Background: Patients with sickle cell disease (SCD) experience painful vaso-occlusive episodes that increase with age; a subset develop chronic pain (CP). CP is usually managed with acute pain management guidelines despite evidence of ineffectiveness. Buprenorphine, a partial opioid agonist, a potent analgesic with less liking and has a respiratory ‘ceiling effect’. Buprenorphine therefore provides an alternative ‘harms reduction’ approach for CP management in pediatric SCD patients. Methods: This single urban center retrospective study assessed the feasibility of inpatient transition to buprenorphine-containing analgesics in adolescents with SCD and CP. Patients aged 12-20 years transitioned from FOA to buprenorphine between December 2020 and September 2022 were included. Acute care utilization, hospital length of stay, and FOA use in both inpatient and outpatient settings were compared pre- and post-buprenorphine induction for at least 6 months. Results: Fourteen adolescents with SCD underwent inpatient buprenorphine induction and maintenance therapy. Inpatient transition using a micro-induction approach was feasible and well tolerated in this population. There were low rates of adverse events such as opioid withdrawal signs. Maintenance on buprenorphine products was sustainable over the one-year post-induction period. Three patients (21.4%) discontinued buprenorphine during maintenance therapy. There was a significant reduction (p<0.05) in acute care utilization, length of stay, and FOA use (both inpatient and outpatient). Conclusion: Inpatient micro-induction to buprenorphine from FOA in adolescent SCD patients with CP is feasible with minimal signs of opioid withdrawals. This study suggests decreased acute care utilization with buprenorphine.