Dr C. Patrick Carroll on the Challenges of Treating Sickle Cell Disease–Related Pain With Opioids

As a result of the opioid epidemic, there have been instances where it has been difficult to treat patients with pain related to their sickle cell disease because of new policies in place intended to curb addiction and overdoses, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

How has the opioid epidemic impacted how sickle cell pain is treated?
Well, I think there have been several different impacts. One, I think, has to do with people who have chronic pain or on chronic opioid therapy. And many of the policies of payers, in particular, seemed to be built around the idea of limiting the number of pills or the dose for acute pain, which may well be reasonable as an outpatient, but the difficulty is that when those policies are applied to people who are already stable on chronic opioid therapy, they can produce some perverse incentives.

There are times, for example, when we've actually been reducing the doses for some people who were trying to moderate risk for or it's not working. And we find ourselves having to do frequent pre authorizations to change people's strengths and so on. So, and then there are other situations in which people have been stable for quite a while, and suddenly there are new restrictions on it, which can cause problems. So, there's one place.

I think providers in general have been more careful about prescribing opioids, which is probably good. But there has been a shift away from the use of opioids that sometimes conflicts with what people who in acute pain you really need to be treated well.
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