Please note that names have been changed for confidentiality reasons.
I am a retired Registered Nurse (R.N. hereafter) of 22 years. For this entry I shall be giving real examples and my personal opinions on pain relief for terminal patients only.
My first complaint re. analgesia came very early on in my career. I was working with a senior R.N…..lets call her Sister Cullen….and we were looking after a patient called Mr. Smith. He had days to live. He was in agony and his family were deeply distressed. The Doctor had written him up for a dose of Morphine that could range from 1mg to 10mg. 1mg of Morphine wouldn’t touch a mouse.
Sister Cullen decided to give Mr. Smith 2mg of Morphine. I voiced my professional displeasure. “He might get addicted,” was her excuse. I’m normally calm but I blew a fuse. “Addicted? He’ll be dead in 3 days…..in agony going the way you’re talking!” 2mg of Morphine was given with nil effect. Sister Cullen didn’t go near the room again. She made me face the distraught family. I swore to take the initiative next time & told the family.
30 minutes before his next dose was due, I called the specialist and asked him to review Mr. Smiths analgesia. 15 minutes later the Doctor arrived and was furious with Sister Cullen. He saw the condition of Mr. Smith and his family and wrote him up for a whopping dose of 25mg of Morphine. He also wrote a scathing report in his notes.
When Sister Cullen and I collect Mr. Smiths drug chart for his next dose, she tried to chastise me.I winked at the family on the way out of the ward. I then showed her the scathing report that the Doctor had written about her pain management perspective. She couldn’t say a work as we drew up the massive dose.
I administered the dose IV as ordered. On assessing Mr. Smith 30 minutes later his observations were fine. He was pain free, lucid and even joking with his family who thanked me. I told them that I was only doing my job. Mr Smith died in his sleep 4 days later. Addicted? Not enough time and besides, who cares? His family had the peace of mind knowing that he was pain free, had time to share memories and say his goodbyes.
I was a 20 years old.
Then there’s Pethedine. It’s a narcotic akin to Morphine but less effective. So why are they still giving it? Easy. Drug companies. I will reserve my views & knowledge about how drug companies work for another entry. They are too complex to extrapolate here.
Pethedine can be given into the muscle or the vein. Into the muscle takes it longer to work with less effectiveness. Into the vein gives a quicker, more effective result. It is always written up by Doctors to be given 4 hourly as required. I’m confused and annoyed. Any Pharmacology book will tell you that its effect is only 2-4 hours. What if your unlucky & only get 2 hours of pain relief? It is also notorious for causing vomiting, requiring a drug called Maxolon be given to relieve the nausea. Oh, goody! A few bonus dollars for the drug companies. Let me re-phrase that. A LOT of bonus dollars for them. We’re talking about a trillion dollar industry here.
My other complaints also relate to analgesia for terminally ill patients. Heroin. The best general analgesic known to man. Why is this drug not available in the hospital setting for Mrs. Huggit who is writhing constantly in agony from ovarian cancer that will kill her in a week As sh is pumped full of massive amounts of Morphine with nil effect, the cancer continues to grow and move under her skin. I’ve seen it happen and am sickened.
Why not give Mrs. Huggit heroin? it may make her groggy but would YOU want to see a close one with moving skin from cancer in intractable pain? It’s not much of a question for anybody with a heart.
Then there’s the outrageous debate about the possible legalisation of medicinal cannabis. I don’t smoke the stuff recreationaly & am undecided on legalising its recreational use. For medicinal use, however, I find it a crime in itself that the drug remains illegal for medical use.
Cannabis has been repeatedly been proven to be an excellent pain killer for terminal patients. 3 independent U.K. surveys have discovered that cannabis is actually a better pain killer specifically for bone cancer than heroin.
As well as it’s pain relieving qualities, cannabis is an excellent appetite stimulant; a major factor in cancer treatment.
Cannabis has now been proven to kill cancer cells. This has been proven in independent surveys globally. If you click the prior link, strong evidence is provided that an element in cannabis called THC actually kills cancer cells.
So why is medicinal cannabis being treated like a narcotic or written off as nonsense?
Drug companies haven’t found a way of making more money from cannabis than they are currently making from their largely unsuccessful (& expensive) contemporary treatments.