Pain control with morphine: Evaluation of prescriptions for oral morphine for out patients at King Faisal specialist hospital and research centre

With the rapid improvement in living standards and health care delivery in Saudi Arabia, people are expected to live longer, patterns of illness will change, and the chronic illnesses which now dominate medical care in the West will develop here. Among these is cancer, which is already the third most common cause of death in Bahrain and Kuwait. Many cancer patients experience considerable distress, particularly pain. Management of symptoms in advanced cancer is now a medical and nursing specialty called palliative care. The most common and most feared symptom in advanced cancer is pain, which can only be effectively relieved with morphine in 60% of such patients. Prescribing narcotics such as morphine for cancer pain in Saudi Arabia has been severely restricted legally because of the fear of addiction, but there is no evidence that the medicinal use of morphine for treating cancer pain causes addiction. This paper describes a review carried out at King Faisal Specialist Hospital and Research Centre, one of the few centers in the Kingdom that can prescribe morphine to outpatients, to review the appropriateness and effectiveness of morphine usage, and to monitor any misuse. The review confirms that morphine usage was appropriate and effective, but that procurement of adequate narcotic supplies from year to year causes severe problems due to the stringency of both national and international regulations. Also, better monitoring of patients on morphine and recording of their level of pain control is required. In general, this survey shows that morphine usage in this hospital is appropriate and that limitations on supplies could be improved by changes to the Ministry of Health regulations

Amoxicillin-clavulanic acid: a case study in the evaluation of drug advertising

There is an absence of objective source of drug information in developing countries, as a result drug advertisement may be the prescriber's primary source of drug information. Several factors have been reported as affecting physician prescribing behavior, including advertising. The prupose of advertising, its validity, and cost will be examined. An advertisement for Augmentin[R] [amoxycillin/clavulanic acid] appearing in the January 1993 Saudi Medical Journal is presented as a case study in the evaluation of drug advertising. To goal of evaluating the Augmentin[R] advertisement is to compare the claims made by the manufacturer with what of objective scientific sources. In the evaluation reported here we could not find literature documentation from accepted scientific sources supporting the claims made in the Augmentin[R] advertisement. The extent to which this kind of advertising contributes to the inappropriate use of antibiotics is unknown. A simple model for evaluating an antibiotic drug advertisement is suggested