Oregon’s Medical Use of Morphine Leads Nation, Federal Data Show

In keeping with Oregon’s pioneering focus on the care of the dying, the state has jumped to the top of the nation in the medical use of morphine, according to the most recent federal data.

Wholesale, per-capita distribution of the painkilling drug was more than 50% higher in the state than the U.S. average in the first six months of 1996, internal Drug Enforcement Administration statistics show. Arizona came in a close second, followed by New Hampshire, Nevada and Washington.

The latest DEA figures for California were not available, but the state ranked 27th in 1995 and 1994.

Oregon’s increasing use of morphine, which is typically given to patients with otherwise untreatable pain, is consistent with its leading role in end-of-life issues, researchers say. In 1994, when voters narrowly approved a measure on doctor-assisted suicide--the only state to do so--it ranked 11th in morphine distribution to retail druggists. In 1995, it was third.

Because the assisted-suicide law has been blocked in the courts--it is up for a vote again this fall--researchers attribute the greater demand for morphine not to an outbreak of assisted suicides but to doctors’ growing willingness to give gravely ill patients “comfort care.”

Dr. Susan Tolle, director of health care ethics at Oregon Health Sciences University, said that the intense suicide debate has sensitized doctors and patients to the need for better pain management.

“Studies consistently show that 40% to 60% of nursing home patients [nationwide] are undermedicated and in pain,” she said. “So the amount of morphine is going to go up if you’re addressing the problem.”

The Oregon Medical Assn., which opposes the state’s assisted-suicide measure, sees the trend of greater morphine use as “good news,” said associate executive director Jim Kronenberg. “If nothing else,” he said, “the physician-assisted suicide debate has had a salutary effect on the medical profession’s attention to death and dying.”

Also contributing to Oregon’s increased morphine use, Tolle said, are several recent regulations that make it easier for doctors to prescribe narcotics, which are tightly restricted and somewhat stigmatized. For example, a 1995 policy gave doctors wider discretion to use morphine for patients with chronic pain who are not terminally ill. And unlike doctors in California and some other states, physicians in Oregon do not have to fill out onerous triplicate prescription forms, Tolle said.

Alicia Super, a registered nurse and pain researcher with the Sisters of Providence Health System in Portland, confirmed that the new data paralleled her clinical experience with morphine.

“The tools are not different from what they were 25 years ago,” she said. “But there’s a heightened interest in learning about them.”

For the first six months of 1996, the DEA figures show, 832 grams of morphine were distributed per 100,000 residents in Oregon, compared to a national average of 500 grams per 100,000 people.