While full agonist opioids are first-line treatment for severe, acute pain, there is little evidence to suggest that escalating doses of full agonist opioids provide benefit for chronic pain.1 Buprenorphine, a partial mu opioid receptor agonist and kappa receptor antagonist, is increasingly used to treat chronic pain in sickle cell disease and previous research suggests safety, feasibility, and reduced acute care utilization.2,3 Yet, optimal timing and approach for transitioning patients with sickle cell disease from full agonist opioids to buprenorphine is unknown. Here, OPRM1 is linked to sickle cell disease.