# Improving Perioperative Care for Patients with Opioid Tolerance

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $701,959

## Abstract

In the United States, nearly 1 in 6 adults filled an opioid prescription in the past year and 10 million adults are
opioid tolerant. Compared with opioid naïve patients, individuals with opioid tolerance experience greater
challenges in managing acute pain especially after having surgery and poorer outcomes following surgical
care. For example, opioid exposure before surgery has been shown to lead to greater rates of opioid
consumption after surgery. Further, patients with opioid tolerance frequently encounter high-risk prescribing
practices and delays in returning to their usual prescriber after surgery, as well as greater rates of morbidity
and mortality after surgery. Evidence-based care pathways have been developed to improve opioid prescribing
before and after surgery for opioid-naïve patients, but little is known about the postoperative needs of patients
with opioid tolerance. Specifically, important knowledge gaps exist regarding the appropriate amount of opioids
to prescribe after surgery, best practices in coordinating opioid therapy during the perioperative period, and the
effectiveness of care coordination pathways to prevent high-risk prescribing practices and optimize clinical
outcomes in this vulnerable population. To address these gaps, we will prospectively capture patient-reported
opioid use and pain outcomes among individuals with opioid tolerance undergoing common surgical
procedures and develop a clinical care pathway to optimize 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 outcomes
and opioid prescribing practices after surgery among opioid tolerant patients in order to calibrate current
prescribing guidelines for common general surgery procedures (Aim 1). We will then conduct qualitative
interviews with surgical patients who have opioid tolerance; their providers; and healthcare leaders. This data
will inform the development of a clinical care pathway for perioperative pain management for patients with
opioid tolerance (Aim 2). Finally, we will conduct a prospective randomized trial to determine the effectiveness
of the care pathway on coordinating care and reducing high-risk prescribing practices after surgery, length of
stay, and readmissions, as well as optimizing patient-reported pain (Aim 3). We hypothesize that
implementation of the care pathway will increase alignment with guideline-concordant prescribing without
adversely impacting patient-centered outcomes. Given the high prevalence of individuals with opioid tolerance
undergoing surgery each year in the United States, interventions to reduce high-risk p...

## Key facts

- **NIH application ID:** 10797393
- **Project number:** 1R01DA058029-01A1
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Mark Bicket
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $701,959
- **Award type:** 1
- **Project period:** 2024-07-15 → 2029-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10797393

## Citation

> US National Institutes of Health, RePORTER application 10797393, Improving Perioperative Care for Patients with Opioid Tolerance (1R01DA058029-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10797393. Licensed CC0.

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