Oral Opioids For Sickle Cell Increased With Intravenous Opioid Shortage

Katherine V. Katsivalis, PharmD

A 2017 shortage of intravenous (IV) opioid medications, led to a rise in oral opioid use for patients with sickle cell disease (SCD), according to new research.

A team, led by Katherine V. Katsivalis, PharmD, University of Illinois at Chicago College of Pharmacy, assessed intravenous opioid medication utilization both prior to and during the shortage on medications and assessed total opioid consumption, length of stay, and prescribing of non-opioid analgesics.

The Shortage

The US Food and Drug Administration (FDA) previously announced a shortage of intravenous opioid medications in October 2017, leaving patients with sickle cell disease particularly vulnerable because a large amount of IV opioid medications are used as standard therapy during vaso-occlusive crises (VOC).

However, at the University of Illinois at Chicago, officials implemented IV to oral conversions for opioid therapies, while encouraging multimodal pain management with non-opioid medications.

The Study

In the single-institution retrospective study, the investigators examined adult patients admitted to adult medicine teams with VOC during February 2017 or February 2018.

The team assessed the number of opioid medications administered to patients during both study periods and then converted quantitates to oral morphine milligram equivalents and compared between the years, as well as the number of patients receiving scheduled non-opioid medications.

Finally, they compared the length of stay and readmission between the 2 years.

The results show intravenous opioid use for VOC decreased by 52% in inpatient services. There was also a 34% decrease in the overall opioid use, while oral opioid use more than double between the 2 years (10.2% in 2017 vs 39.1% in 2018; P <.01).

However, there was not many differences found in either length of stay (6 vs 6 days; P = .4774) and total number of emergency department visits (27 vs 8; P = .276), but there were significantly fewer 30-day readmissions during the 2018 time period than there was during the intravenous medication shortage in 2017 (15 vs 28; P = .025).

“The implementation of IV opioid restrictions resulted in a decrease in IV opioid use in treatment of VOC in patients with SCD without causing increases in length of stay or readmissions,” the authors wrote. “Oral opioids should be considered an option for VOC management in patients with SCD.”

VOC

Individuals with sickle cell disease experience VOCs frequently, as they can begin at any time. During a VOC, the blood vessels of the patient are obstructed which leads to ischemic tissue injury and severe pain. These episodes can increase morbidity and mortality, especially in older patients, as a result of the organ damage caused by repeated VOCs.

Pain crises are the most common reason that these patients visit the emergency department (ED) and are responsible for missed school, work, and decreased health-related quality of life (HRQoL). The impacts of decreased HRQoL include inhibited physical, emotional, and social functioning, and research has shown that impacts are worse among individuals with sickle cell disease compared to the general population and to some other chronic diseases.

The study, “Opioid Use in Vaso-Occlusive Crisis During Intravenous Opioid Drug Shortage,” was published online in Hospital Pharmacy.