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Review
. 2021 Jan 23;10(3):438.
doi: 10.3390/jcm10030438.

Opioids and Sickle Cell Disease: From Opium to the Opioid Epidemic

Samir K Ballas  1
Affiliations
Review

Opioids and Sickle Cell Disease: From Opium to the Opioid Epidemic

Samir K Ballas. J Clin Med. .

Abstract

Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure. The clinical effects of the sickle gene are pleiotropic in nature causing multiple phenotypic expressions associated with the various complications of the disease. The hallmark of the disease is pain that could be acute, chronic, nociceptive, or neuropathic that could occur singly or in various combinations. The acute vaso-occlusive painful crisis (VOC) is the most common cause of admissions to the Emergency Department and/or the hospital. Although progress has been made in understanding the pathophysiology of SCD as well as in developing preventive and curative therapies, effective pain management continues to lag behind and depend mostly on the use of opioids. This review describes the history of opioids from the ancient times of opium to the current use of the many controversial opioids. In addition, the major cause of death of patients with SCD is the complications of the disease itself and not the use of opioids. The use of opioids by patients with SCD has been stable over the years. Judicious use of opioids to treat sickle cell pain according to available guidelines could minimize the unnecessary suffering experienced by patients with SCD.

Keywords: epidemic; mortality; opioids; opium; pandemic; sickle cell disease.

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Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1
Figure 1
Opium poppy. Public domain photograph.
Figure 2
Figure 2
(A) Opium poppy seed pod exuding latex from a cut is mixed with alcohol (B) to make Laudanum (C) known as Opium Tincture. Photographs are public domain.
Figure 3
Figure 3
California poppy seeds have a culinary function and may be used as supplement (A) California poppy seeds for baking and herbal use. Photographs are public domain. (B) California poppy seed bagel. Photograph is public domain.
Figure 4
Figure 4
Opium den and pipe. (A) Opium den and (B) pipe. Photographs are public domain.
Figure 5
Figure 5
Helical structure of the μ-opioid receptor. Reproduced with permission from Manglik, A.; Nature; published by Nature Publishing Group, 2012 [24].
Figure 6
Figure 6
Classical Opioids vs. Biased Opioids. Classical opioids transmit both the beneficial and the harmful side effects. Biased opioids transmit only the beneficial effects. Reproduced with permission from Servick, K., Science; published by American Association for the Advancement of Science, 2020 [33].
See this image and copyright information in PMC

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