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To the Editor.—
In the course of treating patients with severe pain, it is sometimes difficult to continue administering injections of narcotic analgesics over prolonged periods for various reasons. This is especially a problem in terminally ill patients who require higher-than-usual doses or more frequent drug administration than usual. Thus, oral administration of narcotic analgesics becomes desirable.However, effective oral narcotic analgesic therapy is difficult to achieve, primarily for the following two reasons: (1) the relative scarcity of oral dosage forms of potent narcotic analgesics, and (2) the poor bioavailability of these drugs on oral administration. One possible solution to these problems has been to use oral liquid combinations, such as the Brompton cocktail (morphine, cocaine, ethanol, and chloroform). However, this "shotgun" approach is unnecessary and undesirable when the same results could be obtained with other simpler preparations. Furthermore, the efficacy of oral cocaine is suspect, and its commercial availability
Cardoni AA, Walters JK. Methadone for Pain. JAMA. 1978;240(24):2630–2631. doi:10.1001/jama.1978.03290240030009
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