Opioid needs of patients with advanced cancer and the morphine dose-limiting law in Egypt.
BACKGROUND
Morphine is the drug of choice for moderate to severe cancer pain management. The Egyptian Narcotics Control Law limits the amount of morphine prescribed in a single prescription to a maximum of 420 mg for tablets and 60 mg for ampoules. The usual practice in Egypt is to provide that limited amount of morphine on a weekly basis. The aim of this study is to estimate the extent to which Egyptian patients may be undertreated because of this law.


METHODS
We reviewed the medical records of advanced cancer patients referred to the first palliative care unit in Egypt over a seven-month period. Cancer pain was managed following the WHO guidelines. After modifying the internal institutional policy, patients received adequate amounts of the available opioids without any violations of the law.


RESULTS
From 117 eligible advanced cancer patients, 58 (50%) patients required strong opioids, 32 (27%) required weak opioids, and 27 (23%) required no regular opioids. The mean last prescribed opioid dose for those who required strong opioids was 194 mg of oral morphine equivalent/24 h (± 180). For this group of patients, a single weekly prescription would supply enough oral morphine for only 26% of them. In the case of parenteral morphine, none of these patients would receive an adequate supply.


CONCLUSIONS
In view of the current morphine dose-limiting law and practices in Egypt, the majority of patients suffering severe cancer pain would not have access to adequate morphine doses. That dose-limiting law and other restrictive regulations represent an obstacle to cancer pain control in Egypt and should be revised urgently.
Palliative Care Medicine Unit, Kasr Al-Aini Center of Clinical Oncology and Nuclear Medicine (NEMROCK), Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt. alsirafy@gmail.com
Samy A
SA
Alsirafy
Salah M
SM
El-Mesidi
Wesam A
WA
El-Sherief
Khaled M
KM
Galal
Enas N
EN
Abou-Elela
Nahla A
NA
Aklan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D004534:Egypt; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009369:Neoplasms / Q000145:classification*; D010166:Palliative Care / Q000331:legislation & jurisprudence* / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult
D009020:Morphine