A new study published in JAMA Pediatrics highlights how timely opioid administration in the emergency department (ED) can reduce hospitalizations for children with sickle cell disease (SCD) experiencing pain episodes.¹

SCD is the most common inherited blood disorder in the United States, and acute pain is the leading cause of ED visits among affected children. While guidelines recommend opioid treatment within 60 minutes of arrival, evidence linking timely administration to outcomes has been limited.

WATCH: Davis Brousseau, MD, MS, discusses timely opioid administration for children with sickle cell disease

The study underscores the importance of ED protocols designed to deliver pain treatment quickly and consistently. Researchers noted that avoiding unnecessary hospital stays can reduce infection risk, lower costs, and ease the burden on families while freeing up hospital resources.

In the Q+A section below, coauthor Ibrahim Gwarzo, DrPH, MPH, MBBS, of the Department of Pediatrics at Nemours Children's Health and the Sidney Kimmel Medical College at Thomas Jefferson University, breaks down the study.

For complete coverage of the study, click here to view our previous coverage.¹

Q+A with Ibrahim Gwarzo, DrPH, MPH, MBBS

Ibrahim Gwarzo, DrPH, MPH, MBBS | Image credit: Nemours Children's Health

Contemporary Pediatrics:

What do primary care providers need to know when it comes to SCD disease and pain experienced among the pediatric population?

Gwarzo:

Primary care providers play an essential role in managing patients with SCD disease. Although the majority of acute pain episodes are treated in EDs, milder pain episodes are typically treated during outpatient visits. Additionally, primary care providers play other crucial roles in care coordination, chronic pain management, preventive care, and follow up.

Contemporary Pediatrics:

Can you explain the design of your study recently published in JAMA Pediatrics, and how the timing of opioid played a role in hospitalization?

Gwarzo:

Our study was cross-sectional in nature. We used a database of ED visits across several pediatric academic sites in the United States, to examine the relationship between the timeliness of opioid administration and hospitalization for patients with acute, uncomplicated sickle cell pain.

Across over 7,000 ED visits, we found that timely administration of both the first and the second opioid doses was significantly associated with lower odds of hospitalizations for children with acute, uncomplicated sickle cell pain.

Specifically, receipt of the first opioid dose within 1 hour of ED arrival and the second within a 30-minute interval was associated with up to 38% lower odds of hospitalization.

Contemporary Pediatrics:

With a lot of headlines in recent years surrounding opioids (mainly in the older population), can you explain why this condition may require opioid administration and what should the primary care professional keep in mind when a patient is on opioids for pain related to SCD?

Gwarzo:

I think it is safe to say that the opioid abuse epidemic has adversely affected the sickle cell population. These patients are less likely to receive their needed opioid pain medication due to providers' fear of potential abuse. However, studies have shown that opioid use disorder is no more prevalent among the sickle cell population compared to other populations with chronic pain.

Primary care providers should strive to follow national guidelines such as those from the National Heart, Lung, and Blood Institute (NHLBI) and the American Society of Hematology (ASH) on the management of sickle cell pain.

Contemporary Pediatrics:

How important are these findings, and how can the avoidance of a hospital stay have a positive impact?

Gwarzo:

We need to understand that poorly-treated pain episodes that lead to an unnecessary inpatient stay expose these patients to a variety of other risks, including hospital-acquired infections, psychological stress, and potential financial burden.

For health systems, avoiding these admissions frees up resources for other patients who need them and improves the overall efficiency of our healthcare delivery system.

I would like to thank Contemporary Pediatrics for conducting this interview and sharing our work, which we hope will raise more awareness and potentially impact overall sickle cell pain management.

References:

1. Fitch J. Timing of opioids and hospitalizations for sickle cell disease pain. Contemporary Pediatrics. September 8, 2025. Accessed September 10, 2025. https://www.contemporarypediatrics.com/view/timing-of-opioids-and-hospitalizations-for-sickle-cell-disease-pain
2. Fitch J. David Brousseau, MD, highlights impact of timely opioid dosing in pediatric sickle cell pain. September 5, 2025. Accessed September 10, 2025. https://www.contemporarypediatrics.com/view/david-brousseau-md-highlights-impact-of-timely-opioid-dosing-in-pediatric-sickle-cell-pain