6.2.4 Morphine for safe relief of chronic or refractory dyspnoea

Strong opioids such as morphine have been proven to relieve safely and effectively not only pain but also dyspnoea that is refractory to oxygen therapy and treatment of the underlying cause (106–112). Morphine is the most studied and least expensive strong opioid and is widely available on the world market. Consequently, morphine, in both oral fast-acting and injectable preparations, is the most essential of the essential palliative medicines for people with TB (106, 107). Misconceptions about the use of opioids held by health-care workers and caregivers result in unnecessary suffering from pain and chronic or refractory dyspnoea and perpetuate unethical medical practices (108). NTPs should work with the officer responsible for controlled medicines at the health ministry to ensure that these morphine preparations are accessible for TB palliative care at least in TB hospitals and wards, and ideally also at TB clinics, according to international standards (91, 94, 106, 107, 109–112).

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