Feature photo for second Morphine Myths article - 1
Elisabeth G. Smith, MS, BSN, RN, CHPN, Director of Education, Hospice of the Chesapeake
By Elisabeth G. Smith, MS, BSN, RN, CHPN, Director of Education, Hospice of the Chesapeake
We all have preconceived notions about morphine based on misinformation or fictionalized events portrayed by Hollywood. Many people harbor these myths about morphine when they or a loved one become a hospice patient. It’s an important medication in hospice care. We know it brings comfort to people who are in pain or are having trouble breathing. To provide the best care for our patients, we need morphine. We work every day to dispel these myths.
Myth: Morphine can stop people from breathing.
Fact: Among terminal lung disease patients, 95% report breathlessness as a symptom. It can feel like you’re drowning, gasping for air. Morphine opens the blood vessels allowing more blood circulation within the respiratory system. This makes it easier for the lungs to get the bad gases out and the good gases in. The patient becomes calm, their breathing slows down.
A runner is a great example of how this works in healthy people. When they are running a race, they are breathing hard and fast. The body requires more oxygen to fuel this burst of energy. When they finish the race, their body is fully oxygenated. Their breathing naturally slows down.
With morphine dilatating vessels and increasing oxygenation, it’s like breathing while sleeping. Breathing slows down to match their body’s demand, not stopping it.
Myth: Morphine can speed up death.
Fact: If a patient dies shortly after receiving morphine, it may look like the morphine caused the death simply because of the timing.
Many patients are unable to rest because of symptoms. Often suffering is holding back death. Remove the suffering and death can happen in its own timing. Morphine is fast acting, so this can happen in minutes. It didn’t make the death occur; it removed the barrier.
We want our loved ones to be comfortable and die as peacefully as possible. Controlling the symptoms is key.
Myth: I can get addicted to morphine
Fact: Any opioid has the potential to be abused. Any abused drug can cause an addiction. However, for hospice patients using morphine under medical supervision, addiction is very unlikely. In my 16 years as a hospice professional, I have never seen addiction from people taking morphine appropriately.
Myth: If I take morphine early in the treatment of my disease, it won’t work when I really need it.
Fact: Many people think you should save morphine until the pain is at its worst. That is contrary to good symptom management practices. Let’s compare the symptoms your loved one experiences to a fire. There is a better chance of managing the fire when it is small and contained. You don’t want to wait until it is raging out of control. If you wait for the pain to become excruciating, you will have to use more morphine and it will take longer to bring relief.
Baseline discomfort is like a smoldering coal. Long-acting morphine dosed two to three times a day will suppress the smoldering coals. Occasionally, the smoldering coals will flare up. We call this breakthrough discomfort. That’s when we dose with the rapid acting medication. We want to get on top of that fire before it begins to rage.
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Myth: Hospice doctors will push morphine on me.
Fact: Hospice care is patient-centered. Our team is going to assess any barriers to morphine. We make a plan that includes goals of care to ensure all that we do is understood and approved by the patient and family.
We understand that some people have challenges with morphine that can include allergies, experiencing side effects or a history of misuse. There are many other opioids on the market for those who can’t use morphine. There are also non-opioid options, including alternative therapies combined with other drug therapies.
Be open with your hospice team about your fears or concerns. In that openness we can individualize the plans, resources and alternatives. We want you to feel confident in how you care for yourself or your loved one.
The World Health Organization has endorsed morphine as the gold standard of opioids. It's considered the first-line treatment for moderate-to-severe pain and shortness of breath. We can’t let its wrongly earned reputation stop us from using it to help our loved ones find comfort and peace at the end of life.
Learn more about hospice, palliative and grief care at www.hospicechesapeake.org or call 410-987-2003.
