Opioid Use Disorder in Sickle Cell Patients with Vaso-Occlusive Crisis Linked to Greater Cost

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Opioid use disorder in patients with sickle cell disease (SCD) and vaso-occlusive crisis were associated with longer hospital stays and greater costs, according to a new study.¹

Clinicians may worry SCD patients with vasco-occlusive crisis could get addicted to their medication and thus hesitate to prescribe opioids to manage pain. However, avoiding prescribing opioids may lead to under-treatment. For some patients with frequent vaso-occlusive crises, they need opioids to control pain, rather than for addiction.

A 2020 study found 1 vaso-occlusive crisis event was linked to a 9.5% increase in the use of opioids.² In the sample of 3368 sickle cell disease patients, 61.5% of patients experienced at ≥1 vaso-occlusive crisis event, with an average of 2.9 events. Also, 58.7% of patients had an opioid prescription during the study.

“To prevent [vaso-occlusive crisis] events, patients should be encouraged to take appropriate medications that are available in market, such as hydroxyurea, L-glutamine, crizanlizumab, and/or voxelotor when they meet the criteria suggested by clinical guidelines,” the investigators of the 2020 wrote.

Meanwhile, a 2021 study examined clinical factors associated with chronic opioid use in patients with SCD. The study found chronic opioid users were more like to be female (P < .0001), have a higher baseline total white cell count (median 10 × 109/L vs 9 × 109/L) (P = .0009), non-HbSC phenotype (P = 0.034), prescribed the drug hydroxyurea (P = .000047), concurrent psychiatric illness (P = .018), lower hemoglobin (8.5 g/dL vs 8.9 g/dL) (P = 0.055), chronic arthritis (P = 0.06).

A new retrospective study, presented by Abdulsabur Sanni, MD, from Hennepin Healthcare in Minneapolis, at the American Society of Hematology (ASH 2023) on Monday, December 11, 2023, examined the associations between hospitalizations with race, age, and sex.¹ The investigators selected participants from the National Inpatient Sample database who had SCD and vaso-occlusive and were hospitalized from 2016 – 2019. The team compared participants with and without an opioid use disorder using linear and logistical regression models.

Of the 273,460 hospitalizations for vaso-occlusive crisis, 23,120 (8.5%) had an opioid use disorder. After looking at race, age, sex, and income, the investigators found the Black race was linked to opioid use disorder, but age, sex, and age did not have associations. The team noted an increased hospital stay length by 1.23 days in patients with opioid use disorder (95% CI, 1.02 – 1.45; P <.001) and an increased total hospital cost by $5566 (95% CI, 3863 – 7269; P <.001).

For vaso-occlusive crisis hospitalizations, mortality was reduced for patients with opioid use disorder. Except, the reduction was not significant (Odds ratio [OR], 0.58; 95% CI, 0.026 – 1.33; P = .199).

“Providers should consider under-treatment of pain as a potential diagnosis when addiction concerns are present and individualized pain plans should be explored,” Sanni and colleagues concluded.

References

1. ^{Sanni, A, Goble, S, Linzer, M. 3884 Opioid Use Disorder and Vaso-Occlusive Crisis Outcomes: A Retrospective Assessment. American Society of Hematology. December 11, 2023. https://ash.confex.com/ash/2023/webprogram/Paper173555.html. Accessed December 11, 2023.}
2. ^{Kang HA, Barner JC, Richards KM, Bhor M, Paulose J, Kutlar A. Association Between Vaso-Occlusive Crises and Opioid Prescriptions Among Patients with Sickle Cell Disease: A Retrospective Claims-Based Study. JHEOR. 2020;7(1):94-101. doi:10.36469/jheor.001c.13348}
3. ^{Mo G, Jang T, Stewart C, et al. Chronic opioid use in patients with sickle cell disease. Hematology. 2021;26(1):415-416. doi:10.1080/16078454.2021.1932328}