12/11/2020 Let's Talk Morphine...

There are many fears and myths surrounding morphine as a mediation. Let’s talk about those.

Morphine is a very common “comfort care” medicine used at the end of life with Hospice. Morphine is also the most feared medicine by the families and loved ones of those at the end of life. I hear these questions almost every time it is time to use morphine….”What if they get addicted?” “Is it going to make them die faster?” “What if they overdose?” “When I give it to my loved one all they do is sleep, that means they are going to die faster, right?”

While all of these are common and understandable questions none of them are things to worry about. Let’s talk about morphine itself.

Morphine is one of the most effective end of life comfort medications for pain, shortness of breath and anxiety. Those three things are all very uncomfortable and very common at the end of life. Morphine is also one of the most natural forms of painkiller you can use. It is derived directly from the Poppy plant. It has less synthetic, man made chemicals than its rivals such as Codeine, Duladid, and Fentanyl. Those certainly have their place and effectiveness. Morphine is most often given in liquid form at the end of life. This is a benefit because oftentimes people have lost the ability or mental awareness to swallow pills. It can be placed between the cheek and teeth and even if they can’t swallow it it will soak in through the tissue in the mouth. Being in liquid form makes it take effect faster as well, which is helpful in high stress or pain situations.

Morphine helps with pain and is most well known for that. It also is extremely helpful for shortness of breath which often comes at the end of life as the body starts to shut down. Shortness of breath can also come along as a nasty side effect of some terminal illnesses. Morphine will help relax the muscles that control the lungs and make taking in full breaths easier. We did symptom simulation of shortness of breath in my training to be a hospice caregiver and I am here to tell you it is an awful and scary feeling!

Morphine also can help aid with some restlessness and anxiety. Oftentimes you will see morphine used alongside Ativan or Haldol for these types of symptoms.

So let's talk about those questions and fears surrounding morphine that I listed above…

“What if they get addicted?”

• Highly unlikely that at that stage and for what it is being used for that they will be taking it long enough to become addicted. There are rare times when morphine is used for long periods of time for pain in some terminal illnesses but they are closely monitored by a doctor. It is much better to use the morphine than to be in pain and unable to breath. That uses a lot of unnecessary energy for someone who is already at the end of life. Often at the very end people can’t let go because they are in pain and can’t get comfortable. The main goal of hospice is comfort!

“Is it going to make them die faster?”

• Definitely not. Morphine in the doses given for comfort care will not make them die faster. It may make them finally comfortable so they can find the peace to pass but, it will not hasten their death.

“What if they overdose?”

• The dosage prescribed by that patient's doctor at the end of life is very small and timed so that this will not happen. If instructions are followed they do not have a risk of overdosing.

“When I give it to my loved one all they do is sleep, that means they are going to die faster, right?”

• Morphine can make people sleepy especially those first few doses. It is also often used in combination with other medications for anxiety and agitation which can also cause drowsiness. It does not mean they will die faster. It simply means they are not in pain and are resting. Again, normally at this point of the end of life they are sleeping mostly anyway. They are probably more peaceful and comfortable which is the goal. If they are awake because they are in pain or agitated or restless that is not a fun reason to be awake.

Hospice is focused on comfort and dying with dignity in a peaceful, pain free manner. Please don’t be afraid of Morphine when it is time to use it. It really is such a wonderful tool to use.

Til next time...Christa

*the things written in my blog are for information purposes only. They are my opinions and views on the subject. They are in no way meant to be taken as medical advice or diagnosis. I am passionate about what I do and want to share to help others navigate some of the most difficult times in life.