Published on: October 14, 2011

Short Film 22 of 50 in the LIFE Before Death documentary series about the global crisis in untreated pain and the dramatic life changing affect palliative care services can deliver to patients and their families around the world.

In “Opium: Sinner or Saint” we discover that opium can be used both for great good and misused to cause great harm but that a balanced approach must be adopted to assess its overall usefulness to society.

“The reason why opioids are important is because they are our best pain-killing drugs – we need them,” states Dr Cynthia Goh (Singapore). “We need them to control the very bad pain that you see in cancer, HIV disease and many other chronic conditions. The problem with opioids is that people are so scared of them because they associate them with addiction, they associate them with crime and things like that.”

“Opium, or morphine, is part of our body. It is there chemically even normally within our system,” explains Dr MR Rajagopal (India). “It’s part of us. Like the rest of our body and mind we could abuse it.”

“Because the drugs we use to treat pain are controlled substances and because they’re abused, the opportunity for pointing out their negative factors is becoming increasingly more frequent,” continues Dr Kathleen Foley (USA). “And so we get this term ‘bad medicine’. Does that mean insulin is bad because some people die when they take it?”

“I think it’s more a saint than a sinner — by far,” reflects Dr Stephen Connor (USA).

“I’m working in palliative care and pain management so in my opinion is that it’s a saint,” says Professor Lukas Radbruch (Germany).

“We now know, only recently, that dependence on drugs, especially addiction – psychological dependence — has a genetic background. Not everybody necessarily gets it. So understanding it more is necessary,” considers Dr Rajagopal.

“I feel it’s a medicine like all others,” says Dr Daniela Mosoiu (Romania). “And we need to know like all other medicines that there are side effects – there are good effects and side effects — and you need to know how to balance these things.”

“Very often we pain therapists try to promote opium by downplaying its potential for abuse,” reflects Dr Rajagopal. “We need to be very open about it and insist on the right controls. It can be used and abused and that’s the truth, but used properly with reasonable control — I don’t mean unreasonable controls — with reasonable controls it can be very safely established.”

“In countries where appropriate measures have been taken to control illicit drugs and careful examination has been made for the availability of drugs for medical treatment of pain there isn’t any evidence that it has an impact on the so-called war on illicit drugs,” reports Professor Michael Cousins (Australia). “So the two can run in parallel provided sensible things are done.”

“Almost any pharmacologic product we use — even a baby aspirin — have a good side and a bad side,” explains Dr Jay Thomas (USA). “Baby aspirin can prevent heart attacks and strokes – and there’s some evidence they can prevent colon cancer – but it can also produce a fatal gastro-intestinal bleed from an ulcer. So as physicians we’re always looking to use medicines to help people more than hurt them — and that requires some education. So we need to educate people about the side effects of medicines and the potential harms that any medicine can have. And opioids have that dual-edged sword — they can help and they can hurt. But on balance, especially for the types of cancer pains I’m treating, the balance is much more that it’s helpful than it’s hurtful.”

“It’s a saint, no doubt,” concludes Dr Rosene Pirello (USA). “And if it’s appropriately titrated by knowledgeable prescribers it’s absolutely a saint.”

Featuring Dr Cynthia Goh (Singapore), Dr MR Rajagopal (India), Dr Kathleen Foley (USA), Dr Stephen Connor (USA), Professor Lukas Radbruch (Germany), Dr Daniela Mosoiu (Romania), Professor Michael Cousins (Australia), Dr Jay Thomas (USA) and Dr Rosene Pirello (USA).

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