Patterns of Opioid Utilization and Aberrant Opioid-Related Behaviors (AORB) in Pediatric Sickle Cell Anemia Patients: A Systematic Review

Background: Sickle cell disease (SCD) causes recurrent vaso-occlusive pain in childhood which requires opioid analgesia. Opioid utilization and aberrant opioid-related behaviors (AORB) still poorly defined in pediatric Gulf Cooperation Council (GCC) populations. Objective: This systematic review analyzed data on opioid utilization patterns, AORB, opioid use disorder (OUD), and related psychosocial factors in pediatric patients with SCD. Methods: Searches were conducted in PubMed, Web of Science, Scopus, and Embase using terms related to SCD, opioid analgesics, AORB, and pediatric. We consider original cohort, cross-sectional, retrospective, and qualitative studies involving pediatric SCD populations and reporting opioid utilization or AORB. We extract data on study setting, population, opioid-related outcomes, and main findings. Results: Seven studies were included. GCC studies was limited to one Saudi tertiary emergency department study, where morphine was used commonly for acute painful crises and administration within 60 -minutes was associated with higher chance of discharge. International claims data showed that 40% of SCD patients used opioids annually, while 3% of pediatric patients were high-dose users. OUD prevalence in adolescents with SCD was reported as 5.3% in Uganda. Additional opioid use was associated with older age, previous healthcare utilization, depression, pain catastrophizing, caregiver factors, and family support. Conclusion: Opioid utilization in pediatric SCD is affected by recurrent vaso-occlusive pain and acute care needs, data on AORB in GCC children are very limited.