The use of sustained-release morphine in a hospice setting.

Thirty-seven patients with advanced cancer requiring oral administration of strong narcotics for pain control have been treated with one or other of two commercially-available, sustained-release morphine preparations. Patients were followed up primarily at home, supervised by a local hospice care team, and received daily dosage ranging from 60 mg to 420 mg morphine administered as 30 mg sustained-release tablets delivered at intervals from 6 to 10 hours for 'Roxanol SR' and from 8 to 14 hours for 'MS Contin'. Duration of treatment ranged from 2 to 80 days, and 17 of 19 patients who received sustained-release morphine for 20 or more days achieved a stable dosage schedule. Thirty-five of the 37 patients obtained good to excellent analgesia and only 2 of them required intermittent 'rescue' doses of standard morphine between doses of the sustained-release preparation. From experience with the use of the two preparations it was considered that 'MS Contin' was preferable because of the smaller size of the tablets and because of the longer duration of analgesia provided. It is concluded that sustained-release morphine preparations offer a safe and efficacious alternative to immediate-release analgesics and can help to improve the quality of life for the patient and care-givers.