Barriers and Facilitators to Morphine Prescription Among Clinicians in Uganda: A Qualitative Study at Mildmay Uganda

Introduction: Pain management is a critical component of palliative care, particularly for HIV/AIDS and cancer patients. Despite oral morphine being an essential medication for treating moderate to severe pain, its accessibility and utilization remain suboptimal in many resource-limited settings. This study explored the barriers and facilitators to morphine prescription at Mildmay Uganda (Mug) to provide actionable insights for improving pain management practices. Methods: A qualitative study design was employed, involving semi-structured interviews with clinicians. 11 clinicians were purposively sampled based on their experience with morphine prescription and administration between March to April 2016. Data were analyzed thematically to identify key barriers and facilitators influencing morphine use in clinical practice. Results: Three primary barriers to morphine use were identified: opiophobia, knowledge gaps, and legal restrictions. Opiophobia was driven by concerns about addiction and adverse effects, particularly in home-based care settings. Knowledge gaps were highlighted among newly recruited staff and those without formal training, leading to inconsistencies in dosing practices. Legal restrictions, including limited prescriber authorization, further constrained access to morphine, particularly in community-based care. A key facilitator was the strong clinician consensus on morphine’s effectiveness in pain management, which enhanced confidence in its use and encouraged broader adoption in clinical practice. Conclusion: While clinicians acknowledge morphine’s effectiveness in pain relief, its use is hindered by opiophobia, knowledge gaps, and restrictive policies. However, strong clinician consensus on its benefits enhances confidence in prescribing. Targeted training and continuous medical education (CME) are essential to addressing misconceptions and improving competency. Strengthening policies to expand prescriber roles and integrating structured CME into routine practice can enhance clinical outcomes, reduce disparities, and ensure equitable access to pain relief, particularly in resource-limited settings.