OBJECTIVES : Among sickle cell disease (SCD) patients, vaso-occlusive crises (VOCs) are recurrent and unpredictable attacks of acute pain that are often treated with analgesics, including opioids, which have been associated with misuse and overdose. This study examined the association between VOC events and opioid use among SCD patients.

METHODS : This Texas Medicaid retrospective study of medical and prescription claims between 9/1/11-8/31/16 included: patients (2-63 years) with at least one inpatient or two outpatient SCD diagnoses who were continuously enrolled during 12 months post-index. The index date was the first SCD diagnosis. The primary outcome was number of opioid prescriptions, while the independent variable was number of VOC events. Covariates included age, gender, non-opioid medication use, non-study SCD-related medication (penicillin and folic acid) use, evidence of blood transfusions, number of SCD-related complications, number of SCD-related comorbid conditions, and Charlson Comorbidity Index. Negative binominal regression analysis was used to address the study objective.

RESULTS : Of included patients (N=3,368), 1,978 (58.7%) had at least one opioid prescription with a mean±SD of 4.2±7.2. Overall, 2,071 (61.5%) had at least one VOC event with an average of 2.9±4.4. The regression showed that for every increase in VOC events, the number of opioids used increased by 9.5% (incidence rate ratio [IRR]=1.095, 95% CI 1.078–1.111; p<0.0001). Other significant covariates associated with higher opioid use included age (13-17, 18-24, 25-34, 35-44, 45 and older; reference 2-12) higher non-opioid pain medications, non-study SCD-related medications, and SCD-related complications.

CONCLUSIONS : The majority of SCD patients were prescribed opioids and had at least one VOC event. Each VOC event was associated with a 10% increase in use of opioids. Despite the opioid epidemic, payers and providers should be aware of opioid use in the population and should consider appropriate VOC prevention measures, as well as the need for appropriate pain management.