BACKGROUND CONTEXT The opioid crisis in the US is currently catastrophic. A large number of patients use opioids preoperatively. PURPOSE The goal of this study is to look at a group of patients who were on opioids prior to adult spinal deformity surgery, and compare outcomes in those who ceased and those who continued opioid use post operatively. We also aim to identify factors associated with postoperative opioid cessation. STUDY DESIGN/SETTING Retrospective review of a prospective multicenter database of ASD patients. PATIENT SAMPLE A total of 296 surgical ASD patients who were using opioids (daily or weekly) prior to surgical intervention. OUTCOME MEASURES Post-operative opioid cessation or decreased use, HRQOL (SF-36, ODI, back pain, leg pain), and patient satisfaction. METHODS A multicenter prospective database of surgical ASD patients was reviewed. Opioid use was measured using the SRS-22r Q11. We included all surgical ASD patients who using opioids pre-operatively (daily or weekly) and completed 2-year follow up. Patients were divided based on 2-year opioid use: decreased/ceased vs continued. Groups were compared in regards to demographics, radiographic parameters, HRQL, invasiveness of surgery, complications, re-operations, and satisfaction. RESULTS Our database had a total of 1,281 surgical patients, out of which 760 were eligible for 2-year follow up. Of those eligible, 578 (76.05%) completed their 2-year follow up. A total of 547 of these patients answered SRS22R-Q11 at baseline at 2-years (with the remainder choosing to not answer this question). There were 296 (54.11%) of 547 ASD patients undergoing surgery reported using opioids preoperatively. Of those, 171 (57.8%) had decreased or ceased opioids 2 years after surgical intervention. Those who decreased/ceased had a higher proportion of females (83.83% vs 72.00%, p=0.014). There was no other statistically significant difference in demographics (BMI, co-morbidities, age, prior spine surgery, smoking) or radiographic parameters (PI-LL, SVA, PT). Those who decreased/ceased opioids had higher baseline SF-36 MCS – vitality (38.31 vs 35.69, p=0.03), with no difference in the remainder of the baseline HRQL scores (back and leg pain, ODI, SF-36 PCS). There were less 3COs performed in those who decreased/ceased (13.45% vs 25.60%, p=0.013). The groups had similar major complications and re-operations, and similar postop radiographic parameters. Patients that reduced/ceased had significantly better HRQL scores 2 years post operatively: back NSR (3.47 vs 5.3, p=0.0001), leg NSR (2.7 vs 3.95, p=0.0006), SF-36 MCS (50.61 vs 44.62, p=0.0002), SF-36 PCS (39.98vs 31.19, p=0.0001), and ODI (27.9 vs 44.62, p=0.0001). They were more likely to reach MCID (ODI 68.64% vs 27.42%, PCS 75.47% vs 39.17% p=0.0001) and be satisfied with surgery (84.7% vs 71.3%, p=0.003). CONCLUSIONS In ASD patients using opioids pre-operatively, only 57.8% will decrease or cease use at 2-years despite similar correction, complications and reoperations. Those who decrease or cease post op have better HRQL scores and are more satisfied with surgery. Future research should focus on identifying those at risk of continued opioid use and developing strategies for successfully tapering. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.