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Palliation of pain with morphine in cancer patients can be complicated by adverse effects. Tolerance to these effects such as nausea and drowsiness usually occurs within a few days allowing continuation of morphine therapy. However, some patients may develop intolerable adverse effects even after several months on morphine when the dose is increased. A case of morphine-induced hallucinations in a cancer patient who had been on a subcutaneous infusion of diamorphine for several months is discussed. A switch to oxycodone resolved his hallucinations and gave him a new lease of life. The theories behind and evidence for opioid-switching is discussed along with strategies for dealing with intolerable opioid-induced adverse effects.

Morphine-induced hallucinations - resolution with switching to oxycodone: a case report and review of the literature