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Publications

Journal Article Ppublish

PubMed: 39378616 DOI: 10.1016/j.genhosppsych.2024.09.013

Opioid-related emergency admissions in people with opioid dependence/use disorder with and without sickle cell disease: An analysis of multi-state insurance claims.

Gen Hosp Psychiatry 91:83-88

Authors: Shiyuan A Liu, Tashalee R Brown, Allison A King, Lewei Allison Lin, Sana S Rehman, Richard A Grucza, Kevin Y Xu

Affiliations

  • Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America.
  • Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, United States of America; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, United States of America.
  • Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America; Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America.
  • Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI 48109, United States of America; Center for Clinical Management Research (CCMR), Veteran Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States of America.
  • Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America.
  • Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, 1008 S. Spring Avenue, St. Louis, MO 63110, United States of America.
  • Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America.

Abstract

OBJECTIVE

We estimated rates of opioid-related admissions in people with sickle cell disease (SCD) diagnosed with opioid-related disorders.

METHOD

We analyzed ten years (1/2006-12/2016) of multi-state claims data from 191,638 people receiving treatment for opioid-related disorders in the U.S. We used multivariable cox regression to estimate the association between admissions for opioid-related adverse events after initiating treatment and SCD status (SCD[n = 320] vs no SCD[n = 191,318]) among people with opioid-related disorders, controlling for sociodemographic variables and comorbidities. In secondary analyses, we excluded events occurring simultaneously as vaso-occlusive crises (VOCs) and computed rates of admissions for non-opioid substance-related events (i.e., alcohol, cannabis).

RESULTS

Whereas 287(90 %) of the SCD cohort had >1 all-cause admission, of which 199 were for VOCs, only 78(20 %) experienced an opioid-related adverse event. The SCD cohort experienced higher rates of opioid-related admissions than the non-SCD cohort (aHR = 1.82[95 % CI = 1.51-2.19), a finding that remained robust even after excluding events that occurred at the same time as a VOC. SCD diagnoses were not associated with admissions for non-opioid substance-related events.

CONCLUSIONS

Even though clinicians may perceive people with SCD as being at elevated risk for substance use disorders, opioid-related admissions made up only a small fraction of all-cause admissions among people with SCD diagnosed with opioid-related disorders, in contrast to VOCs that comprised the majority of admissions. Opioid-related admissions, while modestly higher among those with SCD than among peers without SCD, were relatively uncommon.

MeSH

Cells, Anemia, Sickle Cell, Emergencies, Multiple Chronic Conditions, Insurance, Drug-Related Side Effects And Adverse Reactions, Opioid-Related Disorders, Therapeutics, Psychiatry, Vaso-Occlusive Crises