Pain, the hallmark complication of
sickle cell disease (SCD), is largely managed with
opioid analgesics in the United States, but comprehensive data regarding the long-term use of
opioids in this patient population is lacking. The
pain medication prescription records from a cohort of 203 SCD patients were analyzed. Twenty-five percent were not prescribed
opioid medications while 47% took only short-acting
opioids, 1% took only long-acting
opioids, and 27% took a combination of short-acting and long-acting
opioids. The median (interquartile range) daily
opioid dose was 6.1 mg (1.7-26.3 mg) of oral
morphine equivalents, which is lower than the published
opioid use among patients with other
pain syndromes. The dose of
opioids correlated with the number of admissions due to vaso-occlusive crisis (VOC) (r = 0.53, P < 0.001). When the patients were grouped into quartiles based on daily dose
opioid use, a logistic regression model showed that history of avascular
necrosis (AVN) (OR: 2.87, 95% CI: 1.37-6.02, P = 0.005), 25-OHD levels (OR: 0.59, 95% CI: 0.38-0.93, P = 0.024) and total
bilirubin concentration (OR: 0.64, 95% CI: 0.42-0.99, P = 0.043) were independently associated with
opioid use quartiles. In conclusion, doses and types of
opioid medications used by adult SCD patients vary widely. Our findings implicate AVN and lower
vitamin D levels as factors associated with higher
opioid use. They also suggest an association of higher
bilirubin levels, possibly suggesting higher hemolytic rate, with lower
opioid use. Am. J. Hematol. 91:1102-1106, 2016. © 2016 Wiley Periodicals, Inc.