Growing Concern Over Opioid Abuse and Addiction Among Sickle Cell Disease Patients in Nigeria
核心洞察
Sickle cell disease (搜索) affects 4–6 million Nigerians, with recurrent vaso-occlusive crises driving heavy reliance on NSAIDs (搜索) and opioids like pentazocine, tramadol, and morphine.
Healthcare professionals report rising opioid addiction among SCD patients, with studies in North-West Nigeria finding an 11.7% opioid use disorder prevalence.
Experts warn that indiscriminate NSAID use can cause peptic ulcers and kidney injury, while opioid misuse leads to dependence, injection-site infections, and blood-borne diseases.
A growing pattern of opioid abuse and addiction among people living with sickle cell disease (搜索) (SCD) in Nigeria is raising alarm among healthcare professionals, who are calling for stricter prescription monitoring, better patient education, and coordinated institutional responses to prevent what they describe as a preventable crisis within an already vulnerable population.
SCD, a serious inherited blood disorder caused by a mutation in the HBB (搜索) (haemoglobin subunit beta) gene, leads to abnormal, sickle-shaped red blood cells that block blood flow and cause severe health complications. Nigeria bears the highest burden globally: according to the Sickle Cell Foundation Nigeria (搜索), about a quarter of the population carries the sickle-cell gene (AS), and WellaHealth estimates that 4 to 6 million people in the country live with SCD (SS or SC), with approximately 100,000 to 150,000 babies born with the disease each year.
The pain crisis driving medication dependence
Pain episodes, which can last from hours to days, are among the most debilitating symptoms of SCD. Dr. Paul Anejodo, a Registrar in Obstetrics and Gynaecology, explained that the disease results from a small mutation in the beta chain of haemoglobin A, where glutamate is changed to valine. "Hgb S forms a rigid polymer chain of Hgb S molecules, which produces long, rigid erythrocytes that tend to get stuck inside blood vessels, resulting in a vaso-occlusive crisis," Anejodo stated.
The management of this pain has become a subject of intense debate among medical doctors, pharmacists, pain therapists, and researchers. While mild pain is managed with acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs (搜索)) like ibuprofen, moderate to severe crises require prescription opioids such as morphine, oxycodone, or fentanyl.
Lagos-based pharmacist James Uche detailed the pharmacological risks: "There is a tendency for them to abuse drugs such as non-steroidal anti-inflammatory drugs (diclofenac, meloxicam, piroxicam, aceclofenac, etc.), analgesics (paracetamol), and opioids (tramadol, codeine and pentazocine). Mainly, most SCD patients use NSAIDs (搜索) and opioids."
Uche explained that most NSAIDs (搜索) act as non-selective inhibitors of cyclooxygenase-1 (COX-1 (搜索)) and cyclooxygenase-2 (COX-2 (搜索)). COX-1 produces prostaglandins that protect the stomach lining, while COX-2 is produced during injury or inflammation. Repeated use of non-selective NSAIDs can expose the stomach lining to injuries, resulting in peptic ulcers. Additionally, because prostaglandins help dilate blood vessels leading to the kidneys, frequent long-term use—especially on an empty stomach—can cause kidney injuries. Comorbidities also pose a problem: when an SCD patient with hypertension uses NSAIDs alongside antihypertensive drugs, the medications can antagonise each other, reducing the efficacy of blood pressure treatment.
The opioid addiction landscape
While NSAIDs (搜索) are regarded as manageable, the use of opioids by SCD patients has raised deeper concerns. A pharmacist identified as Chinedum recounted an encounter with an SCD patient in Port Harcourt who would fabricate stories to obtain pentazocine. "Pentazocine is an opioid, but we always refused to sell it to her without a prescription. She would become angry, aggressive, and sometimes break down in tears," Chinedum said. "Opioids are not routine medications like paracetamol; they require proper medical indication, appropriate dosing, and careful monitoring."
A source at a state-owned hospital confirmed the trend: "We have been seeing a growing rise in drug addiction and one of our findings is that these drugs—and I am referring to opioids—are readily available in pharmacies. That's why health professionals do all they can to wean patients off it once they monitor them and find out that they are having cravings for it."
The source described a particularly alarming incident: "There was an SCD patient who was always demanding morphine, and even after a dose of it was administered to him, he kept fighting with the nurse and secretly went to the fridge and drank morphine, and collapsed there in the ward."
Studies from the National Institutes of Health in the United States peg the addiction rate among SCD patients at about 10%, similar to the general chronic pain population. However, a study in North-West Nigeria found an opioid use disorder prevalence of 11.7%, and another in Uganda reported rates between 5.3% and 8.5%.
Uche elaborated on the pharmacology of pentazocine, one of the most commonly abused opioids among SCD patients: "Pentazocine binds to the kappa opioid receptors to elicit its analgesic effects. But at the same time, it also weakly binds to the mu opioid receptors to produce its therapeutic response of alleviating pain. The challenge with this opioid is its significant effect on the central nervous system. It can predispose patients who use it indiscriminately to dependence, making them develop excessive cravings for the drug, and it also triggers side effects such as euphoria, restlessness, agitation, and withdrawal symptoms."
Because pentazocine is often administered intravenously, subcutaneously, or intramuscularly, repeated injections increase the risk of injection-site infections and blood-borne infections such as HIV and hepatitis due to needle sharing.
Pseudoaddiction versus true addiction
Some experts argue that physiological dependence and tolerance to opioids are expected and necessary for managing chronic pain in SCD, and that this is distinct from psychological addiction. When patients' pain is undertreated, they may exhibit behaviours like seeking prescriptions from multiple doctors or being assertive at pharmacy counters—often labelled as drug-seeking behaviour. Some medical experts contend this is actually "pseudoaddiction," a desperate attempt to obtain adequate pain relief.
A National Institutes of Health study notes: "Because of stigma and the opioid epidemic, physicians sometimes withhold or under-prescribe necessary pain medications. This under-treatment can actively worsen a patient's health-related quality of life."
However, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), defines opioid use disorder as a problematic pattern of opioid use leading to clinically significant impairment or distress, manifested by at least two of 11 defined criteria occurring within a year—including taking opioids in larger amounts or over longer periods than intended, and spending a great deal of time obtaining, using, or recovering from opioids.
A path toward balanced care
Pharmacist and sickle-cell ambassador Perpetua Nnabuenyi emphasised that preventing drug addiction among SCD patients requires coordinated effort from both individuals and healthcare institutions. "At the individual level, patients should adhere to prescribed medications, avoid self-medication, attend regular follow-up appointments, and receive continuous education on the safe use of pain medicines. Family members and caregivers also have a role in encouraging medication adherence and recognising early signs of drug dependence," Nnabuenyi said.
At the institutional level, she called for evidence-based pain management protocols, strengthened prescription monitoring, training for healthcare professionals on responsible opioid prescribing, and integration of psychological support into sickle cell care. "Leveraging health data to monitor prescribing patterns and evaluate treatment outcomes will enable timely interventions and improve patient safety. Preventing drug addiction is a shared responsibility that protects both the health and quality of life of people living with sickle cell disease (搜索)."
Uche noted that some SCD patients seek healthier alternatives, such as Ciklavit—a multivitamin derived from the herb Cajanus cajan—and hydroxyurea, to prevent pain crises. "When these persons come to the pharmacy, they look better managed because they do not have the same problems as those who are heavily dependent on and addicted to painkillers. One thing about medicine is that it only works well at recommended doses. But when you use it indiscriminately and at doses that are not recommended, then you start having issues that may ultimately be life-threatening."
Dr. Anejodo added practical preventive measures: "This includes preventing all forms of infection, such as malaria, urinary tract infections, upper respiratory tract infections and diarrhoea. You need to stay hydrated by drinking water, avoid strenuous exercise or stress, ensure you stay or live in well-ventilated areas, and do not climb to high altitudes."
The World Health Organisation estimates that in 2021, 7.74 million people were living with SCD globally, with 515,000 new births, primarily in sub-Saharan Africa, which accounts for nearly 80% of global cases. SCD caused 81,100 deaths in children under five in 2021, making it the 12th leading cause of death in this age group. Traditional mortality recording underestimates the disease's impact—actual deaths are estimated to be 11 times higher than cause-specific statistics suggest (376,000 versus 34,400 deaths in 2021).