PHILADELPHIA (February 5, 2026) — For many Americans, a routine surgical procedure serves as their first introduction to opioid pain medication. While most stop using these drugs as they heal, a considerable number of "opioid-naïve" patients transition into New Persistent Opioid Use (NPOU)—continuing use long after the typical recovery period.
A new systematic review and meta-analysis led by Penn Nursing researchers, published in Pain Medicine , has identified the specific patient-related risk factors that most accurately predict which individuals are at the highest risk for this dangerous transition. The study, which synthesized data from 27 high-quality studies, found that four primary factors significantly increase the odds of a patient becoming a long-term opioid user following surgery: Medicaid enrollment, preoperative benzodiazepine use, mood disorders, and anxiety.
“Identifying who is at risk before the first incision is made is a critical step in combatting the opioid crisis,” said lead author and doctoral student Yoonjae Lee, DNP, APRN . “Our findings provide a roadmap for clinicians to implement targeted interventions, ensuring that high-risk patients receive enhanced monitoring and alternative pain management strategies.”
The Risk Factor Breakdown
Through a rigorous meta-analysis, the research team derived "pooled odds ratios," which quantify how much each factor is associated with the odds of persistent use:
A Call for Holistic Preoperative Screening
NPOU is defined as continued opioid use beyond three months post-surgery and has been linked to increased morbidity, higher mortality rates, and long-term complications.
The study’s findings emphasize that "opioid-naïve" status, meaning the patient has not used opioids recently, is not a standalone guarantee of safety. By highlighting that social determinants (such as insurance type) and psychological factors (such as anxiety) are just as influential as the surgery itself, the researchers advocate for a more comprehensive approach to preoperative screening. Integrating these data-driven insights into clinical practice can help prevent the unintended consequences of surgical pain management and improve long-term outcomes for patients nationwide. Co-authors for this study include Rosemary C. Polomano; Heath D. Schmidt, PhD; Jungwon Min, PhD; and Peggy A. Compton, PhD; all of Penn Nursing.
# # #
The University of Pennsylvania School of Nursing (Penn Nursing) is a global leader in education and the top NIH-funded nursing research institution in the U.S. Ranked the #1 nursing school in the country by QS University for a decade, Penn Nursing consistently earns top honors from U.S. News & World Report for its BSN and graduate programs. By integrating innovation in research, education, and practice, Penn Nursing prepares nurse scientists and leaders to meet the health needs of a global society. Follow Penn Nursing: Facebook | LinkedIn | YouTube | Instagram .
Pain Medicine
Patient-related risk factors for new persistent opioid use after surgery among opioid-naïve individuals in the United States: a systematic review and meta-analysis
26-Dec-2025