Patients with sickle cell disease often face stigma about their need for pain medication because care providers are suspicious of drug abuse, reports The Dallas Post Tribune. Although this is a long-running issue, the recent high levels of opioid abuse in the US have compounded the problem.
Sickle cell disease (SCD) is an umbrella term for several inherited genetic conditions that cause red blood cells to be deformed. It is most common in people of African, Asian, Middle Eastern, Mediterranean, and Caribbean descent. The main symptoms of SCD are anaemia, increased risk of serious infection, and sickle cell crises (painful episodes that can last up to a week).
Sickle cell crises occur in almost all SCD patients, but the amount varies, with some having over six crises per year. Drinking fluids, keeping warm, and taking over-the-counter painkillers can prevent and treat some sickle cell crises at home. However, more serious crises require immediate medial attention and strong opioid painkillers. They are characterised by intense and debilitating pain that often comes on suddenly. The need for quick and aggressive treatment has been highlighted by several studies that show a link between severe sickle cell crises and increased mortality rates.
However, patients who suffer from frequent pain crises can appear suspicious to health workers, because they often require high doses of pain medication and may ask for specific types of opioids. This is because, as a lifelong condition, patients often build up a tolerance to the opioid painkillers and need a higher dose to produce the same effects. This is different from addiction, where the person would take the opioid without it being medically necessary. In addition this, patients often know the types of medicine that have worked for them in the past, and may request them. These two factors can make healthcare workers mistrustful of patients and reluctant to treat them.
The result is that sickle cell patients often find that their treatment is delayed, at a serious cost to their health. One study found that SCD patients waited an average of thirty minutes longer than people with other conditions characterised by severe pain, such as kidney stones. This was despite patients with SCD rating their pain, on average, as more severe. But this stigma against SCD patients is unfounded. In a review of people who died of opioid overdose, only 0.06% also had SCD, showing the limited role SCD patients really play in the opioid abuse crisis.