Open Access

Opioid dependence among people with haemophilia in a low-resource tropical setting: prevalence and risk factors in northern Nigeria

Sagir G. Ahmed
Sagir G. Ahmed
, 
Umma A. Ibrahim
Umma A. Ibrahim
 and 
Modu B. Kagu
Modu B. Kagu
   | Jun 18, 2019
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Published Online: Jun 18, 2019
Page range: 19 - 28
DOI: https://doi.org/10.17225/jhp00132
Keywords
© 2019 Sagir G. Ahmed, Umma A. Ibrahim, Modu B. Kagu published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Image: Treatment for people with haemophilia (PWH) in Nigeria is limited, with no prophylactic regimen and limited access to factor VIII. Childhood mortality is high and effective pain relief is an issue. In this context, factors including severe haemophilia, blood group, haemoglobin phenotype, chronic arthropathy and survival into adulthood – and the interplay between them – leave some Nigerian PWH at risk of opioid dependence.© Shutterstock
Image: Treatment for people with haemophilia (PWH) in Nigeria is limited, with no prophylactic regimen and limited access to factor VIII. Childhood mortality is high and effective pain relief is an issue. In this context, factors including severe haemophilia, blood group, haemoglobin phenotype, chronic arthropathy and survival into adulthood – and the interplay between them – leave some Nigerian PWH at risk of opioid dependence.© Shutterstock

Image: In the Nigerian context, severe, recurrent and acute pain caused by haemophilia can sometimes only be treated by opioid-based drugs. While opioids are a ‘prescription only’ medication, they can also be acquired through illegal street outlets, making it difficult to determine the dosage of opioids used by individual patients.© Shutterstock
Image: In the Nigerian context, severe, recurrent and acute pain caused by haemophilia can sometimes only be treated by opioid-based drugs. While opioids are a ‘prescription only’ medication, they can also be acquired through illegal street outlets, making it difficult to determine the dosage of opioids used by individual patients.© Shutterstock

Image: ABO blood type and haemoglobin phenotype are indirect risk factors for opioid dependence among PWH in Nigeria. In the absence of prophylaxis, those with blood group O are more likely to be predisposed to musculoskeletal bleeding and, therefore, pain. For those with sickle cell trait or HbAS phenotype, the sickling-associated hypercoagulability that can cause thrombo-embolism in non-haemophilic individuals may reduce spontaneous bleeding in PWH.© Shutterstock
Image: ABO blood type and haemoglobin phenotype are indirect risk factors for opioid dependence among PWH in Nigeria. In the absence of prophylaxis, those with blood group O are more likely to be predisposed to musculoskeletal bleeding and, therefore, pain. For those with sickle cell trait or HbAS phenotype, the sickling-associated hypercoagulability that can cause thrombo-embolism in non-haemophilic individuals may reduce spontaneous bleeding in PWH.© Shutterstock

Frequency of putative risk factors and associated relative risks (RR) for opioid dependence among a cohort of 88 PWH with and without opioid dependence

RISKFACTORSHAEMOPHILIASEVERITYABO BLOODGROUPHAEMOGLOBINPHENOTYPECHRONICARTHROPATHY (ONEOR MORE JOINTS)AGE
SevereMild ormoderateONon-OHbAAHbASPresentAbsentAdultsChildren
Patients withdependence[n=15] no. (%)13(86.7)2(13.3)12(80)3(20)13(86.7)2(13.3)13(86.7)2(13.3)11(73.3)4(26.7)
Patientswithoutdependence[n=73] no. (%)36(49.3)37(50.7)36(49.3)37(50.7)40(54.8)33(45.2)16(21.9)57(78.1)9(12.3)64(87.7)
Relative riskRR=5.2 [C.I.95%: 1.2–21.6], p=0.02RR=3.3 [C.I.95%: 1.0–10.9], p=0.04RR=4.3 [C.I.95%: 1.0–17.9], p=0.04RR=13.2 [C.I.95%: 3.2–54.8], p=0.0004RR=9.5 [C.I.95%: 3.3–26.2], p=0.0001

Arnold-Hilgartner staging classification of haemophilic arthropathy

STAGEFEATURES
0Normal joint
INo skeletal abnormalities, soft tissue swelling present
IIOsteoporosis and overgrowth of epiphysis, no cysts, no narrowing of cartilage space
IIIEarly subchondral bone cysts, squaring of patella, widened notch of distal femur or humerus, preservation of cartilage space
IVFindings of stage III, but more advanced, narrowed cartilage space
VFibrous joint contracture, loss of joint cartilage space, extensive enlargement of epiphysis, substantial disorganisation of joint

Pattern and frequency of chronic arthropathy among a cohort of 88 PWH with and without opioid dependence

PATTERN OF JOINTS AFFECTEDPATIENTS WITH OPIOID DEPENDENCE (N=15)PATIENTS WITHOUT OPIOID DEPENDENCE (N=73)P-VALUES
Patients with arthropathy in one or more joints: no. (%)13 (86.7)23 (26.1)0.006 (significant)
Patients with more than one joint affection: no. (%)8 (61.5)3 (13.0)0.004 (significant)
Patients with advanced arthropathy

Stages IV and V in Arnold-Hilgartner staging classification of haemophilic arthropathy

: no. (%) Patients with knee joint affectation: no. (%)		9 (69.2) 7 (53.8)6 (26.1) 12 (52.2)0.005 (significant) 0.07 (insignificant)
Patients with ankle joint affectation: no. (%)4 (30.8)7 (30.4)0.08 (insignificant)
Patients with elbow joint affectation: no. (%)2 (15.4)4 (17.4)0.06 (insignificant)
eISSN:
2055-3390
Language:
English
Publication timeframe:
Volume Open
Journal Subjects:
Medicine, Basic Medical Science, other, Clinical Medicine, Pharmacy, Pharmacology
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