Buprenorphine, a novel opioid with complex pharmacology, is effective for treating pain and is qualitatively safer than high dose full agonist opioid therapy; but transitioning to buprenorphine can be technically complex and carries some risk of precipitated withdrawal. We report our clinic's experience converting 36 patients with sickle cell disease from full agonist opioids to buprenorphine using a method developed in the past ten years. . In an appropriately interdisciplinary care setting, buprenorphine shows promise as a safe alternative to chronic opioid therapy with early evidence of benefit for high utilizing patients with SCD.