Tuesday, December 1, 2009

Morphine and Cancer Growth - Explained

Structural formula of morphineImage via Wikipedia
Eric Widera at at GeriPal wrote up a great rebuttal to the mini-news hype about some bench research about opioids influencing cancer growth.

The headlines all blared hyperbolic and false oversimplifications of the impact of the research.  Now I am no opioid apologist, but I do have to recognize that I spend a great deal of my education to patients, families, staff, and other doctors de-stigmatizing opioids so they may be used effectively for good pain control while balancing their manageable risks. So while I nearly always am defending appropriate opioid prescribing, I also want to recognize if there is potential harm in its use.

Eric's post is mandatory reading for any hospice or palliative care staff so we can be well informed to refute any claims that morphine will kill people by accelerating cancer growth.  If a family member or patient asks about this and a staff response is just "No it doesn't," we lose a chance for trust building.  If we are able to intelligently respond while respecting the fact the family 'read/saw it in the news' we are much more likely to be respected in return for our knowledge about the most recent information about our field.

In the future with actual in vivo research we may find this to be the case, but this link has not been proven yet and should not affect current standards of care.  Many things have been hypothesized in vitro without ever manifesting the same effect in vivo. 

Please go read the post and email it to your teams.  If anyone has an experience of talking to families/patients about this please feel free to share lessons learned in the comments(while avoiding HIPAA/privacy issues)

(A side note: Issues like this is why I love blogging.  The easy open access sharing of information in a rapid manner that could not be done in a journal, or would be non-archivable like an email, the chance for more open discussion about a potential controversial subject.  Information is power and that power is amplified by sharing and discussing.)
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