title: Morphine and the "lytic cocktail" for terminally ill patients in a French general hospital: evidence for an inverse relationship.
abstract: Undertreatment of cancer pain with analgesic drugs is still a frequent problem in French hospitals. In the absence of good analgesic practices, the use of a so-called lytic cocktail, which combines a neuroleptic (chlorpromazine), an opioid (meperidine), and an antihistamine (promethazine) has become common during the terminal phase of the disease. The lytic cocktail (LC) has been subsequently denounced as a type of disguised euthanasia. The aim of our study was to examine the prescription of morphine and lytic cocktail for terminally ill patients in a 427-bed French general hospital during a 3-year period (1989-1991) that coincided with the beginning of a pain relief service. The study was performed in two steps: a chart review of the 841 deceased patients during the observation period and an examination of morphine and parenteral promethazine consumption from the hospital pharmacy. Data from both the charts and the pharmacy showed an inverse relationship between these treatments. Morphine consumption increased while LC consumption decreased. The number of deceased patients who received LC were 24.4% in 1989, 19.9% in 1990, and 6.6% in 1991 (P < 0.001 between 1990 and 1991). The number of deceased who received morphine were 13.6% in 1989, 20.6% in 1990, and 23.9% in 1991 (P < 0.01 between 1989 and 1990). During the same period, the annual hospital morphine consumption increased by 191%, and the annual hospital parenteral promethazine consumption decreased by 62.5%. Our results suggest that, when pain is more correctly treated, the use of an inappropriate method of symptom control decreases.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Hautes Etudes de Management Hospitalier, Bussy St. Georges, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Meunier-Cartal
authors.forename: J C
authors.initials: JC
authors.lastname: Souberbielle
authors.forename: F
authors.initials: F
authors.lastname: Boureau
mesh_terms: D000368:Aged; D002746:Chlorpromazine / Q000627:therapeutic use*; D016638:Critical Illness; D004338:Drug Combinations; D005260:Female; D005602:France; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008614:Meperidine / Q000627:therapeutic use*; D009020:Morphine / Q000627:therapeutic use*; D010166:Palliative Care; D011398:Promethazine / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; D009020:Morphine; D008614:Meperidine; D011398:Promethazine; D002746:Chlorpromazine