Temporal and agent-level trends in opioid prescribing for patients with severe sickle cell disease

Sickle cell disease (SCD) is marked by recurrent vaso-occlusive crises (VOCs) that often require opioid analgesia. However, national opioid stewardship efforts may inadvertently affect pain management access for individuals with high disease burden, such as those experiencing multiple VOCs annually. The objective was to characterize temporal and agent-specific opioid prescribing patterns in patients with severe SCD, defined as experiencing 3 or more VOCs within a 12-month period.

This retrospective cohort study used integrated electronic health record data (2014-2023) from the University of Pittsburgh Medical Center, a comprehensive SCD center. Adults (≥18 years) with 3 or more qualifying VOCs within a rolling 12-month period were identified. The primary outcome was receipt of an opioid within 7 days of the third VOC. We examined annual trends in opioid use per 100 VOCs and used mixed-effects logistic regression to assess the association between calendar year and post-VOC opioid use, adjusting for patient characteristics. The cohort included 325 patients contributing 1,179 qualifying VOC periods. Overall opioid prescribing declined over time (odds ratio, 0.92 per year; 95% CI, 0.89-0.96). Oxycodone showed the most consistent reduction, while trends for morphine, fentanyl, and hydromorphone varied. Despite high clinical need, the probability of receiving opioids after a VOC episode decreased steadily over the study period.

In patients with severe SCD, opioid prescribing declined significantly between 2014 and 2023. These findings highlight the need for nuanced, individualized stewardship strategies that preserve access to effective pain control while addressing broader efforts to reduce inappropriate opioid use.