scholarly journals Chronic Opioid Use Pattern in Adult Patients with Sickle Cell Disease

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3400-3400 ◽  
Author(s):  
Jin Han ◽  
Santosh L. Saraf ◽  
Xu Zhang ◽  
Michel Gowhari ◽  
Robert E. Molokie ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Hospital Admissions ◽  
Patient Characteristics ◽  
Clinic Visit ◽  
Opioid Use ◽  
Opioid Medication ◽  
Opioid Dose ◽  
Number Of Patients ◽  
Chronic Opioid Use ◽  
Opioid Medications

Abstract Background: Pain, the hallmark complication of sickle cell disease (SCD), is largely managed with opioid analgesics in the United States (1, 2). There is a common perception that SCD patients tend to use high dose of opioids chronically (3, 4), but comprehensive data regarding the long-term use of opioids in this patient population is lacking. Methods: A cohort of 359 adults (age ≥ 18 years old) with the diagnosis of SCD followed at University of Illinois Hospital in FY 2010-2013 was enrolled in a prospective natural history study. An outpatient clinic visit with comprehensive laboratory closest to the enrollment date was selected as the focal point of this report. A total of 140 patients had consistent outpatient follow-up defined as ³4 visits between 6 months prior to and 6 months after this clinic visit (the study period). Pain medication prescribing records, number of hospital admissions, and other clinical variables during the study period were collected and evaluated with descriptive statistics and Spearman correlation. Results: Among the 140 patients analyzed, 74% took short-acting opioid medications and 31% took long-acting opioid medications (Table 1). The median daily opioid dose was 4.8 mg oral morphine equivalents (OME) with an interquartile range (IQR) of 0 to 14.7 mg. Sixty-six percent of patients used less than 10 mg OME daily whereas 11% used more than 50 mg OME daily (Figure 1). Among the short-acting opioids, acetaminophen-hydrocodone was the most commonly used medication (34% of patients) followed by immediate-release morphine (23%) and acetaminophen-codeine (20%) (Table 2). Extended-release morphine was used by 24% of the patients. Twelve patients (8.6%) were prescribed with nonsteroidal anti-inflammatory drugs (NSAIDs), and 16% used medications treating neuropathic pain. The Spearman correlation test with Bonferroni correction showed that the dose of opioid usage was significantly associated with the number of hospital admissions due to vaso-occlusive crisis (VOC) (p<0.0001) (Table 3). Hydroxyurea use, hemoglobin genotype, history of avascular necrosis (AVN) and 25-OHD levels did not correlate with opioid dose. Summary: The doses and types of opioid medications used by adult SCD patients vary widely. The majority of patients use a relatively low dose (<10 mg OME daily). The dose of chronic opioid use has a strong correlation with the frequency of hospital admissions due to VOC, demonstrating the necessity of finding an alternative pain management approach in treating sickle cell pain. 1. L. R. Solomon, J Natl Med Assoc102, 1025 (Nov, 2010). 2. P. Tanabe, Z. Martinovich, B. Buckley, A. Schmelzer, J. A. Paice, J Emerg Nurs41, 227 (May, 2015). 3. W. T. Zempsky, JAMA302, 2479 (Dec 9, 2009). 4. B. S. Shapiro, L. J. Benjamin, R. Payne, G. Heidrich, J Pain Symptom Manage14, 168 (Sep, 1997). The relative frequency = the number of patients taking certain dose of opioids/total number of patients. Table 1. Patient Characteristics. Table 1. Patient Characteristics. Figure 1. Frequency of Opioid Usage in SCD Patients. Figure 1. Frequency of Opioid Usage in SCD Patients. Table 2. Opioid Medication Usage Pattern by SCD Patients. Table 2. Opioid Medication Usage Pattern by SCD Patients. Disclosures No relevant conflicts of interest to declare.

Association of patients’ familiarity and perceptions of efficacy and risks with the use of opioid medications in the management of osteoarthritis

2021 ◽  
pp. jrheum.201133
Author(s):  
Ernest R. Vina ◽  
Cristian Quinones ◽  
Leslie R.M. Hausmann ◽  
Said A. Ibrahim ◽  
C. Kent Kwoh
Keyword(s):  
Medication Use ◽  
Cross Sectional Study ◽  
Opioid Use ◽  
Cross Sectional ◽  
Opioid Medication ◽  
Logistic Regression Models ◽  
Clinical Variables ◽  
Number Of Patients ◽  
Opioid Medications ◽  
Medication Risk

Objective While opioids are known to cause unintended adverse effects, they are being utilized by a number of patients with osteoarthritis (OA). The aim of this study was to evaluate the association of patient familiarity and perceptions regarding efficacy and risks with opioid medication use for OA. Methods A total of 362 adults with knee and/or hip OA were surveyed in this cross-sectional study. Patients’ familiarity with and perceptions of benefits/risks of opioid medications were measured to evaluate potential associations with the utilization of opioid medications for OA within the last 6 months. Logistic regression models were adjusted for sociodemographic and clinical variables. Results In this sample, 28.7% (100/349) reported use of an opioid medication for OA-related symptoms in the last 6 months. Those who were on an opioid medication, compared to those who were not, were younger (mean age 62.5 vs. 64.8), more likely to have ≤ a high school education (48.0% vs. 35.3%), and had higher mean depression (PHQ-8 7.2 vs. 4.9) and OA-related pain (WOMAC 54.8 vs. 46.8) scores. After adjustment for sociodemographic and clinical variables, the following were associated with opioid medication use: higher perception of medication benefit (OR 1.68 [95% CI 1.18, 2.41]), lower perception of medication risk (OR 0.67 [95% CI 0.51, 0.88]), and having family/friends that received the medication for OA (OR 3.88 [95% CI 1.88, 8.02]). Conclusion Among adults with knee/hip OA, opioid use was associated with believing that the medication was beneficial and low risk and being familiar with the treatment.

An evaluation of opioid use during acute hospital admissions

2022 ◽  
Vol 4 (1) ◽  
pp. 24-31
Author(s):  
Alison Blackburn
Keyword(s):  
Acute Pain ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Opioid Use ◽  
Opioid Medication ◽  
Age Range ◽  
The Impact ◽  
Acute Hospital Setting

Long-term opioid use can begin with the treatment of acute pain. However, there is little evidence concerning the impact that better opioid awareness in the acute phase may have on reducing the use of opioids in the long term. This project explored which opioids are routinely prescribed within an acute hospital setting and how these opioids were used over the course of the hospital stay. Codeine and morphine remain the most commonly prescribed opioids. Opioids were prescribed and given to people across the age range, from 16 to 98 years. The project found that 19% of patients were admitted with a pre-existing opioid. Up to 66% of patients were discharged with opioid medication, with almost 20% leaving with more than one opioid. Regular opioid use routinely exposes patients to long-term opioid use and those patients initiated onto opioid medication during admission should have the benefit of planned de-escalation before discharge.

scholarly journals Daily Opioid Use Is Common in Adults with Sickle Cell Disease Presenting to an Acute Care Unit for Treatment of Vaso-Occlusive Pain

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4587-4587
Author(s):  
Fuad El Rassi ◽  
Neli Stoyanova ◽  
Eldrida Randall ◽  
Morgan L. McLemore ◽  
Claudia R. Morris
Keyword(s):  
Clinical Trial ◽  
Acute Care ◽  
Sickle Cell ◽  
Clinical Characteristics ◽  
Pain Therapy ◽  
Admission Rate ◽  
Cell Disease ◽  
Opioid Use ◽  
Chronic Opioid Use ◽  
Acute Care Unit

Abstract Background: Pain is the hallmark of sickle cell disease (SCD), and the most common reason for emergency department (ED) visits and hospitalizations in adults and children with SCD. The Emory University Sickle Cell Center at Grady Memorial Hospital has been providing specialized services for adult SCD patients for 30 years. In addition to daily sickle cell specialized clinics, the center is set up with a 24/7 acute care unit (ACU) that is staffed by specialized SCD providers and manages vaso-occlusive episodes (VOE). The patients are started on intravenous narcotics, fluids and antibiotics within 30 minutes of presenting to the ACU. After eight hours of management, the patient is then either discharged home if the VOE is controlled or admitted to the hospital for continued management. Annually, around 3000 ACU visits are recorded with 17% hospital admission rate (over the last 5 years). Little information is known about the clinical characteristics of adults with SCD and chronic opioid use in the setting of VOE pain. Methods: Clinical data from adult SCD patient visits for VOE presenting to the ACU was prospectively collected over a 4-month period (March 1, 2015- July 1 2015) as part of a screening process of an ongoing clinical trial. Results: 214 patients were evaluated for VOE requiring parenteral opioids, with an admission rate of 18%. Mean age was 31+/-14 years, 53% were male and the majority (80%) had hemoglobin (Hb) SS. See Table 1 for clinical characteristics. Over 80% of patients treated in the ACU were ultimately discharged home. Interestingly, the rate of chronic opioid use was around 50% in both admitted and discharged patients from the ACU. Conclusions: The admission rate for VOE in adults with SCD is low at our center through the utilization of the ACU. 51% of patients requiring admission for continued pain therapy were on daily opioids and most of these patients had Hb-SS. 50% of the patients discharged from the ACU were also on daily opioids which represents a significant finding when trying to recruit opioid-na•ve patients on clinical trials to manage VOE. Additionally, this high percentage of daily opioid users reflects a group of patients with possibly more severe disease, who are at risk of tolerance, hyperanalgesia and difficulty in managing VOE in the outpatient setting. This information is valuable for clinical trial design, as chronicopioid use is often an exclusion criterion for enrollment into novel pain therapy trials in SCD. More research is needed on this important topic. Table 1. Clinical Characteristics of Adults with SCD and VOE presenting to Grady Acute Care Center Characteristics Total(N=214) Admitted(N=38) Discharged (N=176) Patient Visits (%) 100% 18% 82% Male n (%) 114 (53%) 19 (50%) 95 (54%) Female n (%) 100 (47%) 19 (50%) 81 (46%) Age ± SD 31±14 29±10 31±9 Hb SS 170 (80%) 34 (89%) 136 (77%) Hb SC 37 (17%) 4 (11%) 33 (19%) Hb S beta+ thalassemia 7 (3%) 0 7 (4%) Chronic Opioids n (%) 108 (51%) 19 (50%) 89 (51%) Disclosures No relevant conflicts of interest to declare.

scholarly journals Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study

2020 ◽  
Vol 48 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Megan L Allen ◽  
Charles C Kim ◽  
Sabine Braat ◽  
Karin Jones ◽  
Noam Winter ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Surgical Patients ◽  
Opioid Use ◽  
Post Discharge ◽  
Opioid Medication ◽  
Post Surgery ◽  
Opioid Medications

Our aim was to determine the frequency and characteristics of post-surgery prescription of opioid medication and to describe patients’ handling of discharge opioid medications. We performed a multicentre prospective cohort study of adult patients undergoing elective or emergency surgery with a postoperative stay of one or more nights, with phone follow-up at two weeks after hospital discharge. The main outcome measures included the proportion of patients prescribed discharge opioid medications, post-discharge opioid use, opioid storage and disposal. Of the 1450 eligible surgical patients, opioids were dispensed on discharge to 858 (59%, 95% confidence interval (CI) (57%–62%)), with immediate-release oxycodone the most common medication. Of the 581 patients who were discharged with opioid medication and completed follow-up, 27% were still requiring opioids two weeks after discharge. Post-discharge opioid consumption was highly variable in the study cohort. The majority (70%) of patients had leftover opioids and only a small proportion (5%) reported disposal of the surplus. In a multivariate model, patients with characteristics of age 45 years or less (odds ratio, OR = 1.78, 95% CI (1.36–2.33) versus older than 45 years), American Society of Anesthesiologists’ physical status (ASA) scores of 1 or 2 (OR = 1.96, 95% CI (1.52–2.53) versus ASA score 3 to 5), higher anticipated surgical pain (OR = 1.45, 95% CI (1.08–1.94) severe versus moderate, OR = 17.48, 95% CI (5.79–52.69) severe versus nil/mild) and public funding status (OR = 1.89, 95% CI (1.36–2.64) versus other) were more likely ( P < 0.001) to receive discharge opioids. Post-surgery prescription of opioids is common and supply is often excessive. Post-discharge opioid handling included suboptimal storage and disposal.

scholarly journals Association of Inpatient Opioid Utilization and Readmission Risk in Sickle Cell Disease

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4699-4699
Author(s):  
Jin Han ◽  
Santosh L. Saraf ◽  
Michel Gowhari ◽  
Shivi Jain ◽  
Robert E. Molokie ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Validation Cohort ◽  
Cell Disease ◽  
Opioid Use ◽  
Discovery Cohort ◽  
Opioid Dose ◽  
Clinical Variables ◽  
Readmission Risk ◽  
First Admission

Abstract Background: Vaso-occlusive crisis (VOC) is the hallmark complication of sickle cell disease (SCD). The majority of SCD-related healthcare costs in the United States, estimated at $2.4 billion annually, are attributed to frequent healthcare utilization due to recurrent VOC (1-3). Risk factors such as the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) only without opioids, older age, and steroid treatment have been identified to be associated with readmissions in pediatric SCD patients (4, 5), but limited data exist about potential predictors for readmission in adults (6). The impact of inpatient opioid utilization on readmission was evaluated in this study. Methods: Seventy SCD adults treated at the University of Illinois Hospital from 2012-2016 had at least one hospitalization for uncomplicated VOC that was followed by a 30-day readmission (30-DR) and at least one hospitalization without a 30-DR. One hospitalization with a 30-DR and one hospitalization without a 30-DR from each patient were used to form the discovery cohort (a total of 140 hospitalizations from 70 unique patients). Patient characteristics, inpatient laboratory values, outpatient daily opioid use before admission, and inpatient daily opioid use were collected from the electronic medical records, and the ratio of the last inpatient day opioid dose/home opioid dose before admission was calculated. Among the 70 patients in the discovery cohort, 22 patients had more than one hospitalization with a 30-DR. The additional hospitalizations with a 30-DR and matched hospitalizations from the same patient without a 30-DR were used to form a validation cohort (a total of 62 hospitalizations from 22 unique patients). A Wilcoxon signed-rank test was performed to compare the ones with a 30-DR to the ones without. The study was approved by the Institutional Review Board prior to the initiation of chart review. Results: Among the 70 SCD patients identified, the median (IQR) age was 32.5 (25-44) years by the time of the first admission included in this cohort, and 67% were females, 76% were HbSS or Sbeta0 genotype, and 46% were on hydroxyurea before admission. The median (IQR) dose of daily outpatient opioids before the first admission was 170 (64-280) mg oral morphine equivalents (OME). When the hospitalizations without a 30-DR were compared to the ones with in the discovery cohort (Table 1), the ratio of last inpatient day opioid dose/home opioid dose was lower (1.5 vs. 1.9, p=0.024), whereas other relevant clinical variables including length of stay, pain score upon discharge, and hemoglobin or WBC upon discharge were not significantly different between the two groups (Table 1). The proportion of patients who used patient controlled analgesia (PCA) during admission, or underwent opioid dose tapering during hospitalizations, or converted IV opioids to oral ones before discharge was also comparable. In the validation cohort (Table 1), the ratio of last inpatient day opioid dose/home opioid dose in the group without a 30-DR was also lower than the ones with a 30-DR (1.4 vs. 2.0, p=0.033), whereas other clinical variables were comparable. Summary: Here we showed that a high ratio of last inpatient day opioid dose/home opioid dose is associated with readmission risk for sickle cell patients treated for uncomplicated VOC. The results suggest that proper tapering of inpatient opioid dose in reference to patient's home opioid dose before discharge may reduce the readmission risk. Reference: K. L. Hassell, Am J Prev Med38, S512 (Apr, 2010). S. Lanzkron, C. P. Carroll, C. Haywood, Jr., Am J Hematol85, 797 (Oct, 2010). T. L. Kauf, T. D. Coates, L. Huazhi, N. Mody-Patel, A. G. Hartzema, Am J Hematol84, 323 (Jun, 2009). L. M. Okorji, D. S. Muntz, R. I. Liem, Pediatr Blood Cancer64, (May, 2017). A. Sobota, D. A. Graham, E. J. Neufeld, M. M. Heeney, Pediatr Blood Cancer58, 61 (Jan, 2012). M. A. Brodsky et al., Am J Med130, 601 e9 (May, 2017). Disclosures No relevant conflicts of interest to declare.

Hydroxyurea Use in Sickle Cell Disease Patients in a Florida Medicaid Population.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 79-79 ◽  
Author(s):  
Jane N. Ritho ◽  
Dionne Y. Mayhew ◽  
Abraham G. Hartzema ◽  
Huazhi Liu ◽  
Richard Lottenberg
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Slow Release ◽  
Medication Possession Ratio ◽  
Pharmacy Claim ◽  
Early Therapy ◽  
Number Of Patients ◽  
Medicaid Population ◽  
Pain Crisis ◽  
Opioid Medications

Abstract Background: Efficacy of hydroxyurea (HU) was demonstrated in the Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) placebo-controlled randomized clinical trial with a reduction in average crisis rate (weighted mean difference −2.80; CI −4.74 to −0.86). HU was FDA-approved in 1998 for treatment of adults with sickle cell anemia experiencing recurrent painful episodes. An observational 9 year follow-up study of the MSH cohort demonstrated improved survival for patients taking HU. Purpose: To examine adoption and utilization of HU in SCD patients in a Medicaid population. Methods: A retrospective cohort study was conducted using Florida Medicaid eligibility, medical and pharmacy data for January 1, 2001 to December 31, 2005. The Medicaid database consists of medical and outpatient pharmacy utilization and reimbursement claims. SCD patients aged between 16 and 64 years with at least one inpatient or two outpatient SCD diagnosis claims (ICD-9-CM 282.6x), and meeting continuous eligibility criteria were included. HU adoption was determined by the presence of at least one HU pharmacy claim using National Drug Codes. Adherence to HU was calculated using the medication possession ratio (MPR) defined as the cumulative daily dose dispensed (excluding the last prescription refill and hospitalizations) divided by the time period between the first and last HU prescription (Rx) dispensed. Descriptive and bi-variate analyses were used to assess the relationship between patient characteristics, treatment and utilization of medical resources. Results: The mean age of the 2,301 SCD patients identified is 25 years ± 10.9(SD). Of those, the majority were female (64%) and younger than 25 years of age (60%). During the study eligibility period, 72% had at least one SCD-related emergency department visit, 88% at least one hospitalization and 53% at least one inpatient claim for SCD with pain crisis. During the study period, 33.4% of the patients had ≥ 3 hospitalizations for SCD with pain crisis in any 12 month period. Approximately one-third of patients had red blood cell transfusions (36%) but only 4.4% had a claim for iron-chelation. Of all SCD patients 26% used outpatient opioid medications with 65.4% receiving slow-release formulations. Nearly 17% of the cohort (n=384) had at least one pharmacy claim for HU. Compared to non-HU users, HU users were more likely to be males (OR 1.79; CI 1.44–2.23), aged ≥ 25 years (OR 1.35; CI 1.08–1.71), with a history of using slow-release opioid medications (OR 5.95; CI 4.65–7.59) or receiving red cell transfusions (OR 4.21; CI 3.35–5.31). Of those SCD patients eligible to receive HU according to the MSH criteria (≥ 3 hospitalizations a year for SCD crisis), only 38% received at least one HU Rx (OR 11.78, CI: 8.26–16.80). For those patients receiving at least two HU Rx, only 30.2% had a MPR of ≥ 0.60 (see Table). Conclusions: The prevalence of HU use in this Medicaid population is low. Our results suggest that only a small subset of SCD patients receive HU prescriptions consistently. Early therapy drop out and low adherence rates are common in patients prescribed HU. Interventions to promote physician adoption and prescribing of HU are needed, as are efforts to increase patient adherence. HU Possession Ratio Number of patients (%) 0 – < 0.2 69 (28.6) 0.2 – < 0.4 46 (19.1) 0.4 – < 0.6 53 (22.0) 0.6 – < 0.8 36 (14.9) > 0.8 37 (15.4) Total 241 (100)

scholarly journals Prevalence and Risk Factors for Opioid-Induced Constipation in an Older National Veteran Cohort

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Fern FitzHenry ◽  
Svetlana K. Eden ◽  
Jason Denton ◽  
Hui Cao ◽  
Aize Cao ◽  
...  
Keyword(s):  
Elderly Population ◽  
Patient Characteristics ◽  
The Elderly ◽  
Proportional Hazard ◽  
Opioid Use ◽  
Cox Proportional Hazard ◽  
Observational Cohort ◽  
Concomitant Medications ◽  
Opioid Medications ◽  
Cox Proportional Hazard Regression

Objectives. This research describes the prevalence and covariates associated with opioid-induced constipation (OIC) in an observational cohort study utilizing a national veteran cohort and integrated data from the Center for Medicare and Medicaid Services (CMS). Methods. A cohort of 152,904 veterans with encounters between 1 January 2008 and 30 November 2010, an exposure to opioids of 30 days or more, and no exposure in the prior year was developed to establish existing conditions and medications at the start of the opioid exposure and determining outcomes through the end of exposure. OIC was identified through additions/changes in laxative prescriptions, all-cause constipation identification through diagnosis, or constipation related procedures in the presence of opioid exposure. The association of time to constipation with opioid use was analyzed using Cox proportional hazard regression adjusted for patient characteristics, concomitant medications, laboratory tests, and comorbidities. Results. The prevalence of OIC was 12.6%. Twelve positively associated covariates were identified with the largest associations for prior constipation and prevalent laxative (any laxative that continued into the first day of opioid exposure). Among the 17 negatively associated covariates, the largest associations were for erythromycins, androgens/anabolics, and unknown race. Conclusions. There were several novel covariates found that are seen in the all-cause chronic constipation literature but have not been reported for opioid-induced constipation. Some are modifiable covariates, particularly medication coadministration, which may assist clinicians and researchers in risk stratification efforts when initiating opioid medications. The integration of CMS data supports the robustness of the analysis and may be of interest in the elderly population warranting future examination.

scholarly journals Chronic opioid use in patients with sickle cell disease

Hematology ◽  
2021 ◽  
Vol 26 (1) ◽  
pp. 415-416
Author(s):  
George Mo ◽  
Tim Jang ◽  
Connor Stewart ◽  
Leen Khoury ◽  
Natalie Ferguson ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Cell Disease ◽  
Opioid Use ◽  
Chronic Opioid Use

Opioid management strategy decreases admissions in high-utilizing adults with sickle cell disease

2017 ◽  
Vol 13 (3) ◽  
pp. 143 ◽  
Author(s):  
Amy Mager, PA-C, MPAS ◽  
Kristin Pelot, MSSW ◽  
Kathryn Koch, APNP ◽  
Lawrence Miller, PsyD ◽  
Collin Hubler, BS ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Management Strategy ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Psychological Disorder ◽  
Successful Implementation ◽  
Cell Disease ◽  
Opioid Use ◽  
Percent Decrease

Background: A subset of adults with sickle cell disease (SCD) heavily utilizes the emergency department (ED) and hospital. The objective of our study was to determine the efficacy of a multidisciplinary strategy to address unmet needs in highly utilizing adults with SCD.Methods: In a prospective study, adults with SCD with ≥10 admissions per year were assessed by a multidisciplinary team for gaps in medical, social, and psychological care. Thereafter, the team decided upon the subject's predominant domain that drove admissions and instituted an interventional plan. All plans included an opioid management strategy. Preintervention and postintervention admission rate, as well as opioid use, was compared.Results: Twelve subjects were enrolled. Median rate of ED and hospital admissions preintervention was 25 per year. The predominant domains identified were social needs (n = 6), psychological disorder (n = 1), and substance use disorder (n = 5). Multifaceted interventional plans were developed to address a wide range of gaps in care, but an opioid management strategy was the only intervention successfully completed. Even so, when the preintervention versus postintervention admission rate was compared, regardless of the domain, there was a 40 percent decline in hospital admissions (p = 0.03). Consistent with the successful implementation of an opioid management plan, the decrease in admissions was accompanied by a 37 percent decrease in intravenous opioid use (p = 0.02) and 10 percent decrease in oral opioid use (p = 0.04).Conclusion: An opioid management strategy, as part of a larger effort to improve care for high-utilizing adults with SCD, decreased rate of admissions and opioid use.

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