Case Report: Successful Management of Opioid Abuse and Addiction in a Known SCD Patient at the University of Calabar Teaching Hospital, Calabar, Nigeria

Abstract

Background: Opioids are a group of potent analgesic with mixed receptor activities. Pain related symptom accounts for the main reason for substance dependence among sickle cell disease (SCD) patients. Aims: The report aims to elucidate the adverse effects of opioid and its complication (abuse, dependency and addiction) and provides a management strategy for health practitioners to curtail the dependency of SCD patients to opioid use. Presentation of Case: The patient was a 27 years old lady that was diagnosed with sickle cell disease at the age of two. She presented with a two years history of oral self-medication of DF118 and Tramadol. She became dependent on the opioid on the account of sickle cell bone pain crises affecting both her upper and lower limbs with a pain score of 9/10. Other anagelsic like Diclofenac and Pentazocin couldn't ameliorate her excruciating pain but the administration of 60 mg of oral DF118 provided her with quick relieve. The sedative effect of Tramadol and DF118 allows her to sleep comfortably and hence the beginning of her dependency. On review, patient's system was essentially intact and she was further referred for psychiatrist evaluation and possible rehabilitation. Discussion: Recurrent bone pain crisis represent the most common reason patient with SCD seek acute medical care. Due to the quick analgesic relief and euphoric effect derive from both medication, patients feign pain after the genuine pain had subsided in other to continue getting the prescription. The immediate pain assessment and frequent reassessment at 15 min, 30 min, 1 hour then 2 hours with appropriate application of medication until pain relief is very important to prevent drug abuse. Conclusion: Less addictive analgesic should be considered first after observing the nature of the pain before moving to stronger analgesic that has a high potential for abuse and when stronger analgesic is to be used it should be for a short duration.