OBJECTIVES:  To describe pain medication use among Texas Medicaid enrollees with sickle cell disease (SCD) and to determine the factors predicting opioid use. METHODS:  This was a retrospective study using Texas Medicaid claims data from 9/1/11-8/31/15. Medication use of patients who were ≤62 years, had at least 1 hydroxyurea prescription, and had at least 1 inpatient or 2 outpatient SCD diagnoses during the study period were analyzed between 6 months before and 1 year after the first prescription of hydroxyurea. Descriptive statistics and logistic/poisson regressions were conducted to determine the prevalence of pain medication use and to identify predictors of opioid use, respectively. RESULTS:  A total of