Abstract
BACKGROUND: Patterns of opioid prescribing and vaso-occlusive crises (VOCs) are poorly characterized among individuals with sickle cell disease (SCD) across diverse insurance types and age groups. We aimed to evaluate opioid prescribing and VOC trends in publicly and commercially insured individuals with SCD over a 10-year time period in the United States (US). METHODS: We conducted a retrospective cohort study of US administrative claims (2011-2022), analyzing 45,726 commercial and Medicaid beneficiaries with SCD. Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group (1-12, 13-17, 18-27, 28-45, 46-64 years). Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group. FINDINGS: Among 45,726 individuals with SCD (mean age [SD] = 25.1 [16.2]; 39.7% female; 52.9% Medicaid, 47.1% commercial insurance), Medicaid beneficiaries had higher rates than commercial beneficiaries for monthly opioid prescribing (18.3 vs 14.0 per 100) and VOC encounters (16.6 vs 8.2 per 100). Monthly opioid prescribing per 100 people increased with age: 1-12 y = 5.1; 13-17 y = 11.3; 18-27 y = 22.5; 28-45 y = 24.6; 46-64 y = 20.6 per 100. Both Medicaid and commercial beneficiaries experienced declining opioid prescribing beginning in 2011 (commercial monthly percentage change [MPC] = -0.3% [95% CI: -0.3%, -0.2%]; Medicaid MPC = -0.5% [-0.6%, 0.5%]). Down-trending opioid prescribing was not consistently accompanied by up-trending VOCs until the COVID-19 pandemic's onset. Particularly among children and adolescents, VOC-related encounters increased significantly after 2020 across both commercial (MPC = 1.8% [1.5%, 2.2%]) and Medicaid (MPC = 0.6% [0.1%, 1.6%]) beneficiaries. INTERPRETATION: Opioid prescribing and VOC admissions vary by insurance and age. Opioid prescribing declined from 2011 but was not consistently accompanied by increased VOCs until after COVID-19. FUNDING: Analyses of Merative MarketScan Commercial and Multi-State Medicaid Database were funded by grants NIH K12 DA041449 (PI: KYX; data analysts: JLB, DS). Effort for some personnel was supported by P50 MH122351 (KYX, PI: Eric Lenze MD, Michael Avidan MBBCh), K08 K08 DA061258 (KYX), the American Psychiatric Association (APA) Psychiatric Research Fellowship (with funding by NIDA and the APA, KYX), NIH K12NS130673 (LSM), NIH L60HL170453 (LSM), and the St. Louis University Research Institute Fellowship (RAG, JS, JFS, RH); these grants did not fund Merative MarketScan Commercial and Multi-State Medicaid Database data pull.