Morphine kills the pain, not the patient

In today's Lancet the editors note that just over 20 years ago, John Morgan, an American pharmacologist, coined the term opiophobia to describe the analgesic-prescribing habits of physicians he had studied. The recent study from the US National Hospice Outcomes Project, which compared opioid use and survival at the end of life, is thus welcome, as it represents the largest and most sophisticated examination of the issue to date. A systematic review of previous (albeit smaller) studies, from palliative-care services in various countries, found no significant difference in survival according to either absolute morphine dose or change in morphine dose. These results are consistent with widespread clinical experience with morphine for analgesia. Only in the US does the tort system reduce physician willingness to care for patients with chronic pain.