compared to their opioid na¨ ıve counterparts, preoperative prescription opioid users have worse functional outcomes [3], worse clinical outcomes [5, 6], increased hospital length of stay [5, 6], increased pain severity afer surgery [7] even in the context of increased opioid requirements [8], increased specialist referrals for pain management [6], more dissatisfaction with the surgical outcome [7], and a higher prevalence of postsurgical com- plications [6]. Particularly notable is the increased mortality associated with preoperative chronic opioid use. A history of chronic opioid use in patients with end-stage renal disease was associated with 1.6- to 2-fold increased risk of death afer kidney transplantation [9]. Mechanisms for reduced opioid cessation afer surgery in patients taking preoperative opioids are unclear. Research suggests a decreased resolution of postoperative allodynia Hindawi Publishing Corporation Pain Research and Treatment Volume 2015, Article ID 829696, 8 pages http://dx.doi.org/10.1155/2015/829696