Study Confirms Safe Use of Opioids for Pain Control in Sickle Cell Disease

The most common cause of hospital admission among patients with sickle cell disease (SCD) are excruciating pain crises, for which opioid medications are a mainstay of treatment. There have been questions about whether the US opioid epidemic, which has resulted in large increases in opioid-related overdoses and deaths over the past 2 decades, may have affected the death rate among patients with SCD who were treated with opioids in the hospital to relieve pain crises.

According to a study results presented at the 60th American Society of Hematology Annual Meeting & Exposition in San Diego, California, on December 2, 2018, the use of opioid medications for pain control in SCD is relatively safe, and there has been no associated increase in hospital SCD mortality.¹

According to lead investigator Oladimeji A. Akinboro, MBBS, of Boston University School of Medicine, their team found that in-hospital death rates among those with SCD did not increase over a 15-year period despite an increase in hospitalization rates for most adults with SCD over the same period. “We do not see a relationship between opioid use and death in patients who are hospitalized for SCD,” Akinboro said in a statement, noting that the overwhelming majority of these patients need strong pain medication to control acute pain during crises.

The researchers used data from the National Inpatient Sample from 1998 through 2013 and identified hospitalizations for patients with SCD using appropriate ICD-9-CM diagnoses codes. The database is the largest publicly available all-payer inpatient healthcare database in the country and contains data from more than 7 million hospital stays each year. They examined hospitalizations and in-hospital mortality rates and trends for the entire sample of patients with SCD, as well as by the following age groups: 0-17 years, 18-44 years, 45-64 years, and 65 years and over, as well as in-hospital mortality trends in the US Northeast, Midwest, South, and West.

There were 1,755,220 hospitalizations in this patient population between 1988 and 2013; while hospitalization rates initially declined annually by 9.9%—from 39 per 100,000 persons in 1998 to 27 per 100,000 persons in 2002—they did not change significantly from 2002 to 2013. However, there was a significant (3.8%) annual increase in hospitalization rates among young adults with SCD (18-44 years of age), from 43 per 100,000 persons in 2002 to 71 per 100,000 persons in 2013. For SCD patients 65 years of age or older, there was a significant annual increase in hospitalization rates (6.5%), from 2.7 per 100,000 persons in 1998 to 5.4 per 100,000 persons in 2013.

A subgroup analysis showed that rates of opioid-related hospitalizations relative to the total number of hospitalizations in the SCD population were stable over time and similar to the relative rates in the general population. However, unlike in the general population, where inpatient deaths from opioid-related admissions increased over time, SCD inpatient deaths related to opioid toxicity and/or overdose were almost nonexistent over the entire study period—a finding that reinforces the researchers’ conclusion that opioid use for pain control should be considered safe in the SCD population, Akinboro noted.

Adults with SCD are hospitalized frequently, Akinboro explained, and the team expected that if opioid-related mortality had increased in this population, the increase would be apparent in hospital inpatient mortality data. “It is reassuring to find that opioid use during acute pain crisis does not seem to have led to higher mortality in this population,” he said.

While additional research is needed to clarify the reasons hospitalization rates climbed in these 2 age groups, Akinboro wonders whether care fragmentation among adults with SCD may be a reason, in addition to age-related increases in pain-related comorbidity and SCD complications, a result of improved survival among these patients.

“One important message from this study is that healthcare providers need to keep tabs on their patients with SCD and make sure that their care is coordinated,” Akinboro concluded.

Reference

1. Akinboro OA, Nwabudike S, Edwards C, et al. Opioid use is not associated with in-hospital mortality among patients with sickle cell disease in the United States. Findings from the National Inpatient Sample. In: Proceedings from the American Society of Hematology; December 1-3, 2018; San Diego, CA. Abstract 315.