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

Stokes, Andrew1; Berry, Kaitlyn M.1; Collins, Jason M.2; Johnston, Stephen S.3; Hsiao, Chia-Wen4; Waggoner, Jason R.4; Ammann, Eric M.3; Scamuffa, Robin F.3; Lee, Sonia3; Lundberg, Dielle J.1; Solomon, Daniel H.4; Felson, David T.5; Neogi, Tuhina5; Manson, JoAnn E.4,6

doi: 10.1097/j.pain.0000000000001612
Research Paper: PDF Only

The prevalence of obesity has grown rapidly over the past several decades and has been accompanied by an increase in the prevalence of chronic pain and prescription opioid use. Obesity, through its association with pain, may represent an important contributor to the opioid epidemic. This cross-sectional study investigated the relationship between obesity and prescription opioid use among adults aged 35-79 using data from the National Health and Nutrition Examination Survey (NHANES, 2003-2016). Relative to normal weight, BMIs in the overweight (OR, 1.11 [CI, 0.88 to 1.39]), obese I (OR, 1.26 [CI, 1.01 to 1.57]), obese II (OR, 1.69 [CI, 1.34 to 2.12]), and obese III (OR, 2.33 [CI, 1.76 to 3.08]) categories were associated with elevated odds of prescription opioid use. The association between excess weight and opioid use was stronger for chronic opioid use than for use with a duration of less than 90 days (p-value, <0.001). We estimated 14% [CI, 9% to 19%] of prescription opioid use at the population-level was attributable to obesity, suggesting there might have been 1.5 million fewer opioid users per year under the hypothetical scenario where obese individuals were instead non-obese [CI, 0.9 to 20 million users]. Back pain, joint pain, and muscle/nerve pain accounted for the largest differences in self-reported reasons for prescription opioid use across obesity status. Though interpretation is limited by the cross-sectional nature of the associations, our findings suggest that the obesity epidemic may be partially responsible for the high prevalence of prescription opioid use in the United States.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1Boston University School of Public Health, Boston, MA, USA

2University of North Carolina Gillings School of Public Health, Chapel Hill, NC, USA

3Johnson & Johnson, Inc., New Brunswick, NJ, USA

4Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

5Boston University School of Medicine, MA, USA

6Harvard T.H. Chan School of Public Health, MA, USA

Address for Correspondence: Andrew Stokes, PhD Boston University School of Public Health 801 Massachusetts Ave. 3rd Floor, 362 Boston, MA 02118 Tel: 617-414-1276 Email:

© 2019 International Association for the Study of Pain