title: Patterns of opioid use in sickle cell disease.
abstract: Pain, the hallmark complication of sickle cell disease (SCD), is largely managed with opioid analgesics in the United States, but comprehensive data regarding the long-term use of opioids in this patient population is lacking. The pain medication prescription records from a cohort of 203 SCD patients were analyzed. Twenty-five percent were not prescribed opioid medications while 47% took only short-acting opioids, 1% took only long-acting opioids, and 27% took a combination of short-acting and long-acting opioids. The median (interquartile range) daily opioid dose was 6.1 mg (1.7-26.3 mg) of oral morphine equivalents, which is lower than the published opioid use among patients with other pain syndromes. The dose of opioids correlated with the number of admissions due to vaso-occlusive crisis (VOC) (r = 0.53, P < 0.001). When the patients were grouped into quartiles based on daily dose opioid use, a logistic regression model showed that history of avascular necrosis (AVN) (OR: 2.87, 95% CI: 1.37-6.02, P = 0.005), 25-OHD levels (OR: 0.59, 95% CI: 0.38-0.93, P = 0.024) and total bilirubin concentration (OR: 0.64, 95% CI: 0.42-0.99, P = 0.043) were independently associated with opioid use quartiles. In conclusion, doses and types of opioid medications used by adult SCD patients vary widely. Our findings implicate AVN and lower vitamin D levels as factors associated with higher opioid use. They also suggest an association of higher bilirubin levels, possibly suggesting higher hemolytic rate, with lower opioid use. Am. J. Hematol. 91:1102-1106, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois. jhan35@uic.edu.|Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois. jhan35@uic.edu.
authors.forename: Jin
authors.initials: J
authors.lastname: Han
authors.affiliation: Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Santosh L
authors.initials: SL
authors.lastname: Saraf
authors.affiliation: Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Michel
authors.initials: M
authors.lastname: Gowhari
authors.affiliation: Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.|Jesse Brown VA Medical Center, Chicago, Illinois.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Molokie
authors.affiliation: Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Joharah
authors.initials: J
authors.lastname: Hassan
authors.affiliation: Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Chaher
authors.initials: C
authors.lastname: Alhandalous
authors.affiliation: Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Shivi
authors.initials: S
authors.lastname: Jain
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Jewel
authors.initials: J
authors.lastname: Younge
authors.affiliation: Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Taimur
authors.initials: T
authors.lastname: Abbasi
authors.affiliation: Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Machado
authors.affiliation: Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Victor R
authors.initials: VR
authors.lastname: Gordeuk
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000755:Anemia, Sickle Cell / Q000188:drug therapy* / Q000473:pathology; D001157:Arterial Occlusive Diseases / Q000188:drug therapy; D001663:Bilirubin / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D013997:Time Factors; D014481:United States; D014807:Vitamin D / Q000097:blood; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D014807:Vitamin D; D001663:Bilirubin