The contribution of obesity to prescription opioid use in the United States

Stokes, Andrew; Berry, Kaitlyn M.; Collins, James B.; Hsiao, Chia‐Wen; Waggoner, Jeanne G.; Johnston, Stephen S.; Ammann, Eric M.; Scamuffa, Robin; Lee, Sonia; Lundberg, Dielle J.; Solomon, Daniel H.; Felson, David T.; Neogi, Tuhina; Manson, JoAnn E.

doi:10.1097/j.pain.0000000000001612

Cited by 70 publications

(39 citation statements)

References 49 publications

(54 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study found a reduced risk of OUD in arthritis patients who are obese. However, Stokes et al reported the reverse where obesity and OUD were found to be significantly associated as body mass index (BMI) rises [24]. However, there is a possibility that those who were obese and had the same dose of opioid as those who were not obese may not turn out to be at reduced risk of OUD because of their higher body mass index which may be protective due to their drug pharmacodynamics.…”

Section: Discussionmentioning

confidence: 99%

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Oladunjoye

Gauvin

et al. 2020

Cureus

View full text Add to dashboard Cite

Introduction Opioid use was primarily limited to acute pain, postsurgical care, and end of life care setting but now is the most prescribed medication for chronic pain. Arthritis is a chronic disease associated with chronic pain. Given limited options for pain relief in the patient population, these patients are often prescribed opioids and are at increased risk of opioid use disorder (OUD). Therefore, our study aimed to identify factors associated with OUD in patients with arthritis. Methods We analyzed hospitalized adult patients with arthritis with and without OUD using discharge data from National Inpatient Sample (NIS) over five years from January 1, 2010, to December 31, 2014. We looked at trends of OUD in hospitalized patients with arthritis and compared demographic and clinical characteristics of patients with and without OUD using Student's ttest and chi-square test. Multivariate analysis was also used to adjust for variables. Results A total of 21,396,252 arthritis hospitalizations were identified during the five-year study period among which 227,608 had OUD. The prevalence of OUD in arthritis hospitalization increased over the five-year period by 43%. After adjusting for other variables, mental health (OR 2.50 (2.43-2.58)), and substance use (OR 6.39 (6.14-6.66)) disorders were associated with increased odds of OUD. Conclusion The prevalence of OUD among patients with arthritis increased over the five-year study period. Mental health and substance use disorders were associated with increased odds of OUD. More studies are needed to explore alternative pain management options for arthritis patients particularly in those with mental health and substance use disorders.

show abstract

Section: Discussionmentioning

confidence: 99%

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Oladunjoye

Gauvin

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…27−29 In a prior study of the association between BMI and opioid use using data from the National Health and Nutrition Examination Survey, adults with obesity were found to be at higher risk of past-30-day opioid use than individuals with normal weight. 30 However, owing to the cross-sectional design, the observed associations could reflect confounding by illness or reverse causality between pain, opioid use, and weight status. Thus, this study aims to use a nationally representative longitudinal survey to prospectively examine the association between obesity and incident long-term prescription opioid use in an opioid−naïve sample.…”

Section: Introductionmentioning

confidence: 99%

Obesity and Incident Prescription Opioid Use in the U.S., 2000–2015

Stokes

Lundberg

Hempstead

et al. 2020

American Journal of Preventive Medicine

Self Cite

View full text Add to dashboard Cite

Introduction: Prior studies have identified associations between obesity and numerous conditions that increase risks for chronic pain. However, the impact of obesity on prescription opioid use is not well known. This study investigates the association between obesity and incidence of long-term prescription opioid use.Methods: Fifteen panels of the Medical Expenditure Panel Survey from 2000 to 2015 were pooled to generate a sample of civilian non-institutionalized adults aged 30−84 years who were prescription opioid−naïve for approximately 9 months. Incident long-term prescription opioid use was defined as reporting use at 2 of 3 interviews during a 15-month follow-up. BMI was reported at baseline. Analyses were completed in 2019.Results: Among opioid−naïve adults (n=89,629), obesity was strongly associated with incident long-term prescription opioid use. The association increased at progressively higher BMI values, with 24% elevated odds (95% CI=7%, 44%) in adults with overweight (25−29.9 kg/m 2 ) and 158% increased odds (95% CI=106%, 224%) among adults with Class III obesity (40−49.9 kg/m 2 ). These associations grew with higher-dosage opioids. Of the reasons for opioid use, joint pain, back pain, injury, and muscle/nerve pain contributed the most to the excess use observed among adults with obesity. At the population level, 27.0% of incident long-term prescription opioid use (95% CI=19.0%, 34.8%) was attributable to adults having a BMI above normal weight (25−49.9 kg/m 2 ). Conclusions:These findings suggest that obesity has contributed to prescription opioid use in the U.S. Future investments in chronic pain reduction may benefit from increased integration with obesity prevention and treatment. Am J Prev Med 2020;58(6):766−775.

show abstract

“…One potential pathway that may link obesity to deaths of despair and the broader changes in Americans health during midlife is chronic pain. Obesity is strongly associated with chronic pain, and chronic pain is in turn associated with functional limitations, disability, and many psychological conditions such as depression and anxiety ( Gureje et al, 1998 ) and has been suggested as an important contributor to population-level trends in quality of life, suicide, and opioid-related mortality ( Olfson et al, 2017 ; Petrosky et al, 2018 ; Stokes et al, 2019 ). The prevalence of chronic pain has grown steeply over recent decades ( Case & Deaton, 2017 ; Freburger et al, 2009 ; Grol-Prokopczyk, 2017 ; Zimmer & Zajacova, 2018 ), imposing a substantial population health burden in the US.…”

Section: Introductionmentioning

confidence: 99%

Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016

Stokes

Xie

Lundberg

et al. 2020

SSM - Population Health

Self Cite

View full text Add to dashboard Cite

Recent unprecedented increases in mortality and morbidity during midlife are often ascribed to rising despair in the US population. An alternative and less often examined explanation is that these trends reflect, at least in part, the lagged effects of the obesity epidemic. Adults in midlife today are more likely to live with obesity and have a greater cumulative exposure to excess adiposity during their lifetime than any previous generation. Prior work has demonstrated a link between obesity and mortality risk at midlife, but the mechanisms remain unclear. Pain may represent one important pathway linking obesity to mortality trends. Pain is a debilitating condition that has increased significantly over recent decades and is associated with both morbidity and mortality, including suicide and opioid-related mortality. Evidence suggests obesity and pain may be linked, but there is little evidence of an association at the population level. In this paper, we examine to what extent increases in overweight and obesity explain the rising trends in chronic pain observed among middle-aged adults in the US from 1992 to 2016. We assess trends in both mild/moderate nonlimiting pain and severe and/or limiting pain. In doing so, we draw attention to one mechanism through which overweight/obesity may have contributed to recent population health trends. Our analysis found that increases in BMI from 1992 to 2016 may account for up to 20% of the upward trend in mild/moderate nonlimiting pain and 32% of the trend in severe and/or limiting pain for women, and 10% and 19% of the trends respectively for men.

show abstract

The contribution of obesity to prescription opioid use in the United States

Abstract: Supplemental Digital Content is Available in the Text.Individuals with obesity report significantly more prescription opioid use than nonobese individuals according to data from NHANES (2003-2016).

Cited by 70 publications

References 49 publications

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Obesity and Incident Prescription Opioid Use in the U.S., 2000–2015

Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016

Contact Info

Product

Resources

About