Children with Sickle Cell Disease Show No Alarming Trends After Opioid Use

New research identified no worrying trends of long-term or growing use of opioids within three years after the first opioid prescription among opioid-naive children with sickle cell disease (SCD).¹

The retrospective cohort study utilized Medicaid enrollment and claims data from the Georgia Sickle Cell Data Collection (SCDC) program from 2011 to 2019. Data from the analysis showed patients usually filled less than a 30-day supply, despite most having ≥1 vaso-occlusive crisis (VOC) that required medical attention during the 3-year follow-up period.

“The [American Society of Hematology] SCD guidelines recommend rapid opioid treatment for vaso-occlusive crisis-related pain,” wrote the investigative team, led by Angela B. Snyder, PhD, MPH, Georgia Health Policy Center, Georgia State University.

VOCs begin in childhood in people with SCD and recur with unpredictable experiences of acute pain.² At-home treatment includes analgesics, such as opioids, usually prescribed in an acute hospital setting or a pediatric hematologist. Owing to concerns related to the opioid crisis, recent evidence has suggested opioid-naive patients in emergency departments prescribed opioids for acute pain are at increased risk for misuse.

Real-world rates of opioid prescribing in SCD are rare—Snyder and colleagues investigated the patterns of opioid use emerging within three years after the first filled prescription in opioid-naive children with SCD.¹ The team further assessed demographic factors involved in the drug’s use.

A total of 2565 children in the SCDC with confirmed or probable SCD diagnosis, aged 1 to 15 years by 2016, with Medicaid coverage, were included for analysis. Those eligible for the study filled ≥1 opioid prescription between ages 0 to 9 years after 1 year without an opioid prescription. The follow-up for each patient occurred over 3 years from 2012 to 2019, with those missing ≥6 months of Medicaid coverage during follow-up excluded from the study.

For the analysis, the primary outcome for the initial group-based trajectory model was the day’s supply of opioids per quarter during the 3 years. Outcomes were reported as mean or median and categorized by first (25%) and third (75%) quantiles of days’ supply over the analysis period. Descriptive variables included in the analysis consisted of age, sex, SCD genotype, opioid type, and number of VOCs.

Data analysis was conducted between January and November 2023. Among 725 children (mean age, 4.6 years; 344 females [47.4%]) who received an initial opioid prescription, Snyder and colleagues identified only a single pattern of low opioid use. In this population, 421 patients (58.1%) had confirmed hemoglobin SS or hemoglobin Sβ0-thalassemia.

Upon analysis, the mean days’ opioid supply across 3 years was 30.0, with a median of 17.0. Over the study period, 171 patients (23.6%) had 0 VOCs, 330 (45.5%) had 1 to 3 VOCs, and 224 (30.9%) had ≥3 VOCs. The correlation between the number of VOCs and days’ opioid supply was r = .58 (P <.001), according to the analysis.

Among 3215 opioid prescriptions, the analysis showed 818 (25.4%) were filled within 5 days of a hospitalized VOC, to address the need for continued analgesics after hospital discharge. Despite when the fill was made, the median days’ supply per prescription was 5.0. Snyder and colleagues indicated these data suggest that most prescriptions are written in outpatient settings by SCD specialists to benefit severe pain management at home.

“Future research should examine whether low opioid use reflects effective non-opioid pain management strategies or highlights an unintended and potentially harmful treatment access problem secondary to the opioid epidemic,” investigators wrote.

References

1. _{Snyder AB, Zhou M, Attell BK, et al. Opioid Use After First Opioid Prescription in Children With Sickle Cell Disease. JAMA Pediatr. Published online February 19, 2024. doi:10.1001/jamapediatrics.2023.6500}
2. _{Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020;4(12):2656-2701. doi:10.1182/bloodadvances.2020001851}