Expert: Dr Alan Galbraith - 3/21/2009

Question
I'M A 51 YR OLD FEMALE. I AM IN END STAGE CAD,PAD,COPD TRIPLE A,TRIPLE BY-PASS,A VERY BAD BACK,ALOT OF NERVE PAIN.I HURT SO BAD AT TIME I WISH GOD WOULD JUST TAKE ME. I HAVE BEEN ON MS 120MG THEN DROPPED TO 90MGS FOR 4YRS ALSO OXY. 20MGS.IN AUG 2008 I WANT INTO KIDNEY AND LIVER FAILURE AND MY DR. SAID IT WAS BECAUSE OF MS OVERDOSE. HE SAID I TOOK TO MUCH. I KNOW I DIDN'T. I WAS OUT FOR 2 1/2 DAYS BEFORE ANYONE CAME TO CHECK ON ME. I ASKED MY DR. SINCE MY KIDNEY AND LIVER WASN'T WORKING IF THAT COULD CAUSE MY MORPHINE LEVEL TO BE HIGH AND HE SAID NO. HE WOULD MUCH RATHER BELIEVE THAT I TOOK TO MUCH. HE KNNOWS I AM IN PAIN SO HE ALLOWS ME TO HAVE 2 15MGS OF OXY. ADAY.I HAVE ASKED HIM FOR ONE MORE MED A DAY AND HE SAYS NO. I'VE LOOKING FOR CASE STUDIES OF MORPHINE OVERDOSE WHERE IT BUILDS UP IN THE BODY. I FOUND ONE I THINK, I UNDERSTAND SOME OF IT UNTIL IT STARTES TALKING ABOUT MORPHINE 6 AND MORPHINE 3 GLUCURONIDE. HOPE YOU CAN HELP ME. THANK YOU

Answer
Dear Judy

Renal failure in particular can cause an increase in morphine and morphine glucuronides (which are active) in the blood and cause toxic symptoms. Therefore you are correct in your assumption and your doctor cannot say conclusively that you ODed. In your state I think it is irresponsible not to offer you adequate pain relief but can understand your doctor's point of view as well. Persevere or ask to see another doctor who is more at home with palliative care.

Regards

Alan Galbraith