Home-based oral morphine exposure,oral morphine self-medication,and use of other controlled drugs by caregivers of sickle cell paediatric patients and associated factors at Mulago Hospital

Abstract

Background SCD affects about 20,000 babies in Uganda per year. Its painful crisis is managed with analgesia like opioids. Opioid medicine like oral morphine is currently administered by caregivers of sickle cell paediatric patients from home. This project found out that there is a minimal diversion of oral morphine by caregivers of sickle cell paediatric patients. Objectives We determined the prevalence of, factors associated with self-medication and the effect of home-based oral morphine exposure to oral morphine self-medication and controlled drug use among caregivers of sickle cell paediatric patients at Mulago specialized hospital. Methods A comparative study of caregivers of sickle cell paediatric patients at Mulago hospital with or without home-based oral morphine with a sample size of 420 where 210 caregivers of sickle cell paediatric patients were on oral morphine and 210 caregivers of sickle cell patients not on oral morphine. Interviewer-administered questionnaires and urine drug assays were employed. The study variables were demographic, socio-economic characteristics, knowledge and attitude towards oral morphine, and underlying health condition. Data analysis was done by binary logistic regression using SPSS version 26 and Bloom’s cut-off to score knowledge and attitude. Results Out of 210 enrolled caregivers with paediatric sickle cell patients on prescribed oral morphine, 6 acknowledged to have self-medicated with the patients’ oral morphine hence a prevalence of 2.9%. Among the associated factors, good and moderate as scores of attitude towards oral morphine of above 80% and between 60-79% respectively were found to be independently significant with oral morphine self-medication among the participants with OR=6.68 and 21.21 respectively. The two scores had P-values of 0.024 and 0.009 respectively. Oral morphine self-medication was more prevalent in the caregivers exposed to oral morphine than those not exposed to oral morphine with frequency of 6 (2.9%) and 1 (0.5%) respectively. Oral morphine exposure was independently associated with oral morphine self-medication with Z=2.69 and P=0.0036. Out of the 210 caregivers exposed to oral morphine, 10 (4.8%) used other controlled drugs while the 210 caregivers not exposed to oral morphine 7 (3.3%) used other controlled drugs. TCAs (1.7%) were found to be the most used controlled drug and both MDMA and amphetamines (0.2%) were the least used. Exposure to home-based oral morphine was found not associated with the use of other controlled drugs (P=0. 1135, CI=95%). Conclusions Oral morphine self-medication is more common among the caregivers exposed to homebased self-medication than those not exposed to home-based oral morphine. Additionally, those with a good and moderate attitude have a higher tendency of oral morphine self-medication. The study as well revealed that those people exposed to home-based oral morphine use can at times use controlled drugs and thus maximal control of such drugs is highly recommended.