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Daily home opioid use in adults with sickle cell disease: The PiSCES project

Wally R. Smith, MD, Donna K. McClish, PhD, Bassam A. Dahman, PhD, James L. Levenson, MD, Imoigele P. Aisiku, MD, MSCR, Vanessa de A. Citero, MD, Viktor E. Bovbjerg, PhD, MPH, John D. Roberts, MD, Lynne T. Penberthy, MD, MPH, Susan D. Roseff, MD


Background: Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use.

Objective: To report on home opioid use among adults with SCD.

Design: Cohort study.

Participants: Adults with SCD (n = 219) who completed daily pain diaries for up to 6 months and had at least one home pain day.

Main measures: Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics.

Key results: Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p < 0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables.

Conclusions: In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.


sickle cell disease, pain, long-term opioid therapy, epidemiology

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