The 2016 CDC Opioid Prescribing Guidelines May Have Negatively Impacted the Treatment of Individuals With Sickle Cell Disease

The 2016 US Centers for Disease Control and Prevention (CDC) guidelines on opioid prescribing were intended to promote safer and more effective use of opioids for chronic pain and resulted in reduced opioid prescribing. However, these guidelines may have had a negative impact on the treatment of certain populations, including individuals with sickle cell disease (SCD). Researchers used commercial health insurance claims data from 2011 to 2019 to investigate changes in opioid prescribing practices and pain-related health outcomes for a cohort of 14,979 individuals with SCD using an interrupted time series model.

• Compared with pre-guideline trends, the following changes were observed in opioid prescribing after dissemination of the guidelines: decreases in opioid dispensing rate (prescriptions/person-month), number of days supplied per prescription, and opioid dosage.
• After dissemination of the guidelines, there was a significant increase in vaso-occlusive crises-related hospitalizations, but not emergency department visits.

Comments: While the 2016 CDC guidelines were not intended to address the treatment of individuals with SCD, this study suggests that there was a spillover effect resulting in decreased opioid prescribing for this vulnerable population that may have been detrimental to their care. Of note, the 2022 updated guidelines specifically exclude patients with SCD and recommend following disease-specific guidelines.

Darius A. Rastegar, MD

Reference: Kang HA, Wang B, Barner JC, et al. Opioid prescribing and outcomes in patients with sickle cell disease post-2016 CDC guidelines. JAMA Inten Med. 2024;184(5):510–518.