Daily home opioid use in adults with sickle cell disease: The PiSCES project

2015 ◽  
Vol 11 (3) ◽  
pp. 243 ◽  
Author(s):  
Wally R. Smith, MD ◽  
Donna K. McClish, PhD ◽  
Bassam A. Dahman, PhD ◽  
James L. Levenson, MD ◽  
Imoigele P. Aisiku, MD, MSCR ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Symptom Burden ◽  
Opioid Analgesics ◽  
Cell Disease ◽  
Opioid Use ◽  
Short Acting ◽  
Negative Coping ◽  
Long Acting ◽  
Opioid Users

Background: Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use.Objective: To report on home opioid use among adults with SCD.Design: Cohort study.Participants: Adults with SCD (n = 219) who completed daily pain diaries for up to 6 months and had at least one home pain day.Main measures: Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics.Key results: Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p < 0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables.Conclusions: In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.

Outpatient Opioid Use In Adult Patients With Sickle Cell Disease

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4699-4699
Author(s):  
Morey A. Blinder ◽  
Mikala Barnes ◽  
Kimberly French ◽  
Catherine Rogers ◽  
William Berger
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Adult Patients ◽  
Poor Compliance ◽  
Cell Disease ◽  
Opioid Use ◽  
Short Acting ◽  
Urine Drug ◽  
Long Acting ◽  
Chronic Use

Introduction Treatment of sickle cell disease (SCD) has often required the use of opioids for the treatment of pain. While guidelines for specific medications and dosing are available for inpatient and emergency department use, less is known about the outpatient treatment of adult SCD patients. The aim of this study is to evaluate the role of outpatient opioids in adults with sickle cell disease. Method The Adult Hemoglobinopathy Resource Center at Washington University provides care for adult SCD patients throughout the St. Louis, Missouri metropolitan area. All patients have confirmed SCD (Hgb SS, Hgb SC, Hgb Sβ+, Hgb Sβ0, Hgb SOther) and have been seen at least once since 2011 to be included in the study. Patients were considered to be compliant with their outpatient care if they were seen at least once per year and did not miss more than three consecutive appointments. The type of opioid that was used was determined based on the most recent filled prescription. Patients were considered to be on chronic opioids if they received >1 prescription/month or were over a 3 month period. Patients were considered to be on no opioids if they received ≤1 prescription in 3 months. Results Three hundred and seventeen patients have been evaluated between January 2011 and June 2013 of which 9 (2.8%) have died during that time period. Of the surviving patients, 33 (10.7%) have not been actively followed (poor compliance/disruptive behavior-29, incarcerated-2, moved out of town-1, transfer of care-1). Of the patients actively followed, the mean age is 32 years (range 17-72); 148 patients (53.8%) are female and 127 (46.2%) are male. The hemoglobinopathies include SS-175, SC-80, Sβ+-14, Sβ0-5, SCHarlem-1. Long-term red cell transfusions were performed in 25 patients (automated RBC exchange-13, partial manual exchange-8 and simple transfusions-4) and hydroxyurea was prescribed in 101 patients (Hgb SS-92 patients). At present, 151 patients (54.9%) are prescribed chronic long and short acting opioids and 76 patients (27.6%) are on chronic short acting opioids with a much smaller number of patients (40 pts) not receiving opioids. Notably 18 of 40 patients not receiving opioids were effectively treated with either hydroxyurea or transfusion therapy. Of the 104 patients ≤25 years of age, 60 (57.7%) were on chronic long and short acting opioids at the time of their initial care. The most commonly prescribed long-acting opioid used was extended release morphine sulfate and the most common short acting opioid was oxycodone. Because of recent concerns about non-compliance and diversion, urine drug screens have been utilized with increasing frequency to assess opioid use and of the last 30 patients receiving long-acting therapy who were tested, 17 samples did not identify the prescribed medication suggesting some degree of opioid misuse. Conclusions While opioids have been an important adjunctive treatment for patients with sickle cell disease, their most effective use in adult patients is difficult to define. Strategies to decrease the use of opioids in the adolescent and young adult population along with disease-modifying therapy such as hydroxyurea and RBC transfusions would seem to be helpful to decrease the chronic use of opioids. Furthermore, chronic use of opioids is frequently associated with poor compliance. The use of urine drug screens may be helpful to improve compliance and decrease diversion. Disclosures: Blinder: Novartis Pharmaceuticals: Consultancy, Research Funding.

scholarly journals Pain and disease severity relate to long versus short-acting opioid use in adults with sickle cell disease: the PiSCES project

2012 ◽  
Vol 13 (4) ◽  
pp. S15
Author(s):  
W. Smith ◽  
D. McClish ◽  
B. Dahman ◽  
J. Levenson ◽  
I. Aisiku ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Disease Severity ◽  
Sickle Cell ◽  
Cell Disease ◽  
Opioid Use ◽  
Short Acting

Mu Opioid Receptor (OPRM-1) Polymorphisms among Patients with Sickle Cell Disease.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3804-3804
Author(s):  
Sharmila Mehta ◽  
Nicholas Campbell ◽  
Lakiea Bailey ◽  
Ferdane Kutlar ◽  
Dedrey Elam ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Allele Frequency ◽  
Sickle Cell ◽  
Opioid Analgesics ◽  
Mu Opioid Receptor ◽  
Wild Type ◽  
Cell Disease ◽  
Opioid Use ◽  
Mu Opioid ◽  
Pain Frequency

Abstract Opioid analgesics form an important component of the management of acute and chronic pain in patients with sickle cell disease (SCD). Chronic opioid use, sometimes associated with dependence and addiction in a subset of patients, may pose difficult management problems. This adds to the sometime antagonistic relationship that can develop between providers and patients with SCD. Pain management can become a sociological and psychological issue in the management of SCD. The Mu opioid receptor (OPRM-1) is the primary site of action of endogenous opioid peptides (enkephalins and endorphins) and of opioid analgesics, such as morphine, methadone, fentanyl, heroin, and related compounds. Rapid activation of the mu receptor results in a euphoric effect, conferring the reinforcing or rewarding effects of opioids and thus contributing to the development of addiction. It has been known that there is variation between individuals in sensitivity to opioids suggesting potential variation in the receptor protein and the gene. Some recent data have shown that polymorphisms in the OPRM-1 gene affect pain threshold and tolerance as well as opioid requirements for optimal pain control. In an effort to unravel the complex issues surrounding pain frequency, pain tolerance, opioid usage, and opioid addiction in this patient population, we conducted a study of our adult sickle cell patients for the frequency of the two common cSNPs and another SNP in the IVSII (G691C) of the OPRM-1 gene. DNA samples from randomly selected patients were used in this study. The OPRM-1 gene was PCR amplified and subjected to cycle sequencing on an ABI Prism automated sequencer. The results showed that of the 97 adult SCD patients screened for the C17T polymorphism (GenBank accession #AY292291 and 292290), 67 (69.7%) had the wild type (CC), 28 (29.1%) were heterozygous (CT), and 11 (11.4%) were homozygous (TT) for the SNP. This represents an allele frequency for the T of 0.26. Of the 39 sequenced samples for the A1189G, all (100%) showed the wild type (AA). These results closely resemble those reported by Bond et al (PNAS, 95;9608,1998) for the frequency of the two cSNPs in the African-American population (allele frequency of 0.21 for the C17T and 0.016 for the A118G). Of the 16 samples screened for IVS II G691C polymorphism (GenBank accession #AY299483), 6 (37.5%) had the wild type (GG), 9 (56.3%) were heterozygous (GC), and 1 (6.2%) was homozygous (CC). Our results among SCD patients show a high frequency of C17T polymorphism in the OPRM-1 gene. Detailed studies in higher numbers of SCD patients and clinical correlations with pain frequency and threshold, opioid usage, opioid abuse and drug seeking behavior will be undertaken. It is expected that these studies will clarify the role of OPRM-1 polymorphisms as a genetic modifier associated with pain frequency, with tolerance as well as opioid use and abuse.

scholarly journals Daily Associations between Child and Parent Psychological Factors and Home Opioid Use in Youth with Sickle Cell Disease

2019 ◽  
Vol 54 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Amanda L Stone ◽  
Zaria Williams ◽  
Melissa McNaull ◽  
Anna C Wilson ◽  
Cynthia W Karlson
Keyword(s):  
Side Effects ◽  
Sickle Cell Disease ◽  
Negative Affect ◽  
Sickle Cell ◽  
Psychological Factors ◽  
Opioid Analgesics ◽  
Cell Disease ◽  
Opioid Use ◽  
Home Setting ◽  
At Home

Abstract Background Opioid analgesics are frequently used in the home setting to manage episodic pain in youth with sickle cell disease (SCD). Given the risk of adverse side effects, including constipation and sedation, understanding factors associated with at-home opioid use is important for maximizing pain relief while minimizing negative side effects. Purpose The present study aimed to evaluate the relationship between individual psychological factors (pain catastrophizing and negative affect), caregiver psychological factors (catastrophizing about child’s pain and caregiver negative affect), and home opioid use in youth with SCD. Methods Youth with SCD (n = 32) and a caregiver (n = 28) recruited during a routine outpatient hematology visit completed electronic 14 day diaries assessing pain, opioid use, and psychological factors. Results Approximately 28% of youth (n = 9) reported pain ≥50% of diary days and a third of youth (n = 11, 34%) used opioid analgesics at least one of the diary days. The number of days opioid analgesics were used ranged from 0 to 7 (50% of diary days). Results from generalized linear mixed models indicated greater child negative affect accounted for increased odds of opioid use on a given day when accounting for pain intensity. Greater caregiver catastrophizing about children’s pain was also associated with increased odds of children’s opioid use. Conclusions Child and parent psychological factors relate to child opioid use at home for SCD-related pain. Future research is warranted in larger samples to identify targets for interventions to enhance pain management while reducing opioid-related risk and side effects.

scholarly journals Hospitalization Events among Children and Adolescents with Sickle Cell Disease in Basra, Iraq

Anemia ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Zeina A. Salman ◽  
Meaad K. Hassan
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Readmission Rate ◽  
Length Of Hospital Stay ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Opioid Use ◽  
Asthma Symptoms ◽  
The Mean ◽  
High Readmission Rate

Objectives. Despite improvements in the management of sickle cell disease (SCD), many patients still experience disease-related complications requiring hospitalizations. The objectives of this study were to identify causes of hospitalization among these patients and factors associated with the length of hospital stay (LOS) and readmission.Methods. Data from 160 patients (<14 years old) with SCD who were admitted to the Basra Maternity and Children’s Hospital from the first of January 2012 through July 2012 were analyzed.Results. The main causes of hospitalization were acute painful crises (73.84%), infections (9.28%), acute chest syndrome (8.02%), and acute splenic sequestration crisis (6.32%). The mean LOS was4.34±2.85days. The LOS for patients on hydroxyurea (3.41±2.64days) was shorter than that for patients who were not (4.59±2.86days),P<0.05. The readmission rate (23.1%) was significantly higher among patients with frequent hospitalizations in the previous year (OR 9.352, 95% CI 2.011–43.49), asthma symptoms (OR 4.225, 95% CI 1.125–15.862), and opioid use (OR 6.588, 95% CI 1.104–30.336). Patients on hydroxyurea were less likely to be readmitted (OR 0.082, 95% CI 0.10–0.663).Conclusions. There is a relatively high readmission rate among patients with SCD in Basra. The use of hydroxyurea significantly decreases the LOS and readmission rate.

Age-related prescription medication utilization for the management of sickle cell disease among Texas Medicaid patients

2021 ◽  
Vol 17 (4) ◽  
pp. 301-310
Author(s):  
Nidhi Shukla, MS, MBA ◽  
Jamie C. Barner, PhD, FAACP, FAPhA ◽  
Kenneth A. Lawson, PhD, FAPhA ◽  
Karen L. Rascati, PhD
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Age Groups ◽  
Dual Therapy ◽  
Cell Disease ◽  
Opioid Use ◽  
Medication Utilization ◽  
Age Related ◽  
Nonopioid Analgesics ◽  
Chi Square Analysis

Introduction: Sickle cell disease (SCD) is associated with recurrent complications and healthcare burden. Although SCD management guidelines differ based on age groups, little is known regarding actual utilization of preventative (hydroxyurea) and palliative therapies (opioid and nonopioid analgesics) to manage complications. This study assessed whether there were age-related differences in SCD index therapy type and SCD-related medication utilization.Design and patients: Texas Medicaid prescription claims from September 1, 2011 to August 31, 2016 were retrospectively analyzed for SCD patients aged 2-63 years who received one or more SCD-related medications (hydroxyurea, opioid, or nonopioid analgesics).Outcome measures: The primary outcomes were SCD index drug type and medication utilization: hydroxyurea adherence, and days’ supply of opioid, and nonopioid analgesics. Chi-square, analysis of variance, and Kruskal–Wallis tests were used.Results: Index therapy percentages for included patients (N = 2,339) were the following: opioids (45.7 percent), nonopioids (36.6 percent), dual therapy-opioids and nonopioids (11.2 percent), and hydroxyurea (6.5 percent), and they differed by age-groups (χ2 = 243.0, p 0.0001). Hydroxyurea as index therapy was higher among children (2-12:9.1 percent) compared to adults (26-40:3.7 percent; 41-63:2.9 percent). Opioids as index therapy were higher among adults (18-25:48.0 percent; 26-40:54.9 percent; 41-63:65.2 percent) compared to children (2-12:36.6 percent). Mean hydroxyurea adherence was higher (p 0.0001) for younger ages, and opioid days’ supply was higher for older ages.Conclusions: Texas Medicaid SCD patients had low hydroxyurea utilization and adherence across all age groups. Interventions to increase the use of hydroxyurea and newer preventative therapies could result in better management of SCDrelated complications and reduce the frequency of pain crises, which may reduce the need for opioid use.

scholarly journals Medical marijuana certification for patients with sickle cell disease: a report of a single center experience

2020 ◽  
Vol 4 (16) ◽  
pp. 3814-3821 ◽  
Author(s):  
Susanna A. Curtis ◽  
Dana Lew ◽  
Jonathan Spodick ◽  
Jeanne E. Hendrickson ◽  
Caterina P. Minniti ◽  
...  
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Medical Marijuana ◽  
Care Utilization ◽  
Cell Disease ◽  
Opioid Use ◽  
Admission Rates ◽  
Single Center Experience ◽  
Few Data

Abstract More than one-third of adults with sickle cell disease (SCD) report using cannabis-based products. Many states list SCD or pain as qualifying conditions for medical marijuana, but there are few data to guide practitioners whether or whom should be certified. We postulated that certifying SCD patients may lead to a reduction in opioid use and/or health care utilization. Furthermore, we sought to identify clinical characteristics of patients who would request this intervention. Retrospective data obtained over the study period included rates of health care and opioid utilization for 6 months before certification and after certification. Patients who were certified but failed to obtain medical marijuana were compared with those who obtained it. Patients who were certified were invited to participate in a survey regarding their reasons for and thoughts on certification. Patients who were certified for medical marijuana were compared with 25 random patients who did not request certification. Fifty adults with SCD were certified for medical marijuana and 29 obtained it. Patients who obtained medical marijuana experienced a decrease in admission rates compared with those who did not and increased use of edible cannabis products. Neither group had changes in opioid use. Patients who were certified for medical marijuana had higher rates of baseline opioid use and illicit cannabis use compared with those who did not request certification. Most patients with SCD who requested medical marijuana were already using cannabis illicitly. Obtaining medical marijuana decreased inpatient hospitalizations.

scholarly journals A comment on pattern of opioid use in sickle cell disease

2017 ◽  
Vol 92 (4) ◽  
pp. E42-E43 ◽  
Author(s):  
Xiulu Ruan ◽  
Hong Wu ◽  
Dian Wang
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Cell Disease ◽  
Opioid Use

scholarly journals Plasma Endothelin-1, Cytokine, and Prostaglandin E2Levels in Sickle Cell Disease and Acute Vaso-Occlusive Sickle Crisis

Blood ◽  
1998 ◽  
Vol 92 (7) ◽  
pp. 2551-2555 ◽  
Author(s):  
Evangeline Graido-Gonzalez ◽  
James C. Doherty ◽  
Eric W. Bergreen ◽  
Gregory Organ ◽  
Margaret Telfer ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Cell Function ◽  
Immune Cell ◽  
Cell Disease ◽  
Endothelin 1 ◽  
Susceptibility To Infection ◽  
Microvascular Inflammation ◽  
Long Acting ◽  
Factor Α

Abstract The relative contributions of microvascular inflammation and vasomotor dysregulation to the development of acute vaso-occlusive crisis in sickle cell disease have been intensely studied. The present observational study was designed to examine the levels of circulating proinflammatory cytokines, anti-inflammatory cytokines, and vasoactive mediators during and after acute painful crisis. In symptomatic sickle cell patients, plasma levels of endothelin-1 and prostaglandin E2 were elevated during crises compared with healthy African-American controls. These levels had decreased, but not normalized, when patients were seen 1 to 3 weeks after discharge from hospital. Other mediators (tumor necrosis factor α [TNFα], interleukin-1β [IL-1β], IL-6, IL-8, and IL-10) were neither elevated in asymptomatic sickle cell disease nor in acute vaso-occlusive crisis. As a potent long-acting mediator of vasoconstriction and inflammation, endothelin-1 may play a key role in the cycle of ischemia and inflammation that initiates and sustains pain of crisis. The downregulatory effects of prostaglandin E2on immune cell function may contribute to the increased susceptibility to infection observed in patients with sickle cell disease.

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