Objective:

To assess how patients manage postdischarge pain after elective colorectal surgery and compare real-world opioid use with routine prescribing practices, focusing on the effectiveness of non-opioid alternatives.

Key Findings:

• 51% of patients managed pain without opioids post-discharge, highlighting the potential for non-opioid pain management strategies.
• Opioid-free rates were similar across surgical methods: open (47%), laparoscopic (51%), stoma (52%).
• Older age, fewer prescribed opioid pills, no postdischarge cannabis use, and higher patient activation were linked to opioid-free analgesia, suggesting areas for targeted interventions.

Interpretation:

Addressing modifiable predictors such as prescription size and patient activation may reduce unnecessary opioid use and mitigate related harms.

Limitations:

• Self-reported analgesic and cannabis use may introduce recall bias.
• Observational design limits causal inference.
• Lack of data on preoperative cannabis use and dosing.
• Non-standardized pain management practices across sites may affect outcomes.
• Opioid-related adverse events were not assessed.

Conclusion:

The study highlights the potential for non-opioid pain management strategies in colorectal surgery patients, suggesting that addressing modifiable predictors could significantly reduce unnecessary opioid use.