Addiction or pseudoaddiction in sickle cell disease patients: Time to decide - a case series

Abstract

Objective: The objective of this report is to highlight the background factors associated with opioid abuse among Sickle Cell Disease (SCD) patients.

Patients: Eleven patients aged 13-53 years (mean, 26.1yrs) which included six female and five male were seen in the last six year at a tertiary health facility. The modes of abuse ranged from obtaining analgesic prescription from multiple sources, injecting analgesics and sharing analgesics between patients in the hospital.

Results: Five female had either avascular necrosis of the femoral head or pathological fracture secondary to chronic osteomyelitis, so were classified as pseudoaddiction while five male and one female without any identifiable  cause of chronic pain were adjudged to be addicted to opioids. The role of a dysfunctional family background in the response of SCD patients to pain treatment and substance abuse is highlighted.

Conclusion: These cases reveal drug abuse as an emerging or understudied problem among SCD patients and its association with chronic pain in some patients. It is therefore necessary for pain physicians and SCD experts to address the use of opioid in chronic sickle cell pain and provide alternatives and a suitable guideline for their use.

Keywords: Opioid, chronic pain, sickle cell pain, psychosocial issues, substance abuse