Expert Q&A

Opioid-Related Mortality in Patients With Sickle Cell Disease

More than half of all adult patients with sickle cell disease (SCD) experience daily, chronic pain. However, public health initiatives aimed at ending the opioid epidemic may adversely impact this patient population.

Lead study author Lana Mucalo, MD and her team sought to explore the relationship between patients with SCD and opioid-related mortality; they found that opioid-related mortality among this patient population remains low with no significant increase during 2013 to 2019.

Dr. Mucalo answered our questions about the study.1

Consultant360: To begin, what prompted this study?

Lana Mucalo, MD: Individuals with SCD need continued access to pain medications to manage their frequent pain. Because of concerns for opioid-related mortality in the general population, we wanted to investigate opioid-related mortality rates and trends among individuals with SCD. Our hypothesis was that individuals with SCD do not have high rates of opioid-related deaths nor changes in opioid-related mortality trends. Individuals with SCD often receive delayed and insufficient treatment for their pain because of a lack of knowledge about their specific symptoms and common biases. Thus, we felt this was an important question to address.

C360: The results indicated that while the overall opioid-related mortality in White patients and Black patients without SCD increased during 2013 to 2019, opioid-related mortality in Black patients with SCD did not increase during the study period. How does this finding inform clinical practice?

Dr Mucalo: We hope that this finding will help educate health care providers that opioid-related mortality in individuals with SCD has not increased over the past 8 years. We hope this may dispel bias that often factors into the delivery of optimal pain management for individuals with SCD.

C360: What is the current standard of care for prescribing opioids to manage pain in patients with SCD?

Dr MucaloThe American Society of Hematology recently released guidelines for the management of acute and chronic pain for individuals with SCD.2 It is important for anyone caring for individuals with SCD to be familiar with these guidelines to be able to provide optimal pain management.

C360: What are some clinical pearls you use in your practice for managing pain in these patients, either using opioids or alternative pain management strategies?

Dr Mucalo: Adherence to previously mentioned guidelines for pain management is the best approach for optimal care. It is always important to use shared decision-making with the patient when developing pain therapy plans and consult the individual’s SCD health care provider to work collaboratively to manage pain.

C360: What knowledge gaps remain concerning the use of opioids in patients for SCD? What is the next step for research in this area?

Dr Mucalo: It is still unknown why some individuals with SCD experience frequent and/or chronic pain while some experience minimal pain. The pathophysiology of SCD pain is also not well understood, which is a barrier to targeted and/or personalized therapy. Understanding the underlying biology of SCD pain is crucial for tailoring specific therapy for needs of each individual.



  1. Mucalo L, Brandow AM, Singh A.Opioid-Related Mortality for Individuals with Sickle Cell Disease Remains Low with No Significant Increase during 2013-2019. Blood. 2021;138:124. DOI:
  2. Brandow AM, Carroll PC, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020;4(12):2656-2701. doi:10.1182/bloodadvances.2020001851