The Opioid Drug Epidemic and Sickle Cell Disease: Guilt by Association.

Abstract

In 2008, for the first time in Centers for Disease Control and Prevention (CDC) history, death due to motor vehicle accident was no longer the leading cause of injury mortality non-medical death [1]. Drug overdose was the number one cause of non-medical death in the United States [1]. Since 2008, the number of deaths due to drug overdose has been increasing steadily [2–9]. The total number of deaths due to drug overdose was 36,450 in 2008 [10]. In 2013, the total amount of deaths due to drug overdose was 43,982 [10]. Given the alarming nature of these statistics, patients who requested an opioid prescription became targets of suspicion and possible accusation of being drug addicts and/or drug seekers and possibly potential victims of overdose [8,9,11–15]. The advent of precision medicine [16], however, seems to justify such behavior. Since the pharmacodynamics and pharmacokinetics of an opioid vary among patients considerably depending on their individual specific genetic and epigenetic factors, it is conceivable that a certain opioid or a certain dose of an opioid do not apply to all patients all the time. Patients with sickle cell disease (SCD) whose pain was treated with opioids chronically learned which opioid and which dose of an opioid is best to relieve or minimize their sickle pain. Nevertheless, management of sickle cell pain with opioids must follow two tiers as is the case in the management of other types of pain with opioids. The first tier is to optimize analgesia by prescribing adequate dose to minimize pain severity, and the second tier is to minimize risk by frequent monitoring and assessment of opioid related adverse effects and outcomes related to substance use disorders [17]. Although …