New Studies Link Opioid Prescriptions to Obesity

Since prior research has observed an existing link between opioid prescriptions and obesity in the United States, 2 new studies were conducted to investigate and advance the understanding of this association.^{1 2}

The first study, published on March 27 in the American Journal of Preventive Medicine, focused on the impact of obesity on prescription opioid use, investigating specifically the link between obesity and long-term prescription use.¹ The results of the study showed 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.¹

The second study, published on April 2 in JAMA Network Open, built upon the previously established link between opioid prescriptions and obesity to advance understanding regarding pain diagnosis as a reason for primary care clinicians to prescribe opioids for individuals with higher BMIs.² The results showed that the risk of receiving prescription opioids increased progressively with a patient’s BMI.² Prescription opioids for the management of osteoarthritis and other joint disorders had stronger associations with obesity than the mean for any pain diagnosis, with osteoarthritis, other joint disorders, and other back disorders combined accounting for 53.4% of the difference in prescription of opioids by obesity.²

Andrew Stokes, PhD, assistant professor of global health at Boston University School of Public Health (BUSPH), led both studies. In a press release, he explained, “Research on the opioid crisis to date has focused heavily on the supply-side factors that increased access to opioids,” adding that, “Our 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.”³

The JAMA Open Network study results helped to show that overweight or obese patients are more likely to get prescribed opioids than patients with BMIs in the normal range, which, the results show, is largely due to overweight or obese patients having more pain in their joints and back.² In the American Journal of Preventive Medicine study, the results clarified that patients with higher BMIs are also more likely to use opioids long-term.¹ For patients with BMIs considered overweight, there was a 24% increased likelihood of long-term use, whereas there was a 158% increased likelihood for those with BMIs in the obese II range. Commonly identified reasons for opioid prescriptions in this study included joint pain, back pain, injury, and muscle/nerve pain.¹

“Policy efforts are urgently needed to regulate the obesogenic environment in this country,” said Dielle Lundberg, a research fellow in the Department of Global Health at BUSPH and co-author of both studies, in a press release. “When people are denied access to affordable, healthy food and to the sort of built environments that promote physical activity and health across the life course, obesity is more likely to occur. The results of both studies suggest that through obesity, such environments can also increase pain and create future demand for prescription opioids.”³

The researchers noted that the data also highlight an urgent need for improved pain management approaches for millions of Americans who suffer from chronic pain.

“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 prescription of opioids in management of painful musculoskeletal conditions where little evidence exists to support their use,” said Tuhina Neogi, MD, PhD, professor of epidemiology at BUSPH, professor of rheumatology at the Boston University School of Medicine, chief of rheumatology at Boston Medical Center, and co-author of the JAMA Open Network study, in a press release”³

References

• Stokes A, Lundberg DJ, Hempstead K, et al. Obesity and Incident Prescription Opioid Use in the U.S., 2000—2015. American Journal of Preventive Medicine. 2020. doi: 10.1016/j.amepre.2019.12.018.
• Stokes A, Lundberg DJ, Sheridan B, et al. Association of Obesity with Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US. JAMA Network Open, 2020;3(4):e202012. doi: 10.1001/jamanetworkopen.2020.2012.
• Opioid prescriptions linked to obesity [news release]. ScienceDaily; April 2, 2020. sciencedaily.com/releases/2020/04/200402155738.htm. Accessed April 8, 2020.