66 - Trends in Opioid Dispensing among Youths with Sickle Cell Disease in Michigan

Publication Number: 3063.66

Melissa Plegue, University of Michigan Medical School, Ann Arbor, MI, United States; Krista Latta, University of Michigan Medical School, Ann Arbor, MI, United States; Zador Lara, Henry Ford Health, Detroit, MI, United States; Amanda Miglin, University of Michigan, Ann Arbor, MI, United States; Joanne Constantin, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Sarah L. Reeves, University of Michigan Medical School, Ann Arbor, MI, United States

Background: Children with sickle cell disease (SCD) frequently experience debilitating pain. While prior research suggests that opioid dispensing rates among children with SCD are declining, there is limited understanding of the drivers of these trends.

Objective: To describe trends in opioid dispensing among children with SCD in Michigan.

Design/Methods: Children < 19 years of age with SCD were identified through the Michigan Sickle Cell Data Collection (MiSCDC) program using validated methods. Children were included each year from 2018-2022 of continuous enrollment in Michigan Medicaid. Dispensed opioid prescriptions and type (long-acting; short-acting) were identified using validated National Drug Codes. The proportion of children with any dispensed opioid was calculated annually, overall and by age groups. Logistic regression models using generalized estimating equations (GEE) were used to investigate changes in likelihood of any opioid dispensing across years and age groups. Among person-years with at least one dispensed opioid prescription, trends in the annual days’ supply, number of prescriptions, and days’ supply by prescription was modeled by year and age utilizing linear mixed effects regression models.

Results: A total of 1,200 children with SCD contributed 4,371 years of observation (mean age=8.9 (sd=5.2), 50.6% female). 605 (50.4%) children were dispensed at least one opioid (97.2% short-acting; 2.8% long-acting). From 2018-2022, the proportion of children with any dispensed opioid in a year decreased from 39.1% to 32.4%; 22% to 17% in the 0-5, 43% to 34.1% in 6-11 and 50.7% to 44.4% in 12-18 year olds. Decreasing trends over time were found to be consistent across age groups (p-value=0.58) but not significant (p-value=0.07). Average annual number of filled prescriptions significantly increased (p-value=0.007) over time among all age groups with overall means in 2018 of 2.8 (SD=3.8) to 3.2 (SD=4.5) in 2022. Total days’ supply per year did not have a significant change over time in any age group (p-value=0.32). Average days’ supply per prescription significantly decreased over time (p < 0.001) from a mean of 6 (SD=3.9) days in 2018 to 5 (SD=2.7) in 2022, overall.

Conclusion(s): Overall rates of opioid dispensing did not significantly change among children with SCD in Michigan between 2018-2022. However, among children that had at least one dispensed opioid, there was a decrease in number of days’ supply per prescription with a concurrent increase of number of filled prescriptions. This juxtaposition warrants further investigation regarding changes in physician prescribing behaviors.