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At the heart of general practice since 1960

Opioid myths need tackling

From Dr Paula Powell, palliative care doctor, Dr Karen E Groves, medical director, Mr Steven Simpson, pharmacist, Queenscourt Hospice, Southport

We read with interest the article Black cloud over GP palliative care (News, 5 January). We too have observed the 'Shipman effect' and an increasing reluctance in some health professionals to use opioids.

We agree with Dr Irene Carey, consultant in palliative care at Guy's and St Thomas' Hospital, that thorough assessment and prescribing according to the patient's needs rarely results in problems.

To suggest, as Dr Korlipara does, that opioids are 'drugs of last resort' may result in patients being denied adequate analgesia when they most need it. Opioids are effective analgesics used in a variety of settings and, in cancer, can be started at any stage and discontinued if the cause of the pain can be removed.

The dose of opioid required to alleviate pain depends on the current doses of regular opioid being taken by the patient. Some patients may require more than 60mg of morphine to alleviate pain if their regular dose is in excess of 360mg morphine a day. An opioid naive patient, however, requires the starting dose of 5-10mg (or less if they are small and frail or a child).

Unlike the majority of medicines on the market, morphine carries with it myths and misunderstandings that are shared by patients and health professionals alike. This requires the GP to have sound pharmacological knowledge, excellent communication skills and specialist support.

Our experience over the past few years has been that, equipped with an updated knowledge of opioids, GPs are happy to prescribe confidently and do so very well.

End-of-life tools such as the Gold Standards Framework for Community Palliative Care1 and the Liverpool Care Pathway for the Dying2, as well as the support and collaboration of Specialist Palliative Care Services should help.

1 www.goldstandardsframework.nhs.uk

2 Ellershaw J & Wilkinson S (eds). Care of the Dying: A pathway to excellence. Oxford University Press, oxford 2003

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