Seventy-four patients undergoing shoulder surgery were randomized to receive initial prescriptions of 7 oxycodone pills (n=20), 15 pills (n=29), or 23 pills (n=25). The primary outcome was the maximum possible opioid consumption within two weeks, measured in morphine milligram equivalents (MME). Secondary outcomes included opioid refill requests, postoperative pain-related office contacts, and American Shoulder and Elbow Surgeons (ASES) pain scores. Results showed that the 7-pill group had significantly lower opioid consumption (mean 78 MME) compared to the 15-pill (118 MME) and 23-pill (199 MME) groups (P < .001). No significant differences were observed in refill rates, office contacts, or ASES scores among groups. Overall, the study demonstrated that prescribing fewer opioid pills reduced opioid consumption without increasing the need for refills or compromising pain management. This suggests that reducing initial opioid prescriptions is an effective strategy to minimize opioid use after shoulder surgery.