OBJECTIVES: Many questions surround opioid use for non-cancer pain, but little has been published about behavioral patterns of taking opioids in these conditions. The objective of this abstract is to report partial results: patterns of opioid use, and effects of biopsychosocial-spiritual determinants on opioid-taking behaviors.  METHODS: As part of a multiphase, mixed-method study, we conducted wide-ranging quantitative and semi-structured, qualitative interviews of African-American adults with sickle cell disease (SCD). The final sample consisted of 11 men and 10 women, average age 36 years, from various socioeconomic and educational levels. We used a grounded theory approach to analyze the data. RESULTS: Qualitative thematic analysis revealed three phenomena 1) SCD patients exhibited various opioid-taking behavior patterns including adherence, overuse, underuse, and erratic use; 2) A wide variety of biopsychosocial-spiritual factors hindered or motivated opioid use: pain intensity; side effects; fear of addiction; perceived stigma or judgment by others; senses of responsibility, productivity, hopelessness, or obligation; stress; social role pressure; social desirability; bullying; and anticipatory fear of adverse outcomes; and 3) Behaviors varied based on the time of day, week, month, or year, and based on context at times of doses.  CONCLUSIONS: In summary, we found that contextual factors may drastically affect opioid-taking behaviors. Together, These uncovered phenomena raise new hypotheses that may challenge current theories and models of medication-taking behaviors and methods of assessing adherence. These hypotheses call for a new round of research on opioid-taking behavior, and need to be rigorously tested in future research.