Opiates and Respiratory Function in Advanced Cancer

  • T. D. Walsh
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 89)


Oral administration of opiates is the preferred method of relieving chronic pain in advanced cancer. Morphine, methadone and diamorphine (heroin) are the main drugs used for severe pain. Saunders (1979, personal communication) and Mount (1980) reported that respiratory depression in such patients is uncommon when oral morphine (in aqueous solution) is given 4-hourly in individually determined doses, titrated against the patient’s level of pain. These reports were surprising in view of the known effect of opiates on respiratory function (Bellville et al. 1968) and the clinical condition of the patient population in question. Oral morphine is known to provide effective pain relief in up to 95% of cancer patients (Mount 1980) despite low relative bioavailability (Brunk and Delle 1974) compared with parenteral administration. It is likely too that oral administration is associated with lower peaks and less rapid change in morphine plasma levels. Examination of the literature on the effects of opiates on respiratory function (Murray and Grant 1966) reveals that studies have been largely conducted on surgically treated patients following parenteral administration (Rigg 1978) of opiates. The methodology employed has not always had direct clinical relevance, nor have the impairments in respiratory function demonstrated clinical significance (Betcher and Barber 1966).


Respiratory Function Parenteral Administration Oral Morphine Morphine Equivalent Respiratory Tract Disease 
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  1. Bellville JW, Escanaza LA, Wallenstein SL, Houde RW (1968) The respiratory effects of codeine and morphine in man. Clin Pharmacol Ther 9: 435–441PubMedGoogle Scholar
  2. Betcher G, Barber JL (1966) Lung mechanics and physiologic shunt during spontaneous breathing in normal subjects. Anaesthesiology 27: 638–647CrossRefGoogle Scholar
  3. Brunk SF, Delle M (1974) Morphine metabolism in man. Clin Pharmacol Ther 16: 51–57PubMedGoogle Scholar
  4. Cotes JE (1979) Lung function, 4th edn. Blackwell, LondonGoogle Scholar
  5. Grabinski PY, Kaiko RF, Walsh TD, Foley KM, Houde RW (1983) Morphine radioimmunoassay specificity before and after extraction of plasma and cerebrospinal fluid. J Pharm Sci 72: 27–30PubMedCrossRefGoogle Scholar
  6. Kitahata LM, Collins JG (1982) Narcotic analgesics in anesthesiology. Williams and Wilkins, BaltimoreGoogle Scholar
  7. Mount BM (1980) Narcotic analgesics. In: Twycross RG, Ventafridda V (eds) The continuing care of terminal cancer patients. Pergamon, Oxford, pp 79–116Google Scholar
  8. Murray WD, Grant IW (1966) Effects of opiates in chronic bronchitis. Thorax 21: 57–64PubMedCrossRefGoogle Scholar
  9. Rigg JRA (1978) Ventilatory effects and plasma concentration of morphine in man. Br J Anaesth 50: 759–764PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1984

Authors and Affiliations

  • T. D. Walsh
    • 1
  1. 1.Department of Clinical PharmacologyGuy’s HospitalLondonUK

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