One low quality study evaluated the influence of reducing preoperative opioid use on patient reported outcome scores and opioid consumption after TJA.10 In their retrospective case control study, Nguyen et al. found that patients on chronic opioids prior to TJA who reduced their opioid consumption by more than 50% prior to surgery had significantly better patient reported outcome scores after TJA compared to patients who did not reduce their opioid intake prior to surgery. The percent change of improvement in patient reported outcome scores was similar to a control group of opioid naïve patients. Based on this low-quality evidence and the evidence presented above that demonstrates that patients on preoperative opioids have inferior outcomes compared to opioid naïve patients, it is the opinion of the workgroup that reduction of preoperative opioid use may lead to improved patient reported outcomes after TJA. This recommendation was upgraded from consensus to recommendation given the importance of reducing opioid use in light of the current epidemic.