A new study analyzing data from a large database on hospital inpatients appears to show that the use of opioid medications for pain control in patients with SCD is relatively safe, said lead investigator Oladimeji A. Akinboro, MBBS, of the Boston University School of Medicine.

Attacks of excruciating pain are the most common cause of hospital admission among patients with SCD, and opioid medications are a mainstay of treatment for these attacks, known as pain crises. Researchers at Boston University School of Medicine wanted to know whether the U.S. opioid epidemic, which has resulted in a marked increase in opioid-related overdoses and deaths over the past two decades, may have affected the death rate among people with SCD who were treated with opioids in the hospital to relieve these pain crises.

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, Dr. Akinboro said.

“We do not see a relationship between opioid use and death in patients who are hospitalized for SCD,” he said, adding that the overwhelming majority of patients with SCD need strong pain medication to control acute pain during crises.

“Adults with SCD are hospitalized frequently,” he added. “We 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.”

The hallmark of SCD is stiff, sickle-shaped red blood cells that don’t flow smoothly through the blood vessels as normal red blood cells do. A pain crisis occurs when these sickle-shaped red blood cells get stuck in blood vessels, slowing or blocking blood flow and preventing oxygen from reaching all parts of the body.

Dr. Akinboro and his colleagues analyzed data from the National Inpatient Sample, the largest publicly available all-payer inpatient health care database in the United States, which contains data from more than 7 million hospital stays each year. They identified more than 1.7 million hospitalizations for patients with SCD between 1998-2013. They examined rates of hospitalization and in-hospital death both for this entire patient population and for specific age groups (0-17 years, 18-44 years, 45-64 years, and 65 years and over) and by the region of the country where patients were hospitalized (Northeast, Midwest, South, or West).

The analysis found no significant increase in the rate of in-hospital death among those with SCD over the 15-year period examined. By contrast, the death rate related to prescription opioids among the U.S. population without SCD increased 350 percent between 1999-2013.

Overall, the hospitalization rate for patients with SCD declined from 39 per 100,000 people in 1998 to 27 per 100,000 in 2002 and did not change significantly from 2002-2013. Among adults in the 18–44 age group, however, the hospitalization rate increased significantly, from 43 per 100,000 in 2002 to 71 per 100,000 in 2013. For adults ages 65 and over, the hospitalization rate also increased significantly, from 2.7 per 100,000 in 1998 to 5.4 per 100,000 in 2013.

According to subgroup analysis, the rates of opioid-related hospitalizations relative to the total number of hospitalizations in the sickle cell population were stable over time and similar to the relative rates in the general population. However, unlike in the general population in which inpatient deaths from opioid-related admissions increased over time, inpatient deaths related to opioid toxicity and/or overdose were almost non-existent over the entire study period. This further reinforces the study conclusions that opioid use for pain control should be considered safe in the sickle cell disease population, according to Dr. Akinboro.

Dr. Akinboro said further research is needed to clarify the reasons why hospitalization rates climbed in these two age groups, but he suspects one reason may be lack of coordination of medical care for adults with SCD. Another possible explanation is that people with SCD are now living longer than they did in the past and are developing other health problems as they age, he said.  

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

This article is a press release of a study presented at the 60th American Society of Hematology (ASH) Annual Meeting and Exposition, 2018. Read the original here.