Harris AB, Marrache M, Jami M, et al. - In this retrospective cohort study, using an insurance claims database, individuals aged 18–64 who underwent one or two-level primary anterior cervical discectomy and fusion (ACDF) from 2010 to 2015 for degenerative cervical pathology were recognized in order to ascertain the prevalence of and risk factors for chronic opioid use after one and two-level ACDF for degenerative cervical pathology. A total of 28,813 individuals were involved, of which, most were female who underwent single-level ACDF. About 52%, 95%, and 39% of individuals filled an opioid prescription in the preoperative period, the perioperative period, and the postoperative period, respectively. In the perioperative period, high-dose and very high-dose opioid prescriptions were recognized in 45% and 24% of individuals, respectively. In the Western US, the odds and duration of chronic opioid use were highest. Preoperative opioid use drug abuse, depression, anxiety, and surgery in the western region of the United States were factors related to the greatest risk for chronic opioid use. In conclusion, individuals undergoing ACDF generally get high-dose opioid prescriptions following surgery, and specific patient factors raise the risk for chronic opioid use after ACDF.