Thursday, 28 February 2013

Morphine underused as analgesic because of Opium War stigma war

by Zhao Xu in Beijing
Despite its benefits as an analgesic painkiller, morphine finds few backers among doctors because of its opium war associations.
Morphine, a medicine recommended by the World Health Organization as the most effective treatment for severe and chronic pain, is still widely viewed in China as something that people should avoid at all costs, even if they are suffering miserably and have a clinically estimated life expectancy of no more than a few months.
"The key word is addiction," said oncologist and pain-control expert, Liu Duanqi.
However, this is not addiction in the common sense of the word, but one that, according to Xu Guozhu, former director of Peking University's National Institute on Drug Dependence, "dragged the Middle Kingdom to its knees more than one and a half centuries ago and has punched fear deep into the hearts of all her citizens ever since".
"Leaf through any Chinese history book and the First Opium War of 1840 marks the beginning of the country's contemporary history, the beginning of a vast nation's seemingly incessant humiliation at the hands of foreign powers and its long, tortuous and blood-stained road to revival," said Xu, referring to a conflict triggered when British merchants dumped large quantities of opium on the Chinese coast and its subsequent confiscation by concerned Chinese officials.
The war ended in a crushing defeat for the Qing court, whose drug-emaciated subjects were scoffed at by the victors as "the sick men of the East".
By all evidence, that vicious plume of smoke has long dissipated, but the specter remains. And morphine, as a close relative of opium - both are derived directly from the resin of the opium poppy, with the former being "purer and stronger", according to Xu - has endured its "fair" share of suspicion, dread, and plain disgust.
Except that it's all "pure misperception", said Xu, who has personally monitored the clinical tests of nearly 50 types of morphine-based drugs in China, both imported and locally manufactured.
"Clinical observations show that pain itself is capable of putting up the most powerful defense against any potential addiction," he said. "In other words, patients who take morphine for pain relief are much less likely to get hooked than those who do so recreationally, for fun."
One example is the US involvement in the Vietnam War between 1961 and 1973, during which morphine was given extensively to wounded US soldiers. Signs of addiction were later found not in those for whom the medicine was intended, but in their fellow soldiers who had managed to procure the drug with the objective of getting "high".
"Staying away from pain with morphine's help does not mean letting yourself come dangerously close to the claws of addition," said Xu. "The WHO has whittled down the addiction rate for patients using morphine to less than 0.06 percent - the number speaks for itself about the absurdity of rejecting the medicine."
The severity of the issue first rang alarm bells for Chinese policy makers in the early 1990s, as the country began to adopt the WHO's Three-Step Analgesic Ladder in Cancer Pain Relief, a document published in 1986 with the aim of legitimizing and thereby increasing the prescription of morphine, especially among cancer patients in the globe's less developed regions.
It's a battle both Liu and Xu have joined, as they led the charge and pushed the frontiers forward, slowly but consistently, for two decades. Ground has been taken and victories claimed. In 2011 - the latest figures available - the total medical consumption of morphine in China reached 1,100 kilograms. That's roughly 0.79 mg per person, more than six times higher than the number for 1999, and nearly 400 times that of 1980, when per capita morphine consumption in China was a mere 0.002mg.
One milestone breakthrough came in 1998, when the Health Ministry scraped the upper limit capping the total amount of morphine a cancer patient is entitled to during the entire process of treatment. Another followed two years later, when all Chinese hospitals were granted unlimited access to morphine, based on need instead of the number of beds in their wards, as was previously stipulated.
Read more: China Daily

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