Morphine Use in Domiciliary Care under Supervision of Palliative Cancer Clinic in a Medical College: A Demographic Study

Abstract

AIMS and OBJECTIVES:

Morphine, a government controlled drug, is not readily available in India. The myths of morphine, especially respiratory distress at high doses has restricted the use to low suboptimal doses in both hospitals and in domiciliary set ups. The present study was done to determine the demographic profiles for patients treated with morphine on domiciliary care under the supervision of medical college palliative care centre.

MATERIAL and METHODS:

A prospective longitudinal study was performed among patients attending palliative clinic at tertiary care hospital. Raised intracranial tension, severe respiratory distress with history of uncontrolled COPD, bronchial asthma with severe lung impairment and renal and hepatic impairments were contraindications to morphine prescriptions.

RESULTS:

During October, 2013 to March, 2016, 523 patients were started on oral morphine after fulfilling the requirements of pain treatment protocol. In 48.2% of male patients head and neck (32.1%) and lung (27.8%) and in females patients cervical cancer(36.2%) and breast cancer at 33.2% were most common malignancies. 31.7% of patients had evidence of metastases. Palliative radiation was used in 37.3% patients. 19.3% patients had no use of opioids at the time of recruitment which meant that they were started at level WHO ladder step3 on oral morphine directly for control of severe pain. Codeine and tramadol were commonly used opioids either in single drug formulations or in combinations with NSAIDS. Commonly used NSAIDS were ibuprofen (400 -600 mg, QDS) , diclofenac (60mg, QDS) and paracetamol (500mg-1gm, QDS).  15.1% of patients had morphine threshold below 75 mg /day while 26.27% patients had dose in excess of 150 mg/day. None of the patients received dose > 300mg OME according to AQA. Adverse events were not significantly different among the 3 groups of patients.

CONCLUSION:

Morphine availability still remains a problem and training of health personals pertaining to cancer pain treatment and domiciliary morphine use should be mandatory.