Opioid Dispensing Volume and Per-Patient Intensity in Sickle Cell Disease

Importance: Opioids remain central to management of acute and chronic pain in sickle cell disease (SCD). Opioid dispensing declined over the 2010s amid opioid stewardship efforts, but patterns since 2020 are less clear. Analyses aggregating opioids into morphine milligram equivalents (MME) may obscure agent-specific patterns. Objective: To characterize opioid dispensing volume and per-recipient frequency, duration, and dose among individuals with SCD. Design, Setting, and Participants: A retrospective cohort study of commercially insured and Medicaid-enrolled patients with SCD using the Merative MarketScan databases across 3 periods from January 2011 to February 2016, March 2016 to December 2020, and January 2021 to December 2023. Exposure: Calendar time across 3 prespecified periods: January 2011 to February 2016, March 2016 to December 2020, and January 2021 to December 2023. Main Outcomes and Measures: Changes in opioid dispensing were examined across 3 periods (January 2011 to February 2016, March 2016 to December 2020, and January 2021 to December 2023). Segmented regression models estimated monthly percentage changes (MPCs) in 4 outcomes: (1) total dispensed prescriptions per 100 enrollees; and, among enrollees receiving opioids, (2) mean prescriptions per person, (3) mean days supplied, and (4) mean daily MMEs. Analyses included 6 opioids (hydromorphone, hydrocodone, morphine, tramadol, oxycodone, methadone) stratified by insurance type (commercial vs Medicaid). Results: Across 48 760 individuals with SCD contributing person-time, 24 692 (50.6%) were Medicaid beneficiaries, 20 969 (43.0%) were aged 19 to 40 years, and 29 380 (60.3%) were female. From January 2021 through December 2023, total dispensing increased for all 6 agents among Medicaid beneficiaries, with the largest monthly increases for methadone (MPC, 1.76%; 95% CI, 1.24% to 2.29%) and hydromorphone (MPC, 1.43%; 95% CI, 1.00% to 1.86%). Among commercial enrollees, total dispensing increased for oxycodone (MPC, 0.84%; 95% CI, 0.60% to 1.07%) and morphine (MPC, 0.87%; 95% CI, 0.42% to 1.33%), was stable for hydrocodone, hydromorphone, and methadone, and declined for tramadol (MPC, -0.79%; 95% CI, -1.16% to -0.42%). Dispensed prescriptions increased only for oxycodone among commercially insured individuals (MPC, 0.14%; 95% CI, 0.08% to 0.20%) and tramadol among those with Medicaid (MPC, 0.96%; 95% CI, 0.56% to 1.36%). Mean days supplied and mean daily MMEs did not significantly increase for any opioid-insurance combination. Conclusions and Relevance: Among individuals with SCD, total opioid dispensing increased or stabilized during 2021 to 2023 after prior declines, most prominently among Medicaid beneficiaries, without broad increases in per-recipient frequency, duration, or dose. These patterns are consistent with broader distribution of opioid dispensing rather than treatment intensification among recipients.