In two new studies, researchers shed light on the relationship between obesity and the use of prescription opioids in the United States.
One of the studies found that patients with higher body mass indices (BMIs) were up to 158% more likely to use prescription opioids long-term, and that 27% of long-term opioid prescriptions from 2000 to 2015 were attributable to higher BMIs.
The other study examined the pain conditions underlying this increased likelihood of opioid prescriptions for people with higher BMIs.
This study found that osteoarthritis and other joint disorders were the two reasons for an opioid prescription most strongly associated with obesity.
Together, osteoarthritis, other joint disorders, and back disorders accounted for more than half of the difference in opioid prescriptions by obesity.
The research was conducted by a team from the Boston University School of Public Health (BUSPH).
Research on the opioid crisis to date has focused heavily on the supply-side factors that increased access to opioids.
The new studies offer new evidence for policymakers to consider how addressing the roots of this crisis will require attention to the underlying sources of demand for pain relief, including obesity through its association with pain.
For the first study, the researchers used anonymized data from 565,930 patients who were between 34 and 64 years old in 2016 and had a BMI measurement recorded during that year.
They then identified any opioid prescriptions for these patients in the year before or after their BMI measurement, as well as any related pain diagnoses.
The researchers found that patients with BMIs considered “overweight” or “obese” were more likely to be prescribed opioids than patients with BMIs in the “normal” range.
The associations were particularly strong for opioid prescriptions related to joint and back pain, suggesting that these conditions play a significant role in increasing demand for pain management among patients with obesity.
In their other study, the team used data from the Medical Expenditure Panel Survey to report on 89,629 adults between the ages of 30 and 84 years old who had never been prescribed opioids when first surveyed.
They then analyzed the incidence of long-term (approximately 10 months or longer) use of prescription opioids.
The team found that patients with higher BMIs were more likely to use opioids long-term, ranging from a 24% increased likelihood for those with BMIs considered “overweight” to a 158% increased likelihood for those with BMIs in the “obese III” range.
Joint pain, back pain, injury, and muscle/nerve pain were commonly identified as reasons for opioid prescriptions.
These data also highlight the urgent need for better pain management approaches and options for millions of Americans.
The lack of sufficient medication options, woeful underutilization of physical therapy (which is well-supported by high-quality evidence for these conditions), and challenges in supporting weight loss efforts have led to the prescription of opioids in the management of painful musculoskeletal conditions where little evidence exists to support their use.
The lead author of the studies is Dr. Andrew Stokes, assistant professor of global health at BUSPH.
The study findings are published in the American Journal of Preventive Medicine and JAMA Open Network.
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