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Characterization of opioid use in sickle cell disease.
Pharmacoepidemiol Drug Saf. 2018 05; 27(5):479-486.PD

Abstract

PURPOSE

Opioid analgesics are commonly used to treat vaso-occlusive pain episodes in sickle cell disease (SCD), but comprehensive evidence characterizing opioid use in this patient population is limited. Our objective was to characterize opioid use patterns among SCD patients using a large nationwide database.

METHODS

A large, US medical claims database was utilized to identify a cohort of 3882 SCD patients, and characteristics of opioid use were analyzed. Clinical variables including age, gender, medication use, health care utilization, and medical history were evaluated for correlations with opioid use.

RESULTS

Forty percent of patients took opioid medications during a 12-month span, and the prevalence of any opioid use was highest for 20 to 29-year-old patients (58%). The median daily opioid dose was 1.85 mg (interquartile range: 0.62-10.68 mg) oral morphine equivalents (OME). While most opioid users took between 0 and 5 mg OME daily, 3% of pediatric patients and 23% of adult patients used more than 30-mg OME daily. High-dose opioid use was associated with older age, hydroxyurea therapy, nonsteroidal anti-inflammatory drug (NSAID) use, and frequent inpatient hospitalizations. In multivariable-adjusted analyses, patients with vaso-occlusive complications such as pain crisis (OR = 3.8, 95% CI 2.7-5.3) and avascular necrosis (AVN) (OR = 3.7, 95% CI 2.7-5.1) were associated with high-dose opioid use.

CONCLUSIONS

Our study showed that only 40% SCD patients were on opioid analgesics during a 12-month span. However, a non-trivial number of patients used a much higher dose of opioids despite a relatively low average daily opioid dose among SCD patients, particularly with vaso-occlusive complications.

Authors+Show Affiliations

Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA. Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA.Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA. Division of Public Health Sciences, Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28815799

Citation

Han, Jin, et al. "Characterization of Opioid Use in Sickle Cell Disease." Pharmacoepidemiology and Drug Safety, vol. 27, no. 5, 2018, pp. 479-486.
Han J, Zhou J, Saraf SL, et al. Characterization of opioid use in sickle cell disease. Pharmacoepidemiol Drug Saf. 2018;27(5):479-486.
Han, J., Zhou, J., Saraf, S. L., Gordeuk, V. R., & Calip, G. S. (2018). Characterization of opioid use in sickle cell disease. Pharmacoepidemiology and Drug Safety, 27(5), 479-486. https://doi.org/10.1002/pds.4291
Han J, et al. Characterization of Opioid Use in Sickle Cell Disease. Pharmacoepidemiol Drug Saf. 2018;27(5):479-486. PubMed PMID: 28815799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of opioid use in sickle cell disease. AU - Han,Jin, AU - Zhou,Jifang, AU - Saraf,Santosh L, AU - Gordeuk,Victor R, AU - Calip,Gregory S, Y1 - 2017/08/16/ PY - 2017/03/23/received PY - 2017/07/11/revised PY - 2017/07/21/accepted PY - 2017/8/18/pubmed PY - 2019/9/17/medline PY - 2017/8/18/entrez KW - avascular necrosis KW - opioid use KW - pain crisis KW - sickle cell disease KW - vaso-occlusive complications SP - 479 EP - 486 JF - Pharmacoepidemiology and drug safety JO - Pharmacoepidemiol Drug Saf VL - 27 IS - 5 N2 - PURPOSE: Opioid analgesics are commonly used to treat vaso-occlusive pain episodes in sickle cell disease (SCD), but comprehensive evidence characterizing opioid use in this patient population is limited. Our objective was to characterize opioid use patterns among SCD patients using a large nationwide database. METHODS: A large, US medical claims database was utilized to identify a cohort of 3882 SCD patients, and characteristics of opioid use were analyzed. Clinical variables including age, gender, medication use, health care utilization, and medical history were evaluated for correlations with opioid use. RESULTS: Forty percent of patients took opioid medications during a 12-month span, and the prevalence of any opioid use was highest for 20 to 29-year-old patients (58%). The median daily opioid dose was 1.85 mg (interquartile range: 0.62-10.68 mg) oral morphine equivalents (OME). While most opioid users took between 0 and 5 mg OME daily, 3% of pediatric patients and 23% of adult patients used more than 30-mg OME daily. High-dose opioid use was associated with older age, hydroxyurea therapy, nonsteroidal anti-inflammatory drug (NSAID) use, and frequent inpatient hospitalizations. In multivariable-adjusted analyses, patients with vaso-occlusive complications such as pain crisis (OR = 3.8, 95% CI 2.7-5.3) and avascular necrosis (AVN) (OR = 3.7, 95% CI 2.7-5.1) were associated with high-dose opioid use. CONCLUSIONS: Our study showed that only 40% SCD patients were on opioid analgesics during a 12-month span. However, a non-trivial number of patients used a much higher dose of opioids despite a relatively low average daily opioid dose among SCD patients, particularly with vaso-occlusive complications. SN - 1099-1557 UR - https://www.unboundmedicine.com/medline/citation/28815799/Characterization_of_opioid_use_in_sickle_cell_disease_ L2 - https://doi.org/10.1002/pds.4291 DB - PRIME DP - Unbound Medicine ER -