Disease severity indices in sickle cell anaemia patients with therapeutic opiate dependence in Nigeria

ABSTRACT

The role of disease severity in the development of opiate dependence was investigated by studying the pattern of steady state haematological parameters and vaso-occlusive crises in Sickle Cell Disease patients with and without opiate dependence as seen in Maiduguri, Nigeria. The patients were followed up for a 1-year period during which the levels of haematological parameters [including haematocrit, reticulocyte count, irreversibly sickled cells and foetal haemoglobin] and number of vaso-occlusive crises were studied and documented. Patients with opiate dependence had significantly [p < 0.05] lower mean haematocrit of [0.23 L/L], higher mean reticulocyte count [14%] and higher mean level of irreversibly sickled cells [6%] as compared to patients without opiate dependence who had higher mean haematocrit of 0.27 L/L, a lower mean reticulocyte count of 8.4% and lower mean level of irreversibly sickled cells of 3%. However, there was no statistically significant difference in the levels of foetal haemoglobin [Hb F] of 57c and 5.4% [p > 0.05] found among patients with opiate dependence and those without opiate dependence respectively. The number of episodes of vaso-occlusive crises per patient during the period of study was 5.5 among patients who were opiate dependent and was significantly higher than the figure of 1.9 [p < 0.05] seen among patients without opiate dependence. This data is interpreted to suggest that opiate dependent patients had higher rate of haemolysis and vaso-occlusive crises, and by implication greater disease severity, which leads to more vaso-occlusive crises that result in greater exposure to opiate analgesics to which they develop dependence in the course of time during clinical management. Therefore, disease severity is an important risk factor for the development of opiate dependence in sickle cell disease