Implementation of the U.S. Centers for Disease Control and Prevention (CDC) 2016 guideline for opioid prescriptions impaired opioid access for patients with sickle cell disease (SCD), resulting in poor outcomes related to vaso-oclusive crises, according to results of a retrospective study presented at the 2022 American Society of Pediatric Hematology/Oncology Conference.
Although the CDC’s 2016 guideline was not intended to restrict opioid access to patients with SCD, patient reports indicate that their opioid therapy was restricted. The aim of this study was to evaluate the effect of the CDC’s guideline on opioid prescriptions and health outcomes on patients with SCD.
The retrospective cohort study assessed data of 14,979 patients aged 1 year or older with SCD from the IBM MarketScan Commercial Database between 2011 and 2019 using an interrupted time series analysis.
The study population included 9520 adult patients with a mean age of 36. Compared with the pre-guideline time period, there was a significant decrease in the rate of opioid prescriptions (P <.001), the total morphine milligram equivalents prescribed per month (P <.001), and the number of days supplied per prescription (P <.001). The post-guideline time period was marked by a significant increase in veno-occlusive crises resulting in emergency department (ED) visits (P =.045) and hospitalization (P <.001).
Pediatric patients with SCD also experienced unintended consequences of the CDC’s 2016 opioid guideline. Among the 5459 pediatric patients with a mean age of 8.3, there was a significant decrease in the morphine milligram equivalents prescribed per patient (P =.006) and number of days supplied per prescription (P <.001). There was also a significant increase in hospitalization due to veno-occlusive crises (P =.022). The rate of opioid prescriptions, daily morphine milligrams equivalents prescribed per day, and the rate of ED visits were similar before and after implementation of the guideline.
The authors concluded that “The CDC guideline release timing corresponded with decreases in opioid prescribing practices and unfavorable health outcomes among patients with SCD.” The authors added that the guideline “may have an unintended negative impact on this population, with a greater impact in adults compared to pediatric patients.”
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Kang HA, Wang B, Barner J, et al. Effects of the CDC’s 2016 opioid guidelines on pediatric and adult patients with sickle cell disease. 2022 American Society of Pediatric Hematology/Oncology (ASPHO) Conference; May 4-7, 2022. Abstract 2001.