台灣安寧緩和醫學學會長期關注末期病人的痛苦，茲以專業立場及醫學倫理思維，謹就衛生福利部食品藥物管理署109年8月10日「含tramadol成分藥物禁止使用於發生顯著呼吸抑制病人」之公告，表達如下：
一.  弱效及強效鴉片類藥物為疼痛控制不可或缺之藥物
      對於輕度至中度之疼痛，含tramadol成分藥物為常用之第一線藥物。相較於非類固醇抗發炎藥（NSAIDs），tramadol等鴉片類藥物可減少腎功能受損、消化性潰瘍及腸胃出血的風險，更適合某些病人長期使用。
     以癌症疼痛為例，依據美國National Comprehensive Cancer Network （NCCN）Guidelines及歐洲 European Society for Medical Oncology（ESMO） Guidelines二個重要癌症疼痛控制指引，弱效及強效鴉片類藥物為癌症疼痛控制不可或缺之藥物。

二.  臨床情境千緒萬端，個別病例差異懸殊，實不宜以禁用一詞概括性規範
      當病人使用後出現顯著呼吸抑制情況，如呼吸過度緩慢、微弱時，醫師自當依據治療目標與病人最大利益，提供適當之專業處置，包括停止或減量使用鴉片類藥物、給予解劑，或進行緊急處置。

三.  呼吸困難（breathlessness）與呼吸抑制（respiratory distress）二者於臨床醫學上為不同之概念，
　   尤不應混淆
      Tramadol等鴉片類藥物可減緩呼吸速率、減少呼吸中樞對低血氧及高二氧化碳感受性，舒緩呼吸困難導致的窒息感。因此，美國NCCN、歐洲ESMO及英國National Health Service （NHS）的臨床指引，均揭載鴉片類藥物用於安寧緩和醫療病人之呼吸困難，有不可取代之角色。

四.  短效tramadol成分藥品導致呼吸抑制之機率級別為罕見（rare），亦即千分之一至萬分之一
      Tramadol導致呼吸抑制，通常為與酒精或其他麻醉與鎮靜藥物併用造成；對於有嚴重氣喘、二氧化碳滯留、嚴重睡眠呼吸中止的病人，使用tramadol成分藥品固應審慎，但也勿過度渲染、放大其風險。

五.  平衡行善原則與不傷害原則，以同理心維護末期病人之最大利益
      籲請醫界同道，在含tramadol成分及其他鴉片類藥品之使用上，本於實證知識及醫學倫理，落實醫病共享決策之精神，妥善溝通病人之治療目標，平衡行善（舒緩疼痛與呼吸困難）與不傷害（減少藥物副作用）原則，並以同理心維護末期病人之最大利益。

*本立場聲明內容版權所有，請尊重智慧財產權，若需引用，須經本會授權同意，並註明出處及原作者＊Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×Enable GingerCannot connect to Ginger Check your internet connection
or reload the browserDisable in this text fieldRephraseRephrase current sentenceEdit in Ginger×