Dr. Regina McQuillan:

The administration of strong opioids is very widespread because very often we are treating people with difficult pain. We use morphine and other drugs of the same family for pain, breathlessness and coughs. Those are the reasons. We do not use morphine for sedation. It is not a good drug for sedation. When I say that there have been some advances over my years of working hard in medicine, some of that has got to do with a better understanding of other drugs in the morphine class, which are better than morphine. For instance, oxycodone is probably better. It is twice as strong as morphine but better in some patients. There are also drugs like hydromorphone, which is a very old drug, that is better for people with renal failure. There is a better understanding of some of these drugs.

Some of the people who we will walk by on the street when we go back to our cars this evening are on morphine. People who are on morphine, in receipt of palliative care, go to work, mind the children and do all their usual things. Morphine is a good drug in cancer pain but the benefit is not as clear in chronic, benign pain. There is a major problem with how to manage chronic benign pain – "benign" meaning non-cancer pain. That is a major problem worldwide. Morphine is used a lot in palliative care but it is not the only opioid. Very often I am involved in reducing people's doses of opioids as they get sicker because if their kidneys or liver are failing we find that they need less drug rather than more. What we are trying to do is see if people are less well what type of morphine side effects they are having and if we need to reduce the dose of morphine or switch to another drug in the same family.