A common concern with hospice care is the use of morphine and some myths regarding its use. In our last post we discussed an overview of these concerns and why hospice uses morphine. This week we’d like to address the most common objections to its use and some of the myths surrounding that.
“But morphine is for drug addicts.”
While it is true that there is a growing health crisis involving opiates, the sort of Morphine administered in a hospice setting is quite different from the drugs at the center of the opioid addiction crisis. The type of opioids involved in the current health crisis are usually prescription pills unlike the vials, syringes and patches used in hospice.
Morphine use in a hospice setting also consists of much lower, managed doses administered by a trained healthcare professional. An essential part of addiction is the drug-seeking behavior. Hospice patients generally do not exhibit this behavior. When their pain is managed, they don’t go after more opiates. It’s also a good idea to keep a log near the medicine to track the timing, volume and effectiveness of each dose.
“Morphine will make my loved one sleepy and they won’t be themselves.”
Allowing a patient and their family time to share together is one of the primary goals of hospice. Morphine is only given to manage pain and symptoms, not as a means to sedate the patient or make them “high” so that they are not themselves. Morphine, especially in low doses, helps with the patient’s symptoms so that they may be more of themselves than a product of their ailments. It does not affect them mentally or change their personality.
Just as with any medication, when first starting the patient may take some time to adjust. This may include initial drowsiness but after the first few days, these effects go away. Every person is different however, and some may react in different ways to opioids. In these cases it is up to the patient, their family and their care team to consider alternate forms of pain management.
There is no evidence that opioids speed up the process when a person is already terminally ill as long as they receive the proper dose to control their symptoms. The opposite may actually be true. Troubled breathing and constant pain drain hospice patients of their energy and strength. When these symptoms are relieved, the patient can be made more comfortable and even slow down the rate of decline.
This myth stems from the circumstances in which morphine is used. If a patient is in hospice and prescribed morphine, they are usually in the advanced stages of terminal illness. The person is in the process of transitioning with or without the morphine. Sometimes the patient’s final moments may come shortly after a dose of medication, but this is just a coincidence.
Hospice seeks to provide a comfortable passage through the end of one’s life. Hospice never intends to speed up this passage, only to make it more peaceful. Morphine is nothing more than a tool to aid in this goal.
The Morphine Myth
Morphine has a reputation as a strong and dangerous drug so why does hospice use it? When used properly, morphine has several very helpful purposes. While it is not a medication to be taken lightly, there are a lot of misconceptions out there—especially with regards to hospice care.
Morphine is a naturally derived medicine in the same class of opioids as codeine, hydrocodone and oxycodone. It is used to treat sharp, acute pain and it also relaxes the lungs and makes it easier to breathe—a common ailment of those that require hospice care. With reduced pain and easier breathing, the hospice patient can eat, sleep and maintain a higher quality of life with comfort and dignity.
Amid our nation’s current opioid crisis, many myths persist regarding morphine’s legitimate use. These myths result in less than optimal pain and symptom management for hospice patients, but the confusion infused by these myths into the decision-making process can often lead to highly complicated grief for loved ones following a patient’s death.
Dr. TJ Hawkins, Ph.D., Bridgeway Hospice’s Director of Program Services, notes that in over 10 years of experience as a Grief and Bereavement Counselor, he has seen many loved ones struggle greatly from issues of anger and guilt regarding the circumstances surrounding the use of morphine at the end of life. Sometimes these complicated grief factors can lead to serious cases of depression and can highly debilitate their post-loss life. Dr. Hawkins recommends approaching the use of this drug with an open mind and seeking a thorough education of the uses of morphine from your healthcare provider.
Many hospice patients never even take morphine because they don’t need to. It is the degree of pain that the person is in that determines the medication. Hospice practitioners start with the mildest form of medicine and work from there. If it is appropriate that the patient be given morphine, the initial doses are low and slowly increased until they relieve the person’s pain and shortness of breath
While morphine has a reputation as a dangerous boogeyman and a hard drug, it is also a valuable tool for improved quality-of-life for hospice patients. Opioids properly administered in a healthcare setting are nothing to be afraid of. By reading this, you are already doing the right thing by researching and learning more about the topic. Take your time to consider the benefits of this medicine to your loved one’s comfort and dignity.