Patients fear morphine - experts

Fears of addiction and death is keeping some terminally ill patients from seeking pain medicine such as morphine, experts reveal.

Morphine, is a tightly controlled drug that is derived from the opium.  It remains the first-line treatment for acute pain for life threatening illnesses such as cancer, heart and kidney diseases, HIV and diabetes mellitus among others.

However, experts decry that there was stigma surrounding opioids being used in palliative care.

"The moment you mention morphine, someone thinks that they are going to die.  Others think that they will take morphine and be high. However, you can start and stop it," Rose Kiwanuka, the country director at Palliative Care Association of Uganda (PCAU) told participants at a recent meeting in Kampala.

The concerns come at a time when an estimated 3.4 million Ugandans requiring palliative care services cannot access it, while many more continue to die in severe pain. Statistics by PCAU show that for instance in 2010, 80% of the 16,526 patients who died of cancer in Uganda had moderate to severe pain and 50% of the 112,065 people who died due to HIV related causes had moderate to severe pain.

Kiwanuka testified that she herself was a patient who had lived on morphine and was able to carry on with her normal busy working schedule without any problem.

"When I got sick and they told me about morphine, I said it was not yet time for it!  I was given pedithine but the pain was still there…morphine is a good pain killer," Kiwanuka disclosed

"It is about making that patient and the caretakers comfortable. And if one is to die, they die in dignity and minimal suffering, not agonizing pain," she stressed.

Dr. Jacinto Amandua, the former commissioner of clinical services, agreed: "People can go to work on morphine.  But many Ugandans associate morphine with a person's final hours of life which is not true.  It does not cause addiction. It helps maintain mobility, and quality of life."

Controversial laws

Beyond the stigma, are divisive laws. The 2004 narcotic drug statute allows appropriately trained nurses, clinical officers and medical practitioners prescribe oral morphine for pain and symptom control for patients with life threatening conditions. However palliative specialists are contesting the current law 2016 Narcotic Drug and Psychotropic Substances Control Act) as it only allows medical practitioners - and not nurses and clinical officers - to prescribe narcotic medicines.

Dr. Amandua noted that Uganda has over the years received international acclaim for these palliative care efforts.

"However, if we nurses cannot prescribe the drugs yet they are the ones who are always present in our health care system, it will have serious limitations on the provision of palliative care in Uganda," Amandua said.

He recommended that the Ministry of Internal Affairs and the Ministry of Health develop regulations to ensure the availability and accessibility of controlled medicines.

General picture

At least 203 health facilities in Uganda provide some form of palliative care, with morphine being availed free of charge. According to the World Health Organization, palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering. It includes treatment of pain and other distressing symptoms.

The cost of providing comprehensive palliative care to one patient per week is sh86, 000.

The estimate is based on Hospice Africa Uganda's assessment, which largely uses a home-based care model.

Dr. Anne Merriman, the founder of Hospice Africa Uganda said that palliative care helps both patients and family members to cope with distress associated with seeing a loved one in pain.