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Patients vary in opioid sensitivity

From Dr David Church, Machynlleth

Part of the answer to the variability in GP practice regarding opioid dosing (News, 5 January) is that patient sensitivity to opioids is very variable.

I have no reluctance to use morphine in palliative or terminal care, and also in acute trauma, though I will not use it in addictive disorders.

I have experience of an adult male who went fully unconscious and stopped breathing when given only 1mg of morphine, and at the other end of the scale I have given 30mg of diamorphine to a teenager with absolutely no effect (went on to use entonox).

In palliative care I have used doses from minimal to massive to achieve the same effect.

However, I must take issue with the 'expert view' that large doses of morphine (eg 60mg) should only be given 'minutes before death'.

It is cruel to deny patients effective analgesia on the basis they are not yet dead enough, and it is also inviting suspicions if a doctor regularly gives large doses when death is imminent, as this seems more like hastening death deliberately than relieving discomfort through analgesia.

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