heroin and Ovarian-Neoplasms

Strong opioids such as morphine are rarely accessible in low- and middle-income countries, even for patients with the most severe pain. The three cases reported here from three diverse countries provide examples of the terrible and unnecessary suffering that occurs everyday when this essential, inexpensive, and safe medication is not adequately accessible by patients in pain. The reasons for this lack of accessibility are explored, and ways to resolve the problem are proposed.

Topics: Acquired Immunodeficiency Syndrome; Adult; Analgesics, Opioid; Developing Countries; Dyspnea; Fatal Outcome; Female; Health Services Accessibility; Heroin; Humans; Male; Middle Aged; Morphine; Neoplasm Metastasis; Ovarian Neoplasms; Pain; Palliative Care; Patient Rights; Prostatic Neoplasms; Suicide; Terminally Ill

We report the cases of 5 patients who developed severe local toxicity during the subcutaneous administration of morphine sulphate and hydromorphone hydrochloride. All patients required site changes more frequently than once every 24 h due to redness, swelling, or pain while receiving morphine or hydromorphone. All patients showed prolongation in the duration of sites of infusion once an equianalgesic dose of diamorphine hydrochloride (heroin) was started. No change in pain control or systemic toxicity was detected with diamorphine. These findings suggest that diamorphine could be a useful alternative for patients who develop severe toxicity to subcutaneous morphine or hydromorphone.

Topics: Adult; Aged; Colonic Neoplasms; Female; Heroin; Humans; Hydromorphone; Injections, Subcutaneous; Male; Middle Aged; Morphine; Neoplasm Metastasis; Ovarian Neoplasms; Pain, Intractable; Prostatic Neoplasms; Uterine Cervical Neoplasms