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Opioid use steady among younger patients with sickle cell disease
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ATLANTA — Opioid use among younger patients with sickle cell disease remained steady over time, according to findings presented at the ASH Annual Meeting and Exposition.
However, use increased when patients transitioned to adult care, suggesting better strategies and treatments are warranted to decrease use for chronic pain and disease complications, the research showed.
“Opioid utilization in the sickle cell disease population increases with age but, overall, remained steady despite rising concerns of epidemic opioid use in the U.S. general population,” Samir K. Ballas, MD, FACP, emeritus professor of medicine and pediatrics at Thomas Jefferson University, said during his presentation. “Opioid utilization protocols should account for the unique needs of patients with sickle cell disease.”
Clinical guidelines indicate patients with sickle cell disease may receive opioids for acute pain episodes and chronic pain that cannot be managed by other medications. Many patients require long-term opioid treatment to achieve sufficient pain relief. However, real-world data on opioid treatment patterns among this patient population are lacking.
The analysis included annual cohorts of patients enrolled in medical and pharmacy benefits for 2009 to 2014 calendar years. The final cohorts included only patients with 1 year of continuous medical and pharmacy benefits coverage prior to their first sickle cell disease indication in the cohort year.
Ballas and colleagues used commercial administrative claims databases to identify between 2,619 and 3,285 patients (mean age, 27 years; majority female) and Medicaid claims database to identify between 4,807 and 7,007 patients (mean age, 18 years; 50% female) with sickle cell disease.
Researchers then determined opioid use patterns for each cohort using outpatient pharmacy claims, which included the number of claims, date supplied and morphine equivalent daily dose — defined as daily dose multiplied by drug-specific morphine conversion factor. Researchers reported morphine equivalent daily dose as the mean of a patient’s average morphine equivalent daily dose over the year prior to first indication of disease in their cohort year.
Results showed the proportion of patients prescribed opioids remained stable each year during the study period in both claims groups.
A consistently higher proportion of patients with Medicaid used an opioid (65%-70%) than patients with commercial insurance (54%-57%). In addition, patients with Medicaid had more opioid days and opioid claims per patient across all age groups.
Opioid use increased as patients aged in both the commercial group (30% to 60%) and Medicaid group (39% to 77%).
Patients with sickle cell disease had higher opioid use rates in the prior year compared with the 30-day prior use in the general U.S. population; however, these rates remained steady over time.
The number of patients with a vaso-occlusive crisis — and the number of patients who used opioids — increased markedly from ages 12 to 17 years to ages 18 to 30 years in both Medicaid and commercial patients. The morphine equivalent daily dose and average days supplied per patient also increased substantially between these age groups — which mark the transition from pediatric to adult care — for both Medicaid and commercial patients.
Patients with Medicaid were younger when they demonstrated a high opioid use level, defined as a minimum of a 4-month supply (18 to 30 years vs. 31 to 44 years). Medicaid patients also had double the average days supplied in each adult age group — aged 18 to 30 years (200 days vs. 100 days) and 31 to 44 years (300 days vs. 150 days).
From 1999 to 2013, patients with sickle cell disease had fewer deaths related to opioid use (n = 95) than other areas, such heart disease (n = 21,656) and fibromyalgia (n = 144).
Ballas noted several limitations of the study, including that they did not measure opioid-related mortality; findings may not be generalizable to populations with other forms of insurance or uninsured patients; and data are limited to patients identified in claims based on diagnosis via ICD-9-CM codes.
“Better treatments and strategies to decrease opioid use by decreasing acute and chronic pain and sickle cell disease complications are warranted,” Ballas said. – by Melinda Stevens
Reference:
Ballas SK, et al. Abstract 130. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2017; Atlanta.
Disclosures: Ballas reports a speaker role with and honoraria from Novartis. Please see the abstract for all other authors’ relevant financial disclosures.