A plausible causal relationship between the increased use of fentanyl as an obstetric analgesic and the current opioid epidemic in the US

Anesthetic Management of the Pregnant Patient: Part 2

Part 2 of "Anesthetic Management of the Pregnant Patient" reviews fetal development and maternal physiologic changes of interest to the dental practitioner. Part 2 of this review focuses on pharmacologic considerations, particularly the potential impact on the developing fetus. Along with a brief overview involving pharmacokinetics and pharmacodynamics of selected drugs, the following discussion focuses on currently accepted therapies and commonly used agents for pain control, sedation, and general anesthesia in the pregnant patient planned for or undergoing dental treatment.

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

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 opioid use. This cross-sectional study investigated the relationship between obesity and prescription opioid use among adults aged 35 to 79 years using data from the National Health and Nutrition Examination Survey (NHANES, 2003-2016). Relative to normal weight, body mass indices in the overweight {odds ratio (OR), 1.11 (confidence interval [CI], 0.88-1.39)}, obese I (OR, 1.26 [CI, 1.01-1.57]), obese II (OR, 1.69 [CI, 1.34-2.12]), and obese III (OR, 2.33 [CI, 1.76-3.08]) 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 that 14% (CI, 9%-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 nonobese (CI, 0.9-2.0 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. Although 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.