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Pethidine and Diamorphine
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7. |
The Inquiry has focussed mainly on diamorphine, the controlled drug used by Shipman to kill his patients, and pethidine, the controlled drug to which Shipman was addicted in the 1970s. Both drugs have a therapeutic use in the relief of pain. Both give rise to a sense of euphoria and are addictive. Both act as a respiratory depressant. Diamorphine, in particular, is dangerous for that reason. In overdose, respiration is slowed and eventually stops. The lack of oxygen to the brain leads to cardiac arrest and death. This was the means by which Shipman killed at least 214 patients. |
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8. |
In the 1970s, pethidine was widely used by GPs and midwives for the relief of pain in childbirth. Today, its use in general practice is limited, as more effective short-term analgesics are available. Diamorphine is widely used for the relief of severe pain in cases of terminal cancer. Since the early 1990s and the introduction into community medicine of the use of the syringe driver (a device which administers a continuous supply of a drug to the patient), the use of diamorphine has increased. The syringe driver allows greatly improved pain control, and more terminally ill patients can now be treated at home. Often, quite large quantities of the drug are required, as patients become habituated to it. Daily dosages of 1000mg or sometimes even substantially more can be needed. Some GPs also use small quantities of diamorphine for the relief of acute pain during a heart attack or following trauma. In such circumstances, the usual dosage is up to 5mg, although 10mg might be required. Many GPs keep a personal supply of 5mg ampoules for emergency use. Diamorphine is supplied in ampoules containing 5mg, 10mg, 30mg, 100mg and 500mg. The very large ampoules are only rarely used. |
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