The Relationship Between Vaso-Occlusive Crises and Opioid Use in Children with Sickle Cell Disease
A recent retrospective cohort study conducted by Angela Snyder, along with her colleagues from the Georgia Health Policy Center at Georgia State University in Atlanta, discovered no evidence of prolonged or increasing opioid use among opioid-naive children with sickle cell disease (SCD) who were prescribed opioids for acute pain episodes over a 3-year period.
In a cohort of 725 children, it was found that the average days’ supply of opioids over 3 years was 30, even though 45.5% of the patients experienced at least one vaso-occlusive crisis. The study, published in JAMA Pediatrics, revealed a correlation between the number of vaso-occlusive crises and the days’ supply of opioids, with an apparent relationship (r=0.58, P<0.001). Patients who had one to three vaso-occlusive crises were observed to have varying rates of opioid supply duration. 45.6% of them received less than a 10-day supply, while 54.1% were prescribed a supply lasting between 10-36 days, and 29.8% received a supply exceeding 36 days. In contrast, patients with more than three vaso-occlusive crises saw rates of 9.3%, 25.6%, and 62.8%, respectively. Snyder emphasized the importance of understanding that prescribing opioids to children with SCD for pain management does not lead to misuse. She highlighted that many SCD patients received opioid prescriptions at a young age, with 11.2% being prescribed opioids at one year old and 14.3% at two years old. The study analyzed Medicaid enrollment and claims data from the Georgia Sickle Cell Data Collection program from 2011-2019, involving 725 children with a mean age of 4.6 years. During the follow-up period from 2012-2019, 23.6% of patients had no vaso-occlusive crises, 45.5% had one to three crises, and 30.9% had more than three crises. Future research recommendations by Snyder and her team include investigating whether the low opioid use seen in the study is due to effective non-opioid pain management strategies or highlights challenges in accessing appropriate treatment due to the opioid epidemic. While the study focused on Medicaid patients, it raises important questions about opioid use in children with SCD and the need for further exploration into pain management strategies that are both safe and effective for this vulnerable population.