Cross-titrating opioid agonists with buprenorphine for chronic pain in sickle cell disease.

Chronic opioid therapy for pain in sickle cell disease (SCD) carries risks of tolerance, hyperalgesia, and morbidity. Buprenorphine offers a safer alternative, yet optimal induction strategies for SCD patients dependent on full agonists remain unclear and traditionally require mild withdrawal prior to initiation. Three adult SCD patients transitioned from full opioid agonists (morphine equivalent daily dose 90-410 mg) to buprenorphine using a cross-titration strategy stratified by baseline opioid use to avoid withdrawal and maintain analgesia. These cases support an individualized buprenorphine induction approach that continues full agonists, expanding strategies to improve tolerability and transition success for adults with SCD.