April 06, 2020
People who are obese are more likely to use prescription opioids on a long-term basis, spurred by the development of joint and back pain. The finding highlights the need for better pain management options.
While the association between chronic pain and prescription opioid use has been well-documented, little is known about obesity's impact on prescription opioid use. Researchers from Boston University found some possible links in a pair of studies published earlier this month.
One study, published in the American Journal of Preventive Medicine, found that patients with higher body mass indexes were up to 158% more likely to use prescription opioids on a long-term basis. Additionally, 27% of long-term opioid prescriptions from 2000 to 2015 were given to obese patients.
The other study, published in JAMA Open Network, found that osteoarthritis, joint disorders and back disorders were the most common reasons opioids were prescribed to people who are obese.
"Research on the opioid crisis to date has focused heavily on the supply-side factors that increased access to opioids," said Dr. Andrew Stokes, the principal investigator for both studies. "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."
The first study tracked patients who had never been prescribed opioids when they were initially surveyed. Patients considered overweight were 24% more likely to use opioids long-term – a period of at least 10 months – to treat joint pain, back pain, muscle pain, other ailments. Those with the highest BMIs, a classification known as "obese III," were 158% more likely to use opioids long-term.
The second study analyzed data from 565,930 patients between the ages of 34 and 64. Data was collected on opioid prescription use and related diagnoses. Researchers found obesity had the strongest association with opioid prescriptions with joint and back pain.
"Policy efforts are urgently needed to regulate the obesogenic environment in this country," said Dielle Lundberg, a research fellow in BU's department of global health. "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."
Through obesity, such environments also increase pain, creating future demand for prescription opioids, Lundberg added.
Researcher Dr. Tuhina Neogi, the rheumatology chief at Boston Medical Center, said their results also point to the need for better pain management options.
"The lack of sufficient medication options, woeful underutilization of physical therapy and challenges in supporting weight loss efforts have led to prescription of opioids in management of painful musculoskeletal conditions where little evidence exits to support their use," Neogi said.