Prevalence of Substance Use Disorders in Sickle Cell Disease Compared to Other Chronic Conditions: a Population-Based Study of Black American Adults

Abstract

BACKGROUND: Sickle cell disease (SCD) is a heritable chronic health condition characterized by pain symptoms throughout the life course that are routinely treated with opioids. OBJECTIVE: This study examined differences in substance use disorders in Black American adults with SCD compared to those with other chronic conditions or with no chronic conditions. DESIGN: Data from a population-representative sample of Black Americans with SCD, other chronic conditions, and no chronic conditions were obtained from the National Survey of American Life (NSAL) database. Diagnosis of substance use disorder was determined by structured clinical interview. Hierarchical models controlling for covariates (demographics, socioeconomic status, self-rated health, and mood disorders) compared odds of diagnosis between the three groups. PARTICIPANTS: The sample included 4238 African-American and Black Caribbean participants from the NSAL study who were 18 years of age or older. MAIN MEASURES: Measures included age, sex, income, education, marital status, employment, possession of health insurance, health conditions, and substance use disorders diagnosed by structured clinical interview. KEY RESULTS: Controlling for age, sex, and socioeconomic status, there were no differences in odds of a drug use disorder when comparing individuals with SCD to Black adults with other chronic conditions (OR = 1.12; p = 0.804) or no chronic condition (OR = 2.09; p = 0.102). SCD was, however, associated with greater odds of alcohol use disorders when compared to the groups with other chronic conditions (OR = 2.15; p = 0.01) and no chronic conditions (OR = 5.11; p < 0.001). This effect was not better accounted for by socioeconomic status, marital status, self-rated physical health, or the presence of a mood disorder. CONCLUSIONS: SCD was not a risk factor for drug use disorders. Further data will be needed to understand the factors contributing to increased risk of alcohol use disorders in SCD and the role uncontrolled pain symptoms may have in driving substance use.

Opioid Use Among Children and Adults With Sickle Cell Disease in North Carolina Medicaid Enrollees in the Era of Opioid Harm Reduction

“…Patients diagnosed with SCD experience structural racism within health care, including racial biases and stigmatization by health care providers 24 . People with SCD seeking management of pain, are often stigmatized as “drug seekers.” 24–29 However, our study found that a high proportion of enrollees in both cohorts had no opioid prescription claims during the observation period. Prior reports based on multistate claims of opioid prescription fills for people diagnosed with SCD from 2009 to 2014 found that 55% of commercially insured and 67% of Medicaid enrollees had opioid fills 4 .…”

Predictive Factors for 30-Day Readmission and Increased Healthcare Utilization in Sickle Cell Disease Patients: A Single-Center Comparative Retrospective Study

“…Literature suggested a potential association between substance use disorder and SCD, particularly alcohol and cocaine, as well as marijuana. 23 , 24 …”

Psychiatric comorbidities in adults with sickle cell disease: A narrative review

“…168 In the above described National Survey of American Life structured clinical interview study of substance use disorders, a higher prevalence of alcohol-related disorders was observed among individuals with SCD when compared with other chronic conditions, and a general population; an almost two times greater odds of alcohol-related disorders among individuals with SCD compared to other chronic conditions; and almost four times greater odd compared to those with no medical diagnoses. 155 In a large claims database study comparing over 10 000 patients with SCD with the general African American population, SCD was associated with a 4 and 2.5 times higher risk of alcohol use disorder diagnoses in women and men respectively. 169 In PiSCES, participants completed PHQ screening, including five questions about alcohol.…”

“…However, available research does not suggest that patients with SCD have greater prevalence of non‐alcohol substance use disorders. In a structured clinical interview study based on the National Survey of American Life, participants with SCD did not have a greater prevalence of non‐alcohol substance use disorders compared with other participants, both healthy participants and those with other chronic medical conditions, after controlling for sociodemographic factors 155 . An observational study of 258 patients with SCD aged 15 and older gathered self‐report history of illicit substance use including heroin, cocaine, amphetamines and cannabis.…”

“…Alcohol use disorders are more common in patients with chronic pain, and universal screening for alcohol use is indicated 168 . In the above described National Survey of American Life structured clinical interview study of substance use disorders, a higher prevalence of alcohol‐related disorders was observed among individuals with SCD when compared with other chronic conditions, and a general population; an almost two times greater odds of alcohol‐related disorders among individuals with SCD compared to other chronic conditions; and almost four times greater odd compared to those with no medical diagnoses 155 …”