Effort to control opioids in an ER leaves some sickle cell patients in pain

As hospitals aggressively seek opioid-sparing strategies for pain relief, patients with sickle cell disease say new emergency department (ED) policies are hurting—not helping—them.

As hospitals aggressively seek opioid-sparing strategies for pain relief, patients with sickle cell disease say new emergency department (ED) policies are hurting—not helping—them. People with the genetic condition often experience excruciating pain during flare-ups, when deformed red blood cells cause blockages that slow blood flow and cut off oxygen to tissues and organs. If checking into a specialized clinic is not feasible during one of these crises, the local ED is often an alternative destination for treatment. Previously, that meant receiving a direct injection of opioids, such as hydromorphone, to immediately stem the pain. Now, at locations like St. Mary's Hospital in Athens, GA, that means getting a diluted formulation of the drug through the slower delivery of an I.V. drip instead. Advocates like Biree Andemariam, MD, of the Sickle Cell Disease Association of America argue that this patient population is suffering although they are not at risk for the opioid dependency that hospitals are so afraid of facilitating. A 2018 study, for example, showed that despite growing opioid use nationwide, the incidence among sickle cell patients has not changed much over time. However, others—including Troy Johnson, MD, at St. Mary's—insist that these patients are just as vulnerable as others. "We have given sickle cell patients a pass [with the notion that] they don't get addicted—which is completely false," he says. "For us to not address that addiction is doing them a disservice."