Morphine

Q. The consultant at the pain clinic has prescribed morphine but my GP refuses to follow his recommendation. What should I do?

A. Hospital consultants do not normally prescribe drugs for outpatients except in an emergency. Your own general practitioner will have written to the consultant asking his advice within his area of expertise. The consultant can recommend a course of treatment of medication, but it is the responsibility of the general practitioner, who has known and treated his patient, possibly for many years, to decide whether the advice is appropriate. In reaching his decision, your general practitioner will have taken into account many other factors such as advice from consultants in other specialities, previous medication as well as social and family background, about which he often has most information.

Many doctors are still anxious about the long-term effects of powerful drugs such as morphine. It is only recently that it has been accepted that people suffering a certain type of pain can take morphine regularly without having such a high risk of tolerance and dependency on the drug. Tolerance means that the body gets used to the medication and requires bigger and bigger doses to produce the same effect; and this often leads to increased side-effects which, in extreme cases, can be life-threatening. Dependency means that when you have periods of improvement and wish to reduce your intake, you will feel withdrawal effects.

For these reasons it is important that the consultant, the patient and the general practitioner are in agreement before starting morphine. The first step you should take is to ask for a discussion with your general practitioner. Find out what are his reservations and request that he discusses them with the pain clinic consultant. If you finally feel that his refusal to provide the prescription is not in your best interests then you can change to another general practitioner, but bear in mind that he also may feel that long-term morphine treatment is not the best form of treatment for you.

For more information about morphine, go to http://www.painsociety.org