Opioid Trends Differ by Insurance in Sickle Cell Disease

Opioid dispensing volume increased for several agents among people with sickle cell disease from 2021 through 2023, while average days supplied and daily morphine milligram equivalents did not rise significantly, according to a cohort study in JAMA Network Open.

The analysis included 48,760 commercially insured or Medicaid-enrolled individuals aged 1 to 64 years with sickle cell disease. Investigators assessed dispensing trends across 6 opioid agents and prespecified periods spanning 2011 through 2023.

Among Medicaid beneficiaries, total dispensing increased for all 6 agents in the most recent period. The largest monthly increases were observed for methadone, 1.76% (95% CI, 1.24%-2.29%), and hydromorphone, 1.43% (95% CI, 1.00%-1.86%).

Among commercially insured people, dispensing volume increased for oxycodone and morphine, remained stable for hydrocodone, hydromorphone, and methadone, and declined for tramadol. Dispensed prescriptions per person increased only for oxycodone among commercially insured individuals and tramadol among Medicaid beneficiaries.

The authors could not separate the effects of clinical guidelines, the COVID-19 period, opioid policy, and changes in care delivery. Lack of state identifiers in the MarketScan data, shifting insurer participation, and possible residual confounding also limit interpretation.

Source: Xu KY, Attell BK, Buss JL, et al. Opioid dispensing volume and per-patient intensity in sickle cell disease. JAMA Netw Open. 2026;9(9):e2632141. doi:10.1001/jamanetworkopen.2026.32141