Opiates, which include morphine, are proven to be effective at relieving pain and relaxing patients who have acute shortness of breath. Whether a patient is in pain or experiencing severe breathing problems, it is critical that doctors intervene quickly. Any delay increases the risk of cardiac arrest, which can be fatal.
Opiates are used to treat patients with COVID-19 in hospices and care homes, as well as in hospital wards. The recent surge in COVID-19 cases has placed significant pressure on the supply and dispensing of these important medicines.
Another example of how limiting the existing rules can be is the strict way that surplus and unused opiates prescribed to a named patient have to be destroyed. The Department of Health introduced new guidance at the end of April for care homes and hospices on how to reuse surplus medication, but this doesn’t cover most patients who are in their own homes. Before the pandemic, this seemed wasteful, but it didn’t create much of a problem. Now it is more serious.
Having to destroy perfectly good medicine when there is a temporary shortage is nonsensical, and it means some patients suffer longer than they need to.
Home Secretary Priti Patel is responsible for the legislation on controlled drugs and has been aware of problems for some time. On April 1 she asked her scientific advisers for their view on her plans to loosen regulation. They supported the changes that Patel had proposed, which prompted the home secretary to amend the law.
One of these amendments would allow pharmacists to change a prescription for a controlled drug if it would benefit the patient. But there was a caveat: “I must be clear that these measures will not come into use with immediate effect. The government, in close liaison with the NHS service and devolved administrations, will carefully consider when to ‘switch on’ these measures.”
Along with fifty clinicians, academics, public health experts and others, we sent an open letter to Patel calling on her to “switch on” these measures, urgently.
We are not alone in our concern. The Royal College of General Practitioners has also pleaded with the home secretary to relax these regulations to alleviate patients’ suffering.
We have still not had a response from Patel or the Home Office. We can only speculate why we are in the bizarre position of having the legislation in place to ease the suffering of some patients with COVID-19 but not the political will to implement this change in the law.
It is understandable that ministers might be concerned about the consequences of easing restrictions on these powerful drugs. Given the significant mortality in North America in part due to a loosening of controls on these types of medicines, those fears are logical. However, if managed clinically, in a responsible way, the risk of problems such as dependence can be minimised.
It is possible that Patel is wary of introducing changes that might be used to prematurely end patients lives (drugs such as morphine are believed by some people to have been used in this way, even though this is illegal in the UK). Or it could be due to concern that loosening regulations will lead to misuse of opiates, with some finding their way onto the black market. Although this is possible, diversion of opiates to the black market has always been a risk. Irrespective of how tightly there use is controlled there is little evidence for this happening. Equally, this lack of action could be ideologically driven.
Keeping the war on drugs alive
The Conservative party supports the war on drugs so the government may feel any action that loosens controls, irrespective of patient need and benefit, risks sending a message of going “soft” on drugs.
The regulations for all medicines, including more potent varieties, such as morphine, are based on a risk-benefit calculation. Essentially, do the regulations minimise the risks while ensuring the potential for human benefit is maximised?
Many aspects of the COVID-19 crisis have been beyond our control, but this issue is firmly within our ability to intervene and solve a problem. As clinical scientists, we are limited to providing advice. We are reminded that it is politicians who decide. But for every day that the decision to “switch on” these regulations is delayed, suffering continues, and that is both cruel and unnecessary.