Trends in Recurrent Emergency Department Utilization by Opioid-Dependent Sickle Cell Disease Patients: Operational Burden, Policy Intervention, and the Need for Multidisciplinary Outpatient Solutions

Alayob, Musaab Abdulateef

doi:10.33762/mjbu.2026.159666.1302

	Trends in Recurrent Emergency Department Utilization by Opioid-Dependent Sickle Cell Disease Patients: Operational Burden, Policy Intervention, and the Need for Multidisciplinary Outpatient Solutions
The Medical Journal of Basrah University
Article 5, Volume 44, Issue 1, July 2026, Pages 32-42 PDF (386.25 K)
Document Type: Research Paper
DOI: 10.33762/mjbu.2026.159666.1302
Author
Musaab Abdulateef Alayob^*
EHS/IBHOH /UAE
Abstract
Abstract __________________________________________________________________ Background: Sickle cell disease (SCD) is an inherited condition affecting hemoglobin, marked by recurrent painful episodes known as vaso-occlusive crises (VOCs), which frequently necessitate acute intervention in the emergency department (ED). While intravenous opioids are the primary treatment for VOCs, some patients may develop a dependency, resulting in regular, non-urgent visits to the ED even when they are not experiencing clinical crises. This trend significantly strains acute care resources, skews performance metrics, and pressures conventional emergency care delivery models. Aim: 1. To analyze the trend of recurrent emergency department (ED) utilization by opioid-dependent sickle cell disease (SCD) patients over time. 2. To evaluate the operational burden associated with high-frequency ED visits and assess the impact of implementing an 8-hour intravenous morphine administration policy. 3. To explore the implications for developing sustainable multidisciplinary outpatient care strategies to reduce ED dependency and improve patient outcomes. Methods: This retrospective observational study reviewed the ER utilization patterns of opioid-dependent adult SCD patients at Ibrahim Bin Hamad Obaidullah Hospital (IBHOH), Ras Al Khaimah, over 15 months from January 2024 to March 2025. Inclusion criteria were daily or near-daily visits for intravenous morphine without documented crises or significant pain, and non-attendance of outpatient psychiatry or pain management services. Patients younger than 13 years, those requiring inpatient admission for acute complications, or those receiving non-opioid-based pain management were excluded. All data were validated and verified through official emergency department logs and hospital medical records. Monthly visit counts and 48-hour return rates were analyzed per patient. A policy implemented in October 2024 limiting opioid access to every 8 hours was used as a temporal intervention point. Conclusion: This study highlights the significant impact that a small number of opioid-dependent SCD patients impose on emergency services, creating notable clinical and operational challenges. Although policy measures can help redistribute the workload, they do not fully address the root cause of dependency or lessen reliance on emergency departments. These results emphasize the critical need for developing multidisciplinary outpatient care models that bring together hematology, pain management, psychiatry, and addiction medicine. Furthermore, standard quality indicators, such as 48-hour revisit rates, must be updated to avoid penalizing acute care services that deal with complex chronic patient situations. Ongoing multicenter research is crucial to confirm these findings and improve patient-centered care pathways. Keywords: Sickle cell anemia, opioid-seeking behavior, emergency department management, alternative pain management, healthcare resource utilization, protocol enforcement.
Keywords
SCD; opioid; ER

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