Fear of getting hooked, lack of awareness drive away cancer patients from morphine

KOCHI: Though morphine’s power to suppress excruciating pain has made it a vital cog in the treatment of cancer,  access  to the drug and its use have been greatly hampered by the lack of basic knowledge in pain management, training and awareness among medical professionals coupled with the patients’ fear of getting hooked on to it.

Curiously, while regulations keep morphine away from the reach of  palliative patients who are not averse to using the drug, the more fortunate ones among them having access to morphine are hesitant to use it, say oncologists.

As per the surveys conducted in 2015, use of morphine among those suffering from cancer  in Kerala is a mere 1.56mg/capita which is pretty low considering the high rate of cancer incidence.
 With over 35,000 new cases being detected every year and 80 per cent of patients with advanced cancer likely to experience numbing pain, it is imperative the patients have better access to palliative care.

“It is unfortunate patients suffering from searing pain have to travel long distances to get relief. Very few patients have this sort of access. There are also several misconceptions about morphine which prevent those who do have access to the drug keeping off it due to fear of addiction. What they do not realise is every doctor who prescribes pain medication has undergone special training to evaluate their pain and prescribe medicines accordingly,” said Dr Prashanth C V, Palliative Care, Regional Cancer Centre, Thiruvananthapuram.

“Morphine is an opioid (pain reliever) which, if not used as per the doctor’s prescription, can lead to addiction, especially in ampoules. However, when used orally as tablets or syrup, the chance of addiction is low since morphine level in the blood stream rises only slowly. 

“Hence, it does not give ‘a kick’. Even when used as an injection, if the right amount of medicine is used  the chances of addiction are remote,” said Dr M R Rajagopal, Director, Trivandrum Institute of Palliative Sciences (WHO Collaborating Centre for Training and Policy on Access to Pain Relief).
“Two generations of doctors hadn’t even seen oral morphine. Neither did they receive training in this regard nor know how to administer a safe dosage. There is  widespread fear of the unknown among both doctors and patients. The only solution is to provide more education to medical graduates on this front,” said Rajagopal.

Access to morphine  was regulated by law in 1985 following its classification as  an opioid, narcotic drug. In 1998, Kerala was allowed to dispense oral morphine to give cancer patients a pain-free life and, in 2014, the law was further relaxed making the drug more accessible to patients.
To ensure there is no misuse of morphine, physicians require special authority or licence to prescribe opioids and the prescription has a 30-day limit. As of 2015, there were only 167 institutional providers of oral morphine,  which is still lower than the estimated needs of the population.