The article states:
Professional and public anxieties about the effects of morphine continue to hinder adequate prescribing of this vital painkiller for genuine pain relief, claims a Comment in this week's edition of The Lancet.
Nigel Sykes, of St Christopher's Hospice, London, UK, says that the notorious Dr Harold Shipman's* use of morphine as a murder weapon has further increased disquiet among UK medical professionals.It is important that we always maintain that the proper use of opioids does not cause death and should not be confused with acts of euthanasia, which do intentionally cause death. It is not necessary to legalize euthanasia but it is necessary to increase the level of training and support for good palliative care practices.
Dr Sykes claims that the best known fact about morphine among the public and physicians is that it can be addictive, when in fact less than one in 10 000 patients prescribed the drug as part of treatment becomes addicted.
He adds: "For physicians, the second best-known fact is that morphine can precipitate respiratory depression. As a consequence, if offered enough confidentiality, clinicians can be readily found who will confess to having shortened the life of their patients to achieve pain control."
The Comment goes on to say that it is hardly surprising in light of these points that the media view everyday medical practice for severe pain control as increasing the dosage of morphine until the patient dies.
Dr Sykes welcomes the recent study from the US National Hospice Outcomes Project, which studies morphine/opioid use and survival at the end of life - as it provides facts with which to explode the myths about morphine.
The study assessed 725 patients with end-stage cancer, lung disease or heart disease, and found that length of survival was not linked to either absolute or percentage change in dose of morphine or other opioids.
No combination of factors was capable of explaining a variation of more than 8% in survival time, which points to an overwhelming influence of the individual's disease severity.
Only patients who have no experience of opioid treatment are at significant risk of respiratory depression.
Dr Sykes says: "A patient with moderate-to-severe chronic pain, malignant in origin or not, who is given the incremental dose-titration practised in pain and palliative care centres is not at such risk. A physician who truly is killing his or her patient in the name of pain relief is not merciful, just incompetent."
He adds: "This problem matters because underprescribing of opioids remains a major barrier to effective pain control."
Dr Sykes also expresses his concerns for pain relief in developing countries, saying: "If ineffective pain management is still an issue in high-income countries, it is nearly universal in low-income countries where access to morphine is limited or absent, but where most people dying from cancer or AIDS reside."