A retrospective cohort study assessed patterns of opioid use in children with sickle cell disease (SCD) following their initial opioid prescription for pain management, finding that concerning patterns of opioid abuse did not develop.
Researchers did not identify alarming patterns of opioid use in children with sickle cell disease (SCD) in the first 3 years following an initial opioid prescription, according to a study recently published in JAMA Pediatrics.
Pills Laid Out on Table | image credit: Svyatoslav Lypynkyy - stock.adobe.com
Younger children enduring SCD often experience unpredictable, repeated episodes of shooting pain known as vaso-occlusive crises (VOCs). Episodic VOCs typically begin during childhood for those affected by SCD and opioid-based treatment approaches are often prescribed for pain management. However, the study authors noted, there have been concerns about the use and abuse of these medications amidst the opioid crisis that leave clinicians with additional considerations for their patients. For example, the authors pointed to a 2015 study that suggested previously opioid-naïve patients may have an increased likelihood for additional opioid use if they were prescribed opioids for the management of acute pain.
With these concerns and considerations in mind, the authors explained there is a lack of data on opioid prescriptions in the realm of SCD. To explore the rates of opioid prescriptions and patterns of opioid use further, the researchers conducted a study that evaluated these factors within 3 years of an opioid-naïve child with SCD’s first opioid prescription, as well as explored the demographics of this population.
Between 2011 and 2019, Medicaid claims and enrollment data were retrospectively collected from the Georgia Sickle Cell Data Collection (SCDC) program. This program contained data on 2565 patients with either a probable or established diagnosis of SCD by the year 2016. Those eligible for the analysis were aged between 1 and 15 years, were covered by Medicaid, and had at least 1 opioid prescription filled, after at least 1 year without an opioid prescription, by the age of 9. Participating children (n = 725) had follow-ups for 3 years between 2012 and 2019 and were only excluded if they lacked Medicaid coverage for over 6 months during the follow-up period.
Over 94% (n = 684) of the cohort were Black patients, with the rest being classified as “other or unknown” (5.7%, n = 41), and were comprised of 47.4% females (n = 344) and 52.6% males (n = 381). In total, 23.6% (n = 171) experienced 0 VOC events, 45.5% (n = 330) experienced 1-3, and 30.9% (n = 224) experienced more than 3 during their follow-up period. Hydrocodone or “other” prescriptions were the most common (73.5%, n = 533) compared to codeine (26.5%, n = 192).
On average, patients were given a total of 30 days’ supply of opioids throughout the 3-year follow-up period. The durations of their prescriptions were significantly associated with their number of experienced VOC events (P < .001). There were a total of 3215 prescriptions reported. When VOCs led to hospitalizations, 25.4% of patient prescriptions (n = 818) were filled within 5 days of the event, with a median of 5 days’ supply. “This finding suggests that most prescriptions are written in outpatient settings by SCD specialists to help manage severe pain at home,” authors Snyder et al wrote.
The authors only identified a single pattern of low opioid use among children after receiving their first opioid prescription. This data signaled that concerning patterns of increasing or long-term opioid use did not emerge in this SCD population. However, the authors mentioned the limited nature of their study given it only surveyed a cohort of patients covered by Medicaid.
Therefore, they encourage further studies be conducted to investigate patterns of low opioid use, whether these low rates suggest the efficacy of a nonopioid regimen, and the potential of unintended, harmful outcomes or issues of access in this patient population.
Reference
Snyder AB, Zhou M, Attell BK, et al. Opioid use after first opioid prescription in children with sickle cell disease. JAMA Pediatr. 2024;178(4):408-410. doi:10.1001/jamapediatrics.2023.6500
Symptom Documentation Differences in Acute Cancer Care Suggest Sociodemographic Disparities
April 22nd 2025Researchers are calling for more targeted efforts to improve health equity after a new analysis revealed that cancer symptom documentation and burden vary across certain demographics.
Read More
New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
Listen
Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
Listen
Integrated CKD Care Model Cuts ED Visits by 30%, Boosts Specialized Treatment
April 21st 2025An analysis of an interdisciplinary care model for managing chronic kidney disease (CKD) shows hospital admissions dropped by 26% and emergency department (ED) visits decreased by 30% after clinic initiation.
Read More