Tablets beneficial to cancer patients but misconceptions abound, say palliative care experts

M. Santhosh (name changed) was diagnosed with Hodgkin’s Lymphoma at the age of 18 and underwent chemotherapy.

The pain in his abdomen was so severe he wished to end his life. Unable to bear it any longer, he approached a palliative care specialist who put him on oral morphine for a year.

The pill provided him much-needed relief from pain. Today, Santhosh is cured of cancer and leads a normal life.

“Such is the power of oral morphine (tablets) when it comes to relief from pain,” says Mallika Tiruvadanan, specialist in palliative medicine, Lakshmi Pain and Palliative Care Trust.

Sadly, there is not much awareness on the benefits of oral morphine which is recommended for relief from severe pain in cancer patients and those with progressive diseases. Its use is surrounded by several misconceptions even among medical professionals, thus raising the need for creating awareness, say palliative care specialists.

Several medical professionals are cynical of oral morphine, says Republica Sridhar, family and palliative care physician and founder of RMD Pain and Palliative Care Trust.

“Many think it is only for terminal-stage patients. Some are scared it will cause side effects and end up prescribing lower doses. We need to sensitise the medical fraternity,” she says.

Oral morphine can be prescribed for cancer pain and chronic non-reacting pain as in the case of elderly patients suffering from spinal compression and fractures, she says.

One of the misconceptions surrounding the use of oral morphine relates to addiction. “Persons suffering from pain cannot get addicted to oral morphine. It gets absorbed and acts slowly and is good for severe pain. It can improve the condition of a patient and help in leading a normal life. There is no standard dose. We need to increase the dose according to the pain,” says Dr. Tiruvadanan.

Oral morphine is dispensed through the Drugs Controller only to licenced centres and quite a few pharmaceutical companies manufacture them, she says.

“The incidence of cancer is increasing but less than 2 per cent get good relief from pain. In Western countries, oral morphine is prescribed in about 60 to 70 per cent of the cases,” says Dr. Tiruvadanan.

Countries like the USA, Australia and even Bangladesh use more oral morphine than India, for relief from pain, says Kalpana Balakrishnan, head, department of anaesthesia, Cancer Institute, Adyar.

“Tamil Nadu is second in the country, next to Kerala, in the utilisation of oral morphine and so, we are not lagging. But when it comes to standards, we are far behind considering the amount of oral morphine used per person,” she says.

The need of the hour, according to Dr. Balakrishnan, is penetration of palliative care at the primary health centre-level. “Nurses are often apprehensive of administering the dosage prescribed by doctors. More awareness is needed. The tablets can cause constipation but this can be managed if patients are informed,” she says.

Dr. Sridhar says oral morphine is cheaper compared to other drugs such as Buprenorphine and Fentanyl patches. “It costs Re. 1 per 10 mg tablet. A few companies sell it at subsidised rates when we make bulk purchases,” she says.