The specific objectives of our project are to: 1) identify interventions that are objectively associated with reduced short and long term opioid-utilization and significantly fewer adverse effects; 2) adapt effective interventions from 'successful' VAMCs to other VAMCs where there is objective room for improvement in care; and finally, 3) assess the effectiveness of these innovative plans via on-going surveillance for preoperative opioid related adverse events and prolonged use of opioids throughout the VHA.