OBJECTIVES: Because the Centers for Disease Control (CDC) Guideline for Prescribing Opioids for Chronic Pain released in March 2016 was not intended to restrict opioid therapy to patients with sickle cell disease (SCD), we assessed whether the guideline resulted in a shift in prescribing level and negative health outcomes among this population.

METHODS: This retrospective cohort study employed an interrupted time series analysis using the IBM^® MarketScan^® Commercial Database from 1/1/2011 to 12/31/2019. Patients who were ≥1 years old, had ≥3 SCD diagnoses within 5 years, and no cancer diagnosis were included. Monthly-measured opioid use outcomes included: opioid prescription rate, mean total morphine milligram equivalents (MME) per patient, mean daily MME per opioid prescription, and mean number of days supplied per opioid prescription. Monthly rates of vaso-occlusive crisis (VOC)-related emergency department (ED) visits and hospitalizations were measured as health outcomes. Segmented regressions (breakpoint: March 2016) were conducted for the all outcomes and the regression coefficients were used to estimate the changes of trends before and after the guideline release.

RESULTS: The cohort included 14,979 SCD patients with a mean age of 25.9±16.9 years and 56.9% female. Compared to the pre-guideline trend, the following changes were observed after the guideline release: a significant decrease in the opioid prescription rate (–0.29 prescriptions/100 person-month, P<0.001), amount of opioid prescribed (–141.0 MME/person-month, P=0.001; –10.1 MME/prescription-month, P<0.001), and number of days supplied per prescription (-0.05 days/month, P<0.001). However, following release of the guideline, there was a significant increase in the VOC-related hospitalization rate (+0.16 hospitalizations/100 person-month, p=0.001), although no significant change in the VOC-related ED visit rate was observed.

CONCLUSIONS: Release of the CDC guideline was associated with a decrease in opioid prescribing practices and unfavorable health outcomes in patients with SCD. The guidelines may have an unintended negative impact on this population.