I remember first hearing the term "frequent flyer" when I was a junior doctor working in the emergency department.
It was used to describe patients who kept coming back to A&E (Accident & Emergency) again and again with the same problems.
The phrase was usually said with frustration. Sometimes with judgement.
The underlying message was clear: this person keeps coming here when they probably don’t need to.
But I remember thinking:
Why would anyone choose this?
I'd experienced A&E from both sides. I'd worked there as a doctor, and I'd been there as a patient.
I hated both.
The bright lights. The long waits. The noise. The lack of privacy. The feeling of being watched, judged, questioned, and not always believed.
So whenever I heard someone described as a "frequent flyer", I wondered whether we were missing something.
Because if someone keeps coming back to emergency care again and again, maybe the problem is not that they enjoy coming.
Maybe the problem is that we've not understood why they keep needing to return.
And this a systemic pitfall that many sickle patients can find themselves falling into.
I call it the opioid withdrawal crisis cycle.
It can happen after someone is admitted to hospital with a severe sickle cell crisis and needs strong opioid pain relief.
In hospital, this might include morphine, oxycodone, hydromorphone or another strong opioid medication.
If someone has been taking strong opioids for more than a short period, their body can get used to having that medication in the system. Then, if they are discharged home with zero opioid pain medication, the body can go into withdrawal.
Withdrawal can range from mild discomfort to a hellish experience including:
And most importantly increased pain and a huge stress response in the body.
For someone living with sickle cell, that stress can become a problem. It can ignite inflammation and burn vital energy supplies needed to recover.
And in some unfortunate people, it may even contribute to another pain crisis or make the pain feel like its returned with full force.
So to be clear the cycle can look like this:
This is why discharge planning is part of pain management.
The goal is not just to get through the hospital admission. The goal is to get safely back to your normal baseline afterwards.
Whatever dose of opioid was keeping your pain under control in hospital at the time of discharge shouldn't be suddenly stopped.
You should be given a plan to reduce the dose step by step as your crisis settles.
Ask your doctor for a short supply of an equivalent strength oral opioid to take home - so you can reduce the dose safely and stay home.
This is an essential part of successful acute sickle crises treatment. And when this is missed because everyone is focused on the opioid epidemic, the system continues to fail sickle cell patients.
Don't let yourself fall into the opioid withdrawal crisis cycle.
Stay Healthy,
Lewis
