Dr. Elizabeth Latimer recalls with anger the case of a 72-year-old woman admitted to Henderson Hospital in Hamilton, Ont., two years ago with terminal bowel cancer. The patient had endured severe pain for four months because her doctor decided that four daily doses of a mild
pain-killer was an appropriate remedy. Latimer promptly relieved the woman’s pain with 10 mg of liquid morphine. Said Latimer: “When I went to see her the next day she was comfortable, and she started to cry as we were talking. She said, ‘If the pain was so easy to relieve, why did I have to have
it for so long?’ ” Her case is not unique. Indeed, Dr. Lawrence Librach, a Toronto specialist in care for the terminally ill, says that thousands of Canadians suffering from cancer do not receive adequate pain relief.
The two physicians use the resources of the Toronto-based Palliative Care Foundation, a charitable organization formed five years ago to ease the suffering of terminally ill patients across the country. And with the support of the 7,875-member College of Family Physicians of Canada and the Canadian Cancer Society, the foundation has begun a campaign to educate doctors—and the public— about pain control. For one thing, foundation members argue that medical students receive fragmented training in pain-relief techniques. Noted foundation president Dr. Dorothy Ley: “Medical students get teaching in bits and pieces. And until the past decade there has been no thrust to teach the management of pain as a separate discipline.” And Librach says many of his colleagues remain ill-informed about the proper use of such powerful drugs as morphine and heroin. (Heroin became legal last September for use by patients suffering chronic, severe pain.) Said Librach: “Doctors have been taught for so many years to fear their addictive effects that appropriate use of the drugs in many cases just does not happen.”
Indeed, the medical use of heroin is still a hotly disputed topic in Canadian medical circles. Ottawa banned the importation, manufacture and sale of the addictive drug in 1954 but finally bowed in 1985 to a campaign led by Toronto gynecologist Dr. Kenneth Walker, who urged the legal use of heroin for terminally ill cancer patients. Writing a syndicated medical advice column under the name Dr. W. Gifford-Jones, Walker argued that British doctors prescribed heroin because it was the most potent pain-killer available. As well, Walker noted that heroin induces a euphoria which counteracts the depression that often affects a terminally ill patient. Said Walker: “There is a great deal of irrational thinking on this subject. I get letter after letter from people who say that a doctor does not want to use herI oin because their loved one might get addicted—even though he only has a week to live.”
But only 20 of an estimated 1,500 Canadian hospitals are stocking heroin. For one thing, many cancer specialists say that hydromorphone, a morphine derivative that has been marketed in Canada since 1965 under the trade name Dilaudid, is a more potent pain reliever than heroin. In Toronto, Dr. Frank Ferris, who special-
izes in radiation therapy for cancer victims, says that two milligrams of Dilaudid provide the same relief as five to seven milligrams of heroin or 10 mg of morphine.
At the same time, Dr. Neil MacDonald, director of Edmonton’s Cross Cancer Institute, says that the controversy over the legalization of heroin has diverted attention from the need to instruct doctors in pain relief. To that end, the foundation has a $150,000 federal grant—and a $25,000 donation from Toronto-based Knoll Pharmaceuticals Canada Inc., the makers of Dilaudid—to conduct daylong pain management seminars for doctors,
nurses and pharmacists in six major cities across Canada. Among the goals of those sessions: to dispel such widespread medical myths as the belief that morphine—usually administered by injections—is ineffective when taken orally. As well, foundation members are planning to distribute videotapes on pain control to doctors and medical students throughout Canada, as well as producing pamphlets and booklets on the subject for cancer victims and their families. Summing up the spirit of the program, radiation therapist Ferris declared: “Pain is useful. It gives us a signal that there is something wrong in our bodies. But once we know that something is wrong, it becomes a useless entity.”
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