Duncan Barbara, Natuhwera Germanus, Nassuuna Doris, Katusabe Roselight, Kasozi Hanif, Acuda Wilson
Clinical Department, Hospice Africa Uganda, Kampala, Uganda.
Education Department, Institute of Hospice and Palliative Care in Africa, Kampala, Uganda.
J Pain Res. 2025 May 8;18:2361-2371. doi: 10.2147/JPR.S515028. eCollection 2025.
Behaviour suggestive of addiction in some patients on long-term oral liquid morphine (OLM) caused concern amongst the Hospice Africa Uganda clinical team and prompted the survey. This survey aimed to identify serious adverse drug reactions to long-term OLM in patients with chronic pain receiving palliative care.
In Phase 1, the database of patients receiving palliative care at Hospice Africa Uganda was analyzed to find patients taking OLM from 12.7.2017 to 19.10.2017. A purposive review of their medical records was undertaken to identify those on long-term OLM. Phase 2 was conducted between 12.6.2018 and 23.10.2018. All patients on long-term OLM were offered biopsychosocial and spiritual assessment by a pain specialist (BD) to determine whether they were experiencing any serious adverse drug reactions. Phase 3 immediately followed phase 2 assessment. The pain specialist discussed with the participant any medication changes (including OLM) or other therapies to facilitate holistic management of pain for the individual.
In phase 1, 653 patients on OLM were identified. Phase 2 identified 49 patients who were on long-term OLM. Thirty-four patients agreed to participate in the assessment with the pain specialist. Of the 34 participants, 24 had chronic non-cancer pain and two had chronic cancer pain. Eight cancer survivors had incidental chronic non-cancer pain. Serious adverse drug reactions were identified in four participants with chronic non-cancer pain. Two cases of addiction, one case of opioid hyperalgesia, and one probable diversion of morphine.
To our knowledge, the study identified the first documented cases of addiction to OLM in sub-Saharan Africa. Future research involving a larger multicenter sample, longitudinal, and qualitative designs is needed. Education of healthcare practitioners prescribing opioids should put equal emphasis on management of chronic non-cancer pain as do chronic cancer pain to minimize the risk of serious adverse reactions.
乌干达非洲临终关怀医院的临床团队对一些长期服用口服液体吗啡（OLM）患者出现的成瘾性相关行为表示担忧，从而开展了此次调查。该调查旨在确定接受姑息治疗的慢性疼痛患者长期服用OLM后出现的严重药物不良反应。
在第一阶段，分析乌干达非洲临终关怀医院接受姑息治疗患者的数据库，以找出2017年7月12日至2017年10月19日期间服用OLM的患者。对他们的病历进行有目的的审查，以确定那些长期服用OLM的患者。第二阶段于2018年6月12日至2018年10月23日进行。由疼痛专家（BD）对所有长期服用OLM的患者进行生物心理社会和精神评估，以确定他们是否正在经历任何严重的药物不良反应。第三阶段紧接着第二阶段评估进行。疼痛专家与参与者讨论任何药物变化（包括OLM）或其他治疗方法，以促进对个体疼痛的整体管理。
在第一阶段，确定了653名服用OLM的患者。第二阶段确定了49名长期服用OLM的患者。34名患者同意参与疼痛专家的评估。在这34名参与者中，24名患有慢性非癌性疼痛，2名患有慢性癌性疼痛。8名癌症幸存者伴有偶发性慢性非癌性疼痛。在4名患有慢性非癌性疼痛的参与者中发现了严重的药物不良反应。2例成瘾，1例阿片类药物痛觉过敏，1例可能存在吗啡转移。
据我们所知，该研究确定了撒哈拉以南非洲地区首例有记录的OLM成瘾病例。未来需要开展涉及更大规模多中心样本、纵向和定性设计的研究。开具阿片类药物的医护人员的教育应同等重视慢性非癌性疼痛和慢性癌性疼痛的管理，以尽量减少严重不良反应的风险。
