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. 2025 May 8:18:2361-2371.
doi: 10.2147/JPR.S515028. eCollection 2025.

Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care

Barbara Duncan  1 , Germanus Natuhwera  1   2 , Doris Nassuuna  3 , Roselight Katusabe  1 , Hanif Kasozi  1 , Wilson Acuda  2
Affiliations

Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care

Barbara Duncan et al. J Pain Res. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: chronic pain; opioids; oral liquid morphine; palliative care; serious adverse drug reactions.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Showing number of participants against expert recommendation on participants’ oral liquid morphine dosage (n=33).
See this image and copyright information in PMC

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