The Myths of Morphine in Hospice Care
Morphine. It is a relatively small word that often evokes big emotions and can instill fear and hesitancy when discussed. Part of the fear can certainly stem from the shock, denial, grief, and overwhelming stress of facing a terminal illness. Another source of fear is likely due to the wealth of misinformation and misconceptions about morphine portrayed on tv shows, in movies, and in other media. Even in the healthcare world, there are many providers and practitioners who have misgivings about morphine use as there is very little time and focus on end-of-life care in medical or nursing school curriculums. It is no wonder that so many people hold myths about morphine to be true.
Below, I have outlined several of the most common misconceptions surrounding morphine that I regularly address with patients and families with the hope of increasing understanding and acceptance of morphine in hospice and palliative care.
Myth: “I don’t want to get addicted.”
Fact: It is incredibly rare for someone with a life limiting illness who has genuine pain or shortness of breath to become addicted to morphine. If the medications are being taken as prescribed for true symptoms, addiction is very unlikely. According to Tidewell, patients taking morphine do build a tolerance, which means that over time, they may need to increase their dose as their disease advances, or they become accustomed their current dose. This is normal and expected and not a sign of addiction.
Myth: If morphine is taken too soon, it will not be effective at the end-of-life.
Fact: As stated from Hospice of Southern Illinois, taking morphine for pain or shortness of breath early or mid-disease process does not mean that it will not work later. Morphine does not have a ceiling or maximum dose, which means that the nursing staff can work with providers to increase the medication dose safely and gradually if needed over time for increased symptoms.
Myth: Morphine causes over sedation and mental “fogginess.”
Fact: Like all medications, morphine has the potential to cause side effects. Some people do feel tired and more lethargic when they begin taking morphine. This is normal and expected. It typically takes two to three days for the body to adjust to morphine when first introduced into their system. This particular symptom is temporary and clears over time.
It is incredibly rare for someone with a life limiting illness who has genuine pain or shortness of breath to become addicted to morphine.
Myth: Morphine causes respiratory depression.
Fact: Hospice patients are initially started on a very low dose of morphine which can gradually be increased over time if needed; this prevents unsafe drops in breathing rate. As stated in Tidewell, “Let Me Teach You”, when used as prescribed, morphine actually helps reduce symptoms of shortness of breath and air hunger in addition to pain symptoms.
Myth: Taking morphine “means I’m dying.”
Fact: According to Get Palliative Care, morphine being prescribed and given does not necessarily mean a patient is actively or imminently dying. Many opioid drugs such as hydrocodone (also known as Vicodin), oxycodone, hydromorphone (also known as Dilaudid), or fentanyl are used throughout the lifespan (including end-of-life care) to control pain for various reasons. These medications are in the very same class of drugs as morphine, yet very few people realize this or associate them with the same end-of-life care. These drugs are used under the direction of a medical provider for symptom management, just as morphine is. Many hospice and palliative care patients take morphine to manage symptoms of chronic illness for weeks, months, or even years prior to the time of death.
Myth: Taking morphine causes pre-mature death.
Fact: There is little to no evidence that using morphine for symptoms of moderate to severe pain or shortness of breath causes a pre-mature death, according to Palliative Care Network of Wisconsin. Many patients experience a noticeable difference in quality of life and when they have well controlled symptoms. Patients on hospice have one or more terminal and life limiting illnesses, so when they have signs of decline and dying, it is due to their disease progression, not because they are taking medications to reduce and control their symptoms
Morphine has been successfully used for centuries and continues to be one of the gold standards available to ensure relief of pain and comfort. Choosing to use morphine is certainly not a decision to be made lightly, but when disease progression and symptoms reach a certain point, it becomes a useful and necessary tool in improving quality of life.
Having been a hospice nurse for over a decade, I have worked with countless patients who have used morphine to successfully manage symptoms throughout their care. Education and reassurance are the keys to moving through misinformation. I am hopeful with accurate information, the myths and misconceptions surrounding morphine will be dispelled.
This blog post was shared by Keri S., Registered Nurse at Unity Hospice.
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