This article is more than 5 years old. Information may no longer be current.
Opioid use not associated with in-hospital mortality among patients with sickle cell disease
Click Here to Manage Email Alerts
SAN DIEGO — The use of opioids to treat pain among hospitalized patients with sickle cell disease should still be considered relatively safe despite the national opioid epidemic, according to study results presented at ASH Annual Meeting and Exposition.
The in-hospital mortality rate for patients with sickle cell disease in the U.S. has remained steady throughout the opioid epidemic, suggesting that the rate of opioid-related deaths among these patients is low.
“Since the year 2000, the opioid epidemic has... resulted in mass increase of hospitalization rates, deaths and toxicities related to opioid use in the United States,” Oladimeji Akinola Akinboro, MBBS, physician in the section of hematology and medical oncology in the department of medicine at Boston University School of Medicine and Boston Medical Center, said during a press conference. “So we looked at deaths related to opioid use within the sickle cell disease population [compared with] the general population.”
Vaso-occlusive pain accounts for most hospitalizations among patients with sickle cell disease, and opioids are commonly used to treat chronic pain in this patient population.
Researchers gathered data from the National Inpatient Sample between 1998 and 2013 to analyze hospitalization, in-hospital mortality rates and trends for patients with sickle cell disease. Overall, there were 1,755,220 hospitalizations of patients with sickle cell disease in the U.S. during that period.
Overall hospitalization rates for patients with sickle cell disease declined annually by 9.9% (95% CI, 4-15.5) between 1998 and 2002, from 39 per 100,000 patients to 27 per 100,000 patients.
However, among young adults aged 18 to 44 years with sickle cell disease, researchers observed a 3.8% (95% CI, 2.4-5.2) annual increase in hospitalization rates — from 43 per 100,000 patients to 71 per 100,000 patients — between 2002 and 2013.
Further, patients aged 65 years and older with sickle cell disease demonstrated an annual 6.5% (95% CI, 2.9-10.2) increase in hospitalization rates — from 2.7 per 100,000 to 5.4 per 100,000 — between 1998 and 2013.
The South appeared to be the only region of the country that had a significant increase in sickle cell disease hospitalization rates, with an annual increase of 3.5% (95% CI, 0.6-6.4) between 2001 and 2011.
Compared with the 350% increase in opioid prescription-related death rates in the U.S. between 1999 and 2013 among those without sickle cell disease, researchers observed no significant increase of sickle cell disease mortality among hospitalized patients.
The increased hospitalization rates observed among most adults with sickle cell disease may be due to the fragmentation of care for this population, as well as age-related increases in pain from comorbidities, according to the researchers. Sickle cell disease complications also may play a role, as patients with sickle cell disease are living longer.
Akinboro added that, while his study didn’t particularly focus on it, the use of opioids in the sickle cell disease population does not generally lead to outside addiction.
“Studies have suggested in the sickle cell disease population both inpatient and outpatient use of opioids does not translate to opioid use disorders compared to the general population,” Akinboro told HemOnc Today. – by John DeRosier
Reference:
Akinboro OA, et al. Abstract 315. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4, 2018; San Diego.
Disclosures : The authors report no relevant financial disclosures.
Perspective
Back to Top
Ifeyinwa Osunkwo, MD, MPH
Individuals with sickle cell disease experience severe pain, and clinicians often are worried about giving patients narcotics due fears of overdose. Due to the opioid crisis, people have swung the pendulum from ‘We’re going to treat you for your pain and be empathetic’ to ‘I’m afraid of being sued or killing you, so I’m not going to give you anything.’ These data should help to modulate that pendulum and bring people back to rational clinical thinking.
I want to make sure people don’t interpret these conclusions to mean we should give people opioids like they are water. You still have to use risk-mitigating strategies. You have to use sensible medicine, but you also have to use empathetic medicine and data-driven medicine. Don’t assume that every patient with sickle cell disease is going to die of an opioid overdose, because they are not. At the same time, we can’t assume that a patient with sickle cell disease won’t have a potential risk for complication with opioids. We can’t go to either extreme. We have to use our clinical judgement and rely on good research data so we can be objective as opposed to subjective.
I am not surprised about the increased hospitalizations among adults. We are helping patients with sickle cell disease survive longer, but the longer they survive with this disease, the more complications they are going to have and the more admissions they are going to require. Another potential explanation is fragmentation of care. The health system did not prepare for all of these adults with sickle cell disease. There is a tremendous amount of support for pediatric patients, but a 30-year-old is kind of in a dessert because many providers don’t understand how sickle cell disease impacts an adult.
My hope is this finding will highlight to the medical community that we need to address that morbidity that happens as these patients get older. They get admitted to the hospital for pain, blood clots, infections, acute chest syndrome or kidney problems. If we do a better job mitigating the problems that 20-, 30- or 40-year-olds experience, we will have less of a dramatic rise in acute care use among older patients.
The silver lining is that people are living long enough that we now have 60-year-olds with sickle cell disease being admitted to the hospital. We are doing well and we have made progress, but we have to improve the quality of life for patients as they get older.
Read more about
Click Here to Manage Email Alerts