Opioid exposure in haemophilia patients is common and underreported

Abstract

Introduction In an era of increased opioid awareness, data on opioid exposure in haemophilia patients are lacking. Aim The objectives of this study were to (a) provide a detailed description of opioid exposure in haemophilia patients based on written prescription data, (b) compare our findings to national haemophilia‐specific and general population datasets and (c) identify predictors of opioid exposure in haemophilia patients. Methods Medical records of 183 adult and 135 paediatric patients from two haemophilia treatment centres (HTC) were reviewed over a 42‐month period. Chronic exposure and acute opioid exposure were recorded, and results were compared to national haemophilia (ATHNdataset) and general population (CDC) data. Results We found that 56% of adult and 21% of paediatric patients were exposed to opioids, rates substantially higher than reported in the ATHNdataset (6%) and national population data from the CDC. In adults, but not children, severity of haemophilia was a significant predictor of opioid exposure. Most acute opioid prescriptions were not written by the HTC. Conclusions This is the first study in the haemophilia population to examine opioid exposure based on prescription data. Opioid exposure was more common than predicted in both adult and paediatric study populations and was most often prescribed for acute pain or procedures by non‐HTC providers. Haemophilia treatment centres need to take the lead in assessing pain in haemophilia patients, guiding treatment promoting non‐opioid options, strengthen efforts to monitor opioid exposure and collect data on pain treatment in the haemophilia population.

Recombinant factor IX‐Fc fusion protein in severe hemophilia B: Patient‐reported outcomes and health‐related quality of life

“…There may also be a recall bias as participants are asked to report acute pain for a one‐year period. Rates of analgesia use were high, with the associated challenges of analgesia management in people with hemophilia 4,30,33 . The increase in analgesia use reported in this study may reflect patient confidence in their prophylaxis, which subsequently allowed patients to manage joint or arthropathy pain with analgesia, rather than treating as a potential bleed with clotting factor concentrate.…”

“…Rates of analgesia use were high, with the associated challenges of analgesia management in people with hemophilia. 4 , 30 , 33 The increase in analgesia use reported in this study may reflect patient confidence in their prophylaxis, which subsequently allowed patients to manage joint or arthropathy pain with analgesia, rather than treating as a potential bleed with clotting factor concentrate. The difficulty in differentiating between hemarthrosis and hemophilic arthropathy is well recognized.…”

A multi-country snapshot study of pain in people with haemophilia

“…Successful selfmanagement of pain, and not discussing pain openly, contributes to the under-recognition of pain in PwH documented among clinicians [22] . Health care providers and some PwH can be reluctant to use stronger analgesia due to fears of addiction; however, a recent US publication reported that opioid use was higher in paediatric and adult practice than predicted [31] . Witkop and Lambing suggest that despite recognising PwH as the best source for reporting pain, HCPs don't always recognise the importance of treatment and require ongoing education in pain management [32] .…”

The impact of obesity on chronic pain in patients with haemophilia: A multicentre retrospective analysis

“…As pain medications were not frequently recorded in ATHN, 5 we performed a retrospective review of electronic health record (EHR) data at two adult haemophilia treatment centres (University of Pennsylvania and University of Minnesota) between June 2015 and June 2019 in patients with haemophilia A or haemophilia B of any severity. We excluded underweight patients (BMI < 18.5 kg/m 2 ) and patients missing BMI.…”