Overdosing on immediate-release morphine solution has predictable adverse effects

Prescribing responsibility inherently includes adequate ongoing monitoring for medication.
An overdose of morphine can cause respiratory depression; as with any medication, there is a therapeutic window above which toxicities occur. Despite the increasingly widespread use of extended-release morphine for chronic breathlessness when prescribed and monitored in line with international evidence-based recommendations, the literature is not replete with examples of opioid-induced respiratory depression.
Why was the case report by Politis et al. [1] published? Morphine causes drowsiness and obtundation when an overdose is taken. In addition to his 15 mg per 24 h extended-release morphine, the patient in the case report took 12 times his 4-hourly dose of immediate-release oral morphine solution. The effects he experienced are well-described toxicities on the product information and the patient information sheets in every filled prescription for every opioid. This is not about identifying a new danger; use morphine in an unsafe way and it will be an unsafe drug with predictable side-effects. This letter, therefore, highlights that the generic importance of good prescribing and prescribing responsibility inherently includes adequate ongoing monitoring.