Morphine (for Hospice and Palliative Care)
Definition: Morphine is a narcotic (opoid) that’s used to control pain and to help with difficult breathing. To get morphine, you need a doctor’s prescription.
Morphine is considered the “Gold Standard” for 3 main reasons:
• It’s very effective and works quickly.
• It can be administered by many routes.
• It relieves both pain and respiratory distress.
There are myths that surround the use of morphine. It’s a much misunderstood and feared medication. Medical professionals and patients alike share these ideas.
In the minds of many people, the Hospice journey looks something like this: You go on hospice, they give you morphine, then you die. I’ve heard this from many families. Yet after they experience the benefits of hospice, they say “Oh, I wish I’d called you sooner.”
The truth is that patients can be on Hospice for weeks or even months and be comfortable using morphine for much of that time. It can help patients have good quality of life. And like all medications, morphine needs to be respected. When used correctly, it’s amazingly effective.
There’s a rule of thumb with morphine: “Start low and go slow.” Following this rule, gives a patient time to get used to the medication and also allows for discovery of the right dose for this patient.
Though it is the “Gold Standard,” morphine is not “one size fits all”.
Here are two reasons that morphine may not be the best choice.
1. True Allergy: Some people have a true allergy to morphine and if used, it will cause them to go into shock. If they’re not treated right away, they could die. However, side effects are often misunderstood as allergies. Two of the most common side effects are nausea and an upset stomach. These symptoms don’t indicate a true allergy. They will subside after a day or two. And until they subside, other medications can be given to ease them.
2. Type of pain: Morphine is not effective for all types of pain. For instance, if the pain is from nerve damage (called neuropathic pain), morphine would not be a good choice. There are other pain medications that should be used if morphine isn’t appropriate.
An important and easily treated side effect of morphine is constipation.
It is ongoing and doesn’t subside in a few days. Whenever a patient starts on morphine, a stool softener and eventually a laxative should be added to their pill box. (These can be bought over the counter without a doctor’s prescription). Constipation can be very painful and to control it, treatment should begin when morphine is started.
• “If I give my loved one morphine, it’ll kill them.” Morphine is a drug that needs to be respected. It can cause respiratory depression (cause a patient to stop breathing) if too large a dose is given too soon. Hence the above noted Hospice rule of thumb: “Start low and go slow”. Once started on a low dose, the body very quickly gets used to it (builds a tolerance) and the dose can then be increased to meet the pain. I’ve worked with patients that have been on morphine for weeks or even months before they die. It’s true that they eventually die, but what kills them is the cancer or other disease not the morphine.
• “It makes me too sleepy.” Morphine can cause sedation. For the first day or two, a patient may be more sleepy than usual. However, once the body is used to it, the sedative effects will subside.
• And along the same lines: “I don’t want my loved one to sleep. I want them to be awake so we can talk.” There is a deep fatigue that is part of the dying process and the patient naturally needs to sleep more and more. It comes down to creating a balance of quality time with the dying patient and, at the same time, respecting their need for more rest. It can be terribly sad and hard to sit by the bedside unable to share important memories. However, we know that hearing is the last sense to go. This means that your loved one can hear you and does know you’re there. They just can’t respond to you in the ways you’re used to.
• “I don’t want to start morphine because once I do, I’ll just need more and more of it”. Your body will develop a tolerance to morphine so it’s likely that over time the dose will need to be increased. But this is normal. And you always have an option to not increase the medication. That’s your personal choice. Perhaps you would rather be in a little pain and use less medication. That’s up to you.
• “I don’t want to get addicted to drugs”. There is a big difference between your using morphine to treat your pain and an addict using morphine to get high. Once the correct dose is found, you won’t need more, at least for awhile. An addict is using it to get high and is always seeking more. And from a legal standpoint, hospice patients use morphine legally and are not considered to be addicts.
NOTE: The above information is general in nature and each patient’s pain needs to be professionally evaluated before morphine is considered the drug of choice.