CDC's opioid guidelines had unintended consequences for those with sickle cell disease
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Key takeaways:
- Changes to guidelines reduced opioid dispensing rates and opioid dosages among patients with sickle cell disease.
- Federal guidance should be carefully developed for vulnerable populations, researchers said.
The release of the 2016 CDC guidelines for prescribing opioids for chronic pain may have had unintended consequences for patients with sickle cell disease, or SCD, a study showed.
Opioid prescriptions declined in this population, and researchers also noted a rise in pain-related hospitalizations among patients with SCD following the release of the guidance.
Hyeun Ah Kang, PhD, an assistant professor of health outcomes at the University of Texas College of Pharmacy, and colleagues explained that prior research has reported on the effectiveness of the March 2016 guidelines at reducing opioid usage.
“However, this decrease has also occurred among patient groups that fall outside of the intended scope of the guideline, such as those with cancer and SCD,” they wrote in JAMA Internal Medicine.
They noted that people with SCD experience recurrent pain episodes called vaso-occlusive crises (VOC) and “often face restrictive access to opioid therapy, in part because SCD predominantly affects African American individuals (approximately 90%), who are less likely than white patients to receive opioid prescriptions in the U.S.”
Kang and colleagues analyzed claims data from Jan. 1, 2011, to Dec. 31, 2019 — taken from the Merative MarketScan Commercial Database — and assessed changes in prescribing patterns and health outcomes among patients with SCD before and after the release of the CDC guidance. Those outcomes included the rate of opioid prescriptions dispensed, the mean number of days supplied per prescription and the mean total morphine milligram equivalents per patient.
The total cohort comprised 14,979 patients (mean age, 25 years; 56.9% women) with SCD.
The rate of receiving one or more opioid prescriptions among patients with SCD was 0.81 before the guideline was introduced, and it declined significantly after the guideline was released (0.29 prescriptions per 100 person-month; 95% CI, 0.39 to 0.2).
The decreases “imply that this population was susceptible to the guideline’s recommendations and subsequent changes in regulations by state legislatures and health insurance organizations,” Kang and colleagues wrote.
Ultimately, the dispensing rate for patients with SCD was 13.1 percentage points lower by December 2019 compared with the period before the guideline was introduced.
The researchers also found reductions in the number of days supplied per opioid prescription (0.05; 95% CI, 0.06 to 0.04) and opioid dosage per patient (141; 95% CI, 219.5 to 62.5) and per prescription (10.1; 95% CI, 14.6 to 5.6).
There was also an increase in VOC-related hospitalizations following the guideline release (0.16 hospitalizations per 100 person-month; 95% CI, 0.07-0.25), resulting in a 7.05 percentage point increase in December 2019 vs. periods without the guideline.
Age-related differences were also identified because pediatric patients with SCD received fewer opioid prescription fills with lower dosages of opioids and had fewer VOC-related health care visits vs. adult patients throughout the study period.
The researchers explained the CDC’s 2022 opioid guidelines included SCD as an excluded condition and recommends using disease-specific guidelines for managing pain in that population.
“Thus, federal guidelines should be developed with careful consideration of medically vulnerable populations, and their intentions and scope should be clearly communicated with the health care community to avoid unintended consequences,” they wrote.