For Kids With Sickle Cell Disease Prescribed Opioids, No Patterns of Misuse Emerged

No patterns of long-term or increasing use of opioids were identified within 3 years among opioid-naive children with sickle cell disease (SCD) who were prescribed the drugs for an acute pain episode, according to a retrospective cohort study.

In the cohort of 725 children, mean days’ supply of opioids over 3 years was 30, despite 45.5% of patients having a least one vaso-occlusive crisis, reported Angela Snyder, PhD, MPH, of the Georgia Health Policy Center at Georgia State University in Atlanta, and colleagues in a research letter in JAMA Pediatrics. The correlation between number of vaso-occlusive crises and days’ supply was r=0.58 (P<0.001).

Among patients with one to three vaso-occlusive crises during follow-up, 45.6% filled less than a 10-day supply of opioids, 54.1% filled a supply for 10-36 days, and 29.8% filled a supply for >36 days. For those patients with more than three vaso-occlusive crises, these rates were 9.3%, 25.6%, and 62.8%.

Providing opioid prescriptions to children who have experienced pain episodes “does not create patterns of opioid use that are not related to the individual disease course,” Snyder told MedPage Today. “Because of the opioid epidemic, it’s important to make sure that people understand that when giving prescriptions for children with sickle cell disease, you aren’t creating folks who are going to misuse opioids.”

Snyder pointed out that the study showed many SCD patients were getting opioid prescriptions at a young age. For example, 11.2% of the children in the cohort were a year old at the time of first prescription, and 14.3% were 2 years old.

Of 3,215 prescriptions, 25.4% were filled within 5 days of a hospitalization for a vaso-occlusive crisis. Regardless of when filled, median days’ supply per prescription was 5.

This study used Medicaid enrollment and claims data from the 2011-2019 Georgia Sickle Cell Data Collection program, and included 725 children (mean age 4.6 years, 47.4% girls) who filled at least one opioid prescription between ages 0 to 9 years after 1 year without opioid prescriptions. The first prescription was codeine in 26.5% of cases, and hydrocodone/other in the remaining 73.5%.

These children were followed for up to 3 years from 2012 to 2019. During follow-up, 23.6% of patients had no vaso-occlusive crises, 45.5% had one to three, and 30.9% had over three.

Of the patients, 58.1% had confirmed hemoglobin SS or hemoglobin S β⁰-thalassemia, and 23.6% had hemoglobin SC.

Snyder and colleagues suggested that future research look at 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.”

A limitation to the study was its focus on patients with Medicaid, which potentially restricted generalizability to patients with commercial insurance, they noted.