Do Doctors Understand That Morphine Kills Pain, Not Patients?

Main Category: Pain / Anesthetics
Also Included In: Palliative Care / Hospice Care
Article Date: 10 Mar 2007 - 0:00 PST

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Medical practitioners are ignorant of the facts and must stop reinforcing the public's perception that morphine hastens death in sick patients or alters their survival, finds new research published today. Two papers in the peer reviewed journal Palliative Medicine, published by SAGE Publications address and correct this common and misleading misconception, often picked up by the media, that morphine is a lethal drug and a common cause of death when used to control symptoms in the dying.

The papers are supported by leading palliative care consultants across the UK who have signed a letter condemning the outdated perceptions of medical practice which do not reflect the reality of modern clinical work.

Professor Bassam Estfan and colleagues from The Taussig Cancer Center demonstrate that morphine, a type of opioid, when prescribed properly in patients suffering with pain, does not cause respiratory depression, the mechanism by which lethal opioid overdose kills.

They studied a series of 30 patients admitted to a specialist palliative care in-patient unit with severe cancer pain, who were each treated with morphine. Breathing was monitored and there were no significant changes before and after the pain was controlled.

Dr Rob George from University College London and Dr Claud Regnard from the St Oswald's Hospice are both consultants in palliative medicine and comment on this paper, highlighting the erroneous linkage between morphine and the so-called Double Effect where the risk of a potential, unintended consequence of treatment is justified if the purpose and intention of that treatment is to benefit the patient.

"Unlike many other drugs, morphine has a very wide safety margin," says Dr George. "Evidence over the last 20 years has repeatedly shown that, used correctly, morphine is well tolerated, does not cloud the mind, does not shorten life, and its sedating effects wear off quickly. This is obviously good for patients in pain, but not for those who want to be put into a coma".

Drs George and Regnard consider possible explanations for this persisting fallacy in the medical and public mind and some motives that may underlie them. Doctors in palliative care are never faced with the dilemma of controlling severe pain at the risk of killing the patient. They manage pain with drugs and doses adjusted to individual patients so that they can be comfortable and able to live with dignity until they die. A competent clinician will use proportionately small, repeated doses matched to the individual, usually with other pain relievers and non-pharmacological treatments or care, and always with the aim of achieving relief without harm.

"A single large dose, especially intravenously, with no attempt to minimise serious adverse effects, suggest either negligence or malice," comments Dr George. "There is a history here. Since early animal studies, a basic physiological truth taught to medical students is that morphine depresses respiration. It seems to stay with them for life. For morphine-naïve, human subjects this is also true Shipman showed that."

"There is no evidence to suggest that morphine is a killer," Dr George continues. "It could be perceived that not to give it is an act of brutality. Those of us in palliative care can be confident that what we do is to care as people die, not to use death as a form of care. We urge those in the medical community to understand and appreciate the facts and truths about morphine and other opioids it's time to set the record straight."

SAGE PUBLICATIONS
http://www.sagepub.com/