Buprenorphine Initiation Regimen for Pain in Two Pregnant Patients with Sickle Cell Disease

Sickle cell disease (SCD) causes significant morbidity and mortality, affecting approximately 100,000 people in the United States. Chronic pain negatively impacts quality of life and is estimated to occur in 30% to 40% of adolescents and adults with SCD. As a result, patients often rely on opioids for pain control. Management of pain and opioid use is further complicated when patients with SCD become pregnant. Patients with SCD face an increased risk of maternal and perinatal complications compared to the nonpregnant sickle cell population. In the SCD population, buprenorphine is thought to be a safer alternative than full mu opioid agonists like oxycodone. However, there is scant literature on the use of buprenorphine for pain in SCD patients who become pregnant. We present buprenorphine initiation for pain in two pregnant patients with SCD on chronic opioids. The buprenorphine transition was started by the inpatient palliative care team and continued by the outpatient palliative providers. As the patients' pregnancies progressed, we encountered challenges with continuing buprenorphine for pain in SCD. Neither patient remained on buprenorphine for the full duration of their pregnancy. We describe the challenges and lessons we learned in these cases.