Relationship between Non-Prescribed Drug Use and Employment Status of Patients with Sickle Cell Disease

Introduction: Patients with sickle cell disease (SCD) suffer from recurrent episodes of acute vaso-occlusive crises that cause acute musculoskeletal pain and chronic pain due to complications such as avascular necrosis of the joints or bone infarcts. Most of these patients are on chronic opioid medications to manage their acute and chronic pain. Generally, patients with chronic pain syndrome are more prone to use illicit drugs more than the general population. In addition, patients with SCD have high rates of unemployment, which may put certain individuals at risk for negative coping behaviors such as illicit drug use. This study aim at investigating the relationship between the use of non-prescribed drug (illicit drug) and employment status of patients with SCD.

Patients and Methods: This was a pilot study of SCD patients at UT Physicians Comprehensive Sickle Cell Center from January 2012 to July 2018. We administered surveys during routine clinic visits and we reviewed clinical data in the electronic medical records. We used results of comprehensive urine drug screen (UDS) to evaluate for the use of non-prescribed drugs. UDS was done, on average every 3 to 6 months, on each patient. Descriptive analysis was performed with frequency distributions. Univariate logistic regression was conducted to investigate the association between non-prescribed drug use and employment status.

Results: A cohort of 78 SCD patients completed surveys about employment and non-prescribed drug use. In the survey, only ten patients (12.82%) reported using at least one non-prescribed drug. However, after the chart review for urine drug screens, twenty one out of seventy eight (26.92%) were using non-prescribed drugs. Most of the SCD patients using non-prescribed drug (71%) used Marijuana and three patients used multiple non-prescribed drugs. Seven out of twenty one (33.33%) of the non-prescribed drug users and 18 out of 57 (31.58%) of the non-drug users are employed. The univariate logistic regression analysis showed non-prescribed drug use is not statistically associated with employment status among SCD patients (P-value=0.8829).

Conclusions: In this sample, we concluded that there was no obvious relationship between non-prescribed drug use and employment status of patients with SCD. In our cohort, marijuana was the most commonly used non-prescribed drug, which might be partly due to its effect on chronic pain management. Non-prescribed drug use was quite common (26.92%), but was under-reported (13%) among users. It is important to note that only 3 out of 78 patients (3.85%) used multiple non-prescribed drugs; hence, polysubstance abuse was rare in our sample.