<h3>BACKGROUND CONTEXT</h3> Various barriers to appropriate postoperative opioid use have been identified in patients undergoing spine surgery. However, knowledge is limited on whether or not these barriers change as a result of going through the experience of surgery. <h3>PURPOSE</h3> The aim of this study is to assess how barriers to appropriate opioid use change in patients following elective spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective chart review. <h3>PATIENT SAMPLE</h3> Adult patients (18 years old) who underwent elective spine surgery and completed the short version of the Barriers Questionnaire Taiwan (S-BQT) and Patient Reported Outcomes Measures Information System (PROMIS) questionnaires preoperatively and at 1-year postoperative followup. <h3>OUTCOME MEASURES</h3> Opioid barriers score (OBS) derived from the summation of subscores within the S-BQT questionnaire, patient reported comfort with the use of naloxone and confidence in nonopioid medications to effectively manage postoperative pain. <h3>METHODS</h3> A preoperative and 1-year postoperative OBS (0-35) was calculated for each patient using their S-BQT surveys. A high opioid barriers score (hOBS) was defined as a score above the sample 75th percentile (OBS > 16). Postoperative changes in patient reported confidence in nonopioid medications and comfort with the use of naloxone were assessed. Abnormal PROMIS scores were defined as: high pain interference, sleep disturbance, anxiety, depression, fatigue for scores 60; and low physical function and social roles satisfaction for scores 40. Bivariate statistics and multivariate regression were used to assess for factors associated with high OBS and postoperative changes, while controlling for age, sex, Charlson Comorbidity Index (CCI), prior opioid use, procedure and spinal region. <h3>RESULTS</h3> Within 98 patients who met inclusion criteria, there were no differences in preoperative versus postoperative OBS (11.9 ± 6.4 vs 12.2 ± 7.1, p = 0.80). At both time points, fear of addiction was the highest S-BQT subdomain score. Postoperatively, there was an increase in patient reported confidence in nonopioid medications for pain control (p = 0.01), but no changes were observed in confidence with the use of naloxone (p = 0.70). Preoperatively, the odds of having hOBS (OBS >16) were increased with high anxiety (Odds Ratio [OR] 9.8, 95% Confidence Interval [CI] 1.8 - 66.7) and decreased with prior opioid use (OR 0.10, 95%CI 0.02-0.40). Postoperatively, high sleep interference (OR 7.0, 95%CI 1.2 - 44.9), depression (OR 8.7, 95%CI 1.2-82) and low social satisfaction (OR 7.5, 95%CI 1.3 -54.3) were associated with increased odds of developing hOBS in patients with previously normal barrier scores (OBS <16). <h3>CONCLUSIONS</h3> No significant changes in barriers to appropriate opioid use or patient reported comfort with naloxone were observed following the experience of spine surgery. These findings underscore the need for standardized preoperative opioid counseling to promote safe and appropriate opioid use following surgery. Patients with high levels of anxiety are likely to benefit most from these sessions as they may be predisposed to having significant barriers to appropriate postoperative opioid use. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.