This I Believe

Alvin - Fort Worth, Texas
Entered on April 5, 2007
Age Group: 30 - 50
Themes: illness

I believe morphine is a good medicine.

I am a doctor in hospice and palliative care, I see sick and dying people. I also treat many people who are not dying but are having severe pain. I find resistance to the use of opioids, like morphine, from patients and even doctors almost daily. Last week I saw a woman in her 70’s who had severe lung disease and back pain. She told me hydrocodone helped her pain but she hated it. “Why?” I asked.

“Because it makes people crazy.”

“Does it make you crazy?” I asked.

“No it makes me feel good and helps me get through my day.”

After questioning her further she was using this medicine appropriately but felt guilty for using an opioid medicine. Weak opioids like hydrocodone and strong opioids like morphine are regulated by state and federal law and they should be because of the potential for abuse. Most states require special prescriptions to write for medicines like morphine. I know doctors that don’t own the special prescriptions and are proud of it. They tell me “My patients will not get addicted to that stuff because I won’t give it to them.” These doctors and many lay people don’t understand that addiction is using a medicine for the way it makes you feel. You have to take the drug for the feeling even though you know it is bad for you. Standing outside in the cold to smoke a cancer causing cigarette is addiction.

I believe strong opioid medications such as morphine, hydromorphone, and oxycodone are good medications when used appropriately. I believe there are some people who deserve these medications without being subjected to judgment or second guessing. These people are:

1. Cancer patients. Some cancer causes severe pain and having cancer sucks for you if you have it and for your loved ones watching you go through it.

2. AIDS patients. The HIV virus and some of the medications used to treat it can cause painful nerve damage. Like cancer AIDS sucks.

3. Veterans. Some penetrating limb and spine injuries cause chronic pain. Some of the first descriptions of chronic pain from nerve injury were made during the Civil War. If you got shot up in a war you deserve to have your pain treated appropriately.

4. Older people. I graduated from medical school in 1989. I have yet to meet or even hear of a grandma selling narcotics on the street. She may be out there but I have not met her yet and I treat a lot of grandmothers.

5. Patients with sickle cell disease. People with sickle cell disease deserve respect for living with a terribly painful congenital disease.

These are the people, in my opinion, who deserve morphine the most. I know there are many others however, if I can convince some of my doubting colleagues to treat the most deserving folks then other people with painful conditions might get their pain treated appropriately as well.