TITLE:
Morphine Dosing and Drug-Related Mortality in Patients with Sickle Cell Disease: A Comprehensive Systematic Review
AUTHORS:
Ali Alalwi, Taysir Aali, Ahmad Alali, Ibrahim Al Battat, Fatimah Alsaleh, Rayhanah Alsaif, Norah Alanazi, Saba Ghaswala, Hassan Alalawi, Hosseini Zahra, Ferando Dushmanthi, Ali Abu Azran, Hussain Al Asker, Ali Al Najjad, Hassan Aabbad, Ali Alali, Hind Alhumaid, Zahra Al Musaylem, Ageel Alnasser, Wafa Almuraidi, Murtadha Al Hamdan, Abdullah Alsanawi, Ali Alibraheem, Abdullah Alshawaf, Mohammed Alalwi, Hassan Almohana
KEYWORDS:
Sickle Cell Anemia, Morphine, Opioid Mortality, Vaso-Occlusive Crisis, Pain Management
JOURNAL NAME:
Open Journal of Nursing,
Vol.15 No.8,
August
18,
2025
ABSTRACT: Background: Sickle cell anemia (SCA) patients frequently require morphine therapy for vaso-occlusive crises, yet concerns about morphine-related mortality have emerged. This systematic review examined the relationship between morphine dosing and drug-related mortality in adult SCA patients. Methods: We searched PubMed, EMBASE, Cochrane Library, and CINAHL databases in June 2025 for studies examining morphine dosing and mortality outcomes in adult SCA patients. Two reviewers independently screened articles and extracted data on morphine dosing patterns, clinical outcomes, and drug-related deaths. Results: Nine studies were included comprising: 1 randomized controlled trial, 3 longitudinal cohort studies, 2 cross-sectional studies, and 3 observational studies. Morphine equivalent doses ranged from 0.8 mg/kg/day to 2.3 mg/kg/day across institutions, representing nearly three-fold variation. Despite frequent high-dose morphine use, drug-related mortality was remarkably low (standardized mortality ratio 0.23; 95% CI 0.18 - 0.29). Respiratory depression occurred in