Addiction and Sickle Cell Disease

WhatsApp Discussion held on 17th July 2020

Facilitator: Dr Kelechi Okeagu

Key words: People Living With Sickle Cell Disease (PLWSCD)

Introduction

Addiction and how it affects people living with sickle cell disease is an all-encompassing topic because it touches on every aspect of life of this unique group.

PLWSCD are unique, the world doesn’t seem to know very much about them, that’s the issue.

What is addiction?

Simply put, is a state of independence produced either by the habitual taking of substances or by regularly engaging in certain activities.

Important word to consider here is Independence.

Independence: is a physical and/or psychological effect produced by habitual taking of certain substances characterized by a compulsion to continue taking the substance.

Thus you can breakdown Independence to two (2) components:

1. Physical dependence: this happens when stooping a substance causes certain body problems like sweating, vomiting or tremors that are reversed when these substances are re-started.

2. Psychological dependence: is what happens when continuous use of a substance induces reliance on it for a state of feeling well and content but nobody problems like i mentioned earlier.

So looking closely it is actually possible to have a physical dependence without being addicted but addiction is usually not far off. This is really important for health care providers to understand in order not to be a source of bias or lead to poor treatment.

Addiction becomes apparent by a change in behaviour caused by biochemical changes in the brain after continued substance abuse. Substance use becomes the main priority regardless of the harm they may cause to themselves or others

Addiction makes people act irrationally when they don’t have the substance; they are addicted to in their system.

Thus Addiction = Mental+ Physical reliance on a substance with uncontrollable behaviour to obtaining and using a substance.

Now the brain is programmed in a complicated way where you have a complex mixture of substances secreted and these substances carry out their effect by binding to certain things called receptors on cell surfaces to produce their effects.

Now, some of these substances of abuse have similar chemical properties as these substances in the brain so they are also able to bind to their receptors to produce an effect.

Now imagine a situation where you have an individual who is dependent on these substances, what happens is that as the level of this substance increases in the body the brain adapts by increasing the number of receptors it has available in order to create the desired effect.

With each dose, the individual develops some form of resistance meaning they need higher doses to achieve the same effect. So the brain produces more receptors to achieve this. This brings about a cascade of events that leads to a situation if these substances are in lower levels the brain produces unpleasant effects both physical and mental, that leads to addiction.

Most abused substances by PLWSCD

  1. Codeine
  2. Pentazocine
  3. Alcohol
  4. Marijuana
  5. Cannabis
  6. Diazepam
  7. Tramadol
  8. Morphine
  9. Fentanyl
  10. Nicotine

Strong pain killers are the common culprits due to chronic pain.

Tramadol and pentazocine are less potent compared to morphine and fentanyl

Nicotine in cigarettes is also on the list though it tends to give you more of a psychological dependence

Why do PLWSCD get addicted?

So it is a mixture of physical and psychological reasons.

1. Primarily, these substances, especially the really strong opioids/ pain killers are used for pain control. The major reason for hospital admission and frequent hospital visits in PLWSCD is vaso-occlusive crisis and chronic pain syndrome

There is widespread speculation that people with SCD may become drug dependent if painful crisis is treated with strong pain killers. There is no scientific evidence to prove this. This leads to poor treatment by health personnel. Paradoxically individuals suffering from SCD who are not adequately treated may develop addiction to narcotics due to self-medication to treat pain. A lot of these drugs can be bought on the street nowadays

2. Another reason could be the social stigma attached to SCD: lots of communities alienate PLWSCD due to lack of understanding, ignorance, traditional/religious beliefs thus making them vulnerable and exposed to using these substances which give them a temporary respite but not solving the real issues. Some develop mental disorders like anxiety, depression, low self esteem, which can all contribute significantly to substance misuse.

3. Poor self-care education: when PLWSCD are not properly educated about their condition, on how to avoid stressors, importance of proper hydration and general advice on how to reduce frequent pain crisis, this increases the risk of addiction to strong pain killers

4. Genetic composition of individuals:  if a family member experiences addiction, the chances of addiction in other relatives is high

5. Environment also plays a role:  Lack of parental involvement can lead to greater risk taking or experimentation. Abuse or neglect from parents and family equals use of substances to cope with their emotions

6. Peer pressure: Pressure from friends to fit in.

7. Underlying mental health issues: this creates a vicious cycle (depression, anxiety).

8. Method of drug use: Drugs smoked or injected into the body tend to be more addictive than those swallowed

Prevention and Management

  1. A multidisciplinary approach which involves all health care workers including social workers, mental health specialist and the whole community is used.
  2. Good support groups and system.
  3. Always involve each individual in their management no matter how young you think they are. Always explain things to them in the language they will understand. You cannot succeed if you do not carry them along.
  4. Proper education of PLWSCD about self care- how to avoid emotional or environmental stressors, importance of being well hydrated, having a family physician, when to seek help) is an essential part of managing SCD. If the number of crisis is reduced, there is a good chance of reducing addiction.
  5. Effective management of pain, use other pain killers and other treatment regimen like hydroxyurea, safe blood transfusion when necessary to reduce crisis and proper management.
  6. Pain regimen should be individualized, using what is most effective for the individual.
  7. Institutional Care and Rehabilitation will be needed for management.

Addiction Is Best Prevented Over Being Managed

DO NOT DENY ANYBODY LIVING WITH SCD ADEQUATE PAIN CONTROL EVEN WITH THE USE OF OPIOIDS.

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