Low dose morphine puts people with chronic breathlessness back in the driving seat

Cancer care

By Michael Woodhead

15 Jul 2020

Being able to drive is an important issue for palliative care patients with chronic breathlessness and many feel they should be able to do so safely when taking low-dose morphine, Australian research shows.

With Australia the first country in the world to approve sustained-release low dose morphine for the treatment of chronic breathlessness, researchers at Flinders University, Adelaide, asked patients how this would affect their perceived ability to drive.

In interviews with 11 patients with COPD participating in a clinical trial of morphine for chronic breathlessness, driving was nominated as one of the most important aspects of daily life because it was the key to maintaining independence and a sense of self worth.

Patients and their carers said that the ability to drive was crucial to quality of life when the debilitating effects of chronic breathlessness on exertion would otherwise impair mobility and the capacity for social engagement, daily activities and well-being.

And while some patients said that breathlessness did not impair their driving skills, because driving was a sedentary activity, others said they feared breathlessness at rest would reduce their concentration and deter them from driving. Several said they addressed this by bringing oxygen with them in the car and use it while driving, raising concerns about safety and legality.

However all the participants in the study believed that their use of low dose morphine did not have any adverse impact on their ability to drive, even immediately after starting the drug or titrating up to maximum daily dose of up to 32mg.

Despite this, several expressed fears about the possible impact of low dose morphine on their psychomotor skills and driving ability – and particularly the safety of others – based on their expectations of the risks with conventional morphine doses and formulations.

These fears were shared by carers, some of whom believed that the patient with chronic breathlessness should not be treated with low dose morphine because this would disqualify them from fitness to drive and hasten their decline into permanent impairment.

The study authors said the findings showed a need for more research into the safety of low dose morphine and driving, particularly to inform doctors when counselling patients with chronic breathlessness on fitness to drive.

“There is a common assumption in the clinical setting that people should refrain from driving in the first hours or days after initiating any opioid. There are no published RCTs to confirm this should be the case with low-dose sustained-release morphine,” they wrote.

“Frequently, clinicians advise patients not to drive immediately after taking opioids. There is a need for further research to understand if patients taking regular, low-dose, sustained-release morphine are able to drive safely given the different pharmacokinetic profile they have to immediate-release oral morphine solutions,” they said.

And if clinicians advise people taking low-dose sustained-release morphine to stop driving, they should be aware that this may have severe implications for people’s wellbeing and social functioning, they added.

“This study raises the hypothesis that low doses of sustained-release morphine may have no impact on driving even during therapy initiation and careful upward titration. This is in line with previous studies showing that uncontrolled [breathlessness] symptoms are more likely to have an impact on driving than therapeutic opioids,” they concluded.

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