Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care
Barbara Duncan,1 Germanus Natuhwera,1,2 Doris Nassuuna,3 Roselight Katusabe,1 Hanif Kasozi,1 Wilson Acuda2 1Clinical Department, Hospice Africa Uganda, Kampala, Uganda; 2Education Department, Institute of Hospice and Palliative Care in Africa, Kampala, Uganda; 3Research Department, International Res...
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Dove Medical Press
2025-05-01
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| author | Duncan B Natuhwera G Nassuuna D Katusabe R Kasozi H Acuda W |
| author_facet | Duncan B Natuhwera G Nassuuna D Katusabe R Kasozi H Acuda W |
| author_sort | Duncan B |
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| description | Barbara Duncan,1 Germanus Natuhwera,1,2 Doris Nassuuna,3 Roselight Katusabe,1 Hanif Kasozi,1 Wilson Acuda2 1Clinical Department, Hospice Africa Uganda, Kampala, Uganda; 2Education Department, Institute of Hospice and Palliative Care in Africa, Kampala, Uganda; 3Research Department, International Rescue Committee, Kampala, UgandaCorrespondence: Germanus Natuhwera, Email ngermans16@gmail.com; gnatuhwera@hospice-africa.orgBackground: Behaviour suggestive of addiction in some patients on long-term oral liquid morphine (OLM) caused concern amongst the Hospice Africa Uganda clinical team and prompted the survey. This survey aimed to identify serious adverse drug reactions to long-term OLM in patients with chronic pain receiving palliative care.Methods: In Phase 1, the database of patients receiving palliative care at Hospice Africa Uganda was analyzed to find patients taking OLM from 12.7.2017 to 19.10.2017. A purposive review of their medical records was undertaken to identify those on long-term OLM. Phase 2 was conducted between 12.6.2018 and 23.10.2018. All patients on long-term OLM were offered biopsychosocial and spiritual assessment by a pain specialist (BD) to determine whether they were experiencing any serious adverse drug reactions. Phase 3 immediately followed phase 2 assessment. The pain specialist discussed with the participant any medication changes (including OLM) or other therapies to facilitate holistic management of pain for the individual.Results: In phase 1, 653 patients on OLM were identified. Phase 2 identified 49 patients who were on long-term OLM. Thirty-four patients agreed to participate in the assessment with the pain specialist. Of the 34 participants, 24 had chronic non-cancer pain and two had chronic cancer pain. Eight cancer survivors had incidental chronic non-cancer pain. Serious adverse drug reactions were identified in four participants with chronic non-cancer pain. Two cases of addiction, one case of opioid hyperalgesia, and one probable diversion of morphine.Conclusion: To our knowledge, the study identified the first documented cases of addiction to OLM in sub-Saharan Africa. Future research involving a larger multicenter sample, longitudinal, and qualitative designs is needed. Education of healthcare practitioners prescribing opioids should put equal emphasis on management of chronic non-cancer pain as do chronic cancer pain to minimize the risk of serious adverse reactions.Keywords: chronic pain, opioids, oral liquid morphine, palliative care, serious adverse drug reactions |
| format | Article |
| id | doaj-art-973cd7497ebb4d299d0ec9cd3502ad4f |
| institution | Kabale University |
| issn | 1178-7090 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj-art-973cd7497ebb4d299d0ec9cd3502ad4f2025-08-20T03:53:11ZengDove Medical PressJournal of Pain Research1178-70902025-05-01Volume 18Issue 123612371102795Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative CareDuncan B0Natuhwera G1Nassuuna D2Katusabe R3Kasozi H4Acuda W5RetiredClinical, Education, and AdministrationResearchClinicalMonitoring and EvaluationEducationBarbara Duncan,1 Germanus Natuhwera,1,2 Doris Nassuuna,3 Roselight Katusabe,1 Hanif Kasozi,1 Wilson Acuda2 1Clinical Department, Hospice Africa Uganda, Kampala, Uganda; 2Education Department, Institute of Hospice and Palliative Care in Africa, Kampala, Uganda; 3Research Department, International Rescue Committee, Kampala, UgandaCorrespondence: Germanus Natuhwera, Email ngermans16@gmail.com; gnatuhwera@hospice-africa.orgBackground: Behaviour suggestive of addiction in some patients on long-term oral liquid morphine (OLM) caused concern amongst the Hospice Africa Uganda clinical team and prompted the survey. This survey aimed to identify serious adverse drug reactions to long-term OLM in patients with chronic pain receiving palliative care.Methods: In Phase 1, the database of patients receiving palliative care at Hospice Africa Uganda was analyzed to find patients taking OLM from 12.7.2017 to 19.10.2017. A purposive review of their medical records was undertaken to identify those on long-term OLM. Phase 2 was conducted between 12.6.2018 and 23.10.2018. All patients on long-term OLM were offered biopsychosocial and spiritual assessment by a pain specialist (BD) to determine whether they were experiencing any serious adverse drug reactions. Phase 3 immediately followed phase 2 assessment. The pain specialist discussed with the participant any medication changes (including OLM) or other therapies to facilitate holistic management of pain for the individual.Results: In phase 1, 653 patients on OLM were identified. Phase 2 identified 49 patients who were on long-term OLM. Thirty-four patients agreed to participate in the assessment with the pain specialist. Of the 34 participants, 24 had chronic non-cancer pain and two had chronic cancer pain. Eight cancer survivors had incidental chronic non-cancer pain. Serious adverse drug reactions were identified in four participants with chronic non-cancer pain. Two cases of addiction, one case of opioid hyperalgesia, and one probable diversion of morphine.Conclusion: To our knowledge, the study identified the first documented cases of addiction to OLM in sub-Saharan Africa. Future research involving a larger multicenter sample, longitudinal, and qualitative designs is needed. Education of healthcare practitioners prescribing opioids should put equal emphasis on management of chronic non-cancer pain as do chronic cancer pain to minimize the risk of serious adverse reactions.Keywords: chronic pain, opioids, oral liquid morphine, palliative care, serious adverse drug reactionshttps://www.dovepress.com/serious-adverse-drug-reactions-to-long-term-oral-liquid-morphine-in-pa-peer-reviewed-fulltext-article-JPRChronic painopioidsoral liquid morphinepalliative careserious adverse drug reactions |
| spellingShingle | Duncan B Natuhwera G Nassuuna D Katusabe R Kasozi H Acuda W Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care Journal of Pain Research Chronic pain opioids oral liquid morphine palliative care serious adverse drug reactions |
| title | Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care |
| title_full | Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care |
| title_fullStr | Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care |
| title_full_unstemmed | Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care |
| title_short | Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care |
| title_sort | serious adverse drug reactions to long term oral liquid morphine in patients with chronic pain a cross sectional survey in palliative care |
| topic | Chronic pain opioids oral liquid morphine palliative care serious adverse drug reactions |
| url | https://www.dovepress.com/serious-adverse-drug-reactions-to-long-term-oral-liquid-morphine-in-pa-peer-reviewed-fulltext-article-JPR |
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