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Study: Children With SCD Not Found to Abuse Opioids Long-Term

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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

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

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