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

Wally R. Smith, MD; Donna K. McClish, PhD; Bassam A. Dahman, PhD; James L. Levenson, MD; Imoigele P. Aisiku, MD, MSCR; Vanessa de A. Citero, MD; Viktor E. Bovbjerg, PhD, MPH; John D. Roberts, MD; Lynne T. Penberthy, MD, MPH; Susan D. Roseff, MD

doi:10.5055/jom.2015.0273

Authors

Wally R. Smith, MD
Donna K. McClish, PhD
Bassam A. Dahman, PhD
James L. Levenson, MD
Imoigele P. Aisiku, MD, MSCR
Vanessa de A. Citero, MD
Viktor E. Bovbjerg, PhD, MPH
John D. Roberts, MD
Lynne T. Penberthy, MD, MPH
Susan D. Roseff, MD

DOI:

https://doi.org/10.5055/jom.2015.0273

Keywords:

sickle cell disease, pain, long-term opioid therapy, epidemiology

Abstract

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.

Author Biographies

Wally R. Smith, MD

Florence Neal Cooper Smith Professor of Sickle Cell Disease, Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.

Donna K. McClish, PhD

Professor, Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia.

Bassam A. Dahman, PhD

Assistant Professor, Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia.

James L. Levenson, MD

Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia.

Imoigele P. Aisiku, MD, MSCR

Assistant Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Vanessa de A. Citero, MD

Dept. de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.

Viktor E. Bovbjerg, PhD, MPH

Associate Professor, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.

John D. Roberts, MD

Professor, Section of Medical Oncology, Department of Medicine, Director, Yale Adult Sickle Cell Program, Smilow Cancer Hospital at Yale - New Haven, New Haven, Connecticut.

Lynne T. Penberthy, MD, MPH

Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.

Susan D. Roseff, MD

Chair, Division of Clinical Pathology, Department of Pathology, Virginia Commonwealth University, Richmond, Virginia.

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