Can Morphine Kill You?

The importance of morphine in hospice care

Morphine is one of the best tools hospice has for managing pain. However, it’s also one of the most misunderstood. Myths about the dangers of morphine have persisted for centuries. For example, these include the drug’s potential to cause respiratory depression to claims that morphine can kill someone.

Myths about morphine can have a direct, negative impact on patient care. It is not uncommon for family members or even healthcare workers to fall victim to pervasive misinformation. Consequently, they may believe incorrectly that morphine accelerates death. Nothing could be further from the truth.

Since 1805, morphine and its derivatives have been the leading painkiller of choice for physicians. As a result, they used morphine for everything from treating chronic pain to advanced medical illnesses.

Properly administered morphine is a highly effective way to relieve the symptoms and suffering caused by a failing body.

In this article, we’re going to discuss the safety of morphine and its importance in hospice care. As a result, we hope that you’ll see the benefits of this medication for end-of-life care.

Why and how morphine is administered

In the simplest terms, morphine is provided to relieve pain quickly. Additionally, few other medications work quite as rapidly to ameliorate severe pain.

There are four main reasons why morphine continues to be the gold standard for pain management:

1. Rapid onset of action
2. Safety
3. Scalability
4. Reliability

The most common methods to administer morphine include:

• Orally, via tablets, in both short and long-acting forms
• Rectally
• Subcutaneously (under the skin)
• Intramuscularly (into the muscle)
• Intravenously (through the bloodstream)
• Transdermally (through the skin)
• Sublingually (under the tongue)
  • Sublingual morphine (brand name: Roxanol) is easy to use and hard to overdose. This makes it a standard medication amongst hospice care providers

Morphine, opioids and safety

A 2010 National Center for Biotechnology Information article looked at the appropriate use of opioids (like morphine). They found that opioids did not cause respiratory depression.

This was based on a comprehensive review of existing studies. In other words, no significant relationship was found between the following:

• opioid dose

• change of dose

• use of sedatives

• time of death

The multiple studies surveyed included the largest study of patients in hospice care in North America. Consequently, no significant correlation between the increased dosage of morphine and death was found. Even double-doses of short-acting morphine did not increase the likelihood of fatalities.

When used appropriately, morphine improves a patient’s quality of life. Properly administered, it can also lead to increased appetite, strength, and movement. Additionally, controlling pain puts patients in a better mood, which improves social interactions.

Adequate pain management also:

• decreases blood pressure

• reduces shortness of breath

• boosts the exchange of oxygen and carbon dioxide (CO2)

• improves sleeping patterns

Dosage and efficacy

Hospice care providers give morphine in the same dosage as hydrocodone. This is the opioid used in the commonly-prescribed medications Norco and Vicodin. For instance, two of the most common doses of Norco are 5/325 (5 mg of hydrocodone with 325 mg of acetaminophen) and 10/325 (10 mg of hydrocodone with 325 mg of acetaminophen).

The starting dose of Roxanol (liquid morphine) is the same as one tablet of Norco 5/325. The highest possible dose for a dropper or sublingual syringe is two tablets of Norco 10/325. Certainly, these are not dangerous doses.

Roxanol takes effect quickly after sublingual administration. It begins to take effect within 15-30 minutes, with its peak effect an hour after dosage. The medication lasts for upwards of four hours.

To ensure maximum efficacy, patients generally don’t eat or drink for 15 minutes. This allows the medication to become fully absorbed into the oral mucosa.

Most hospice care providers, including Parentis Health, start with the smallest dose. This is 5 mg of Roxanol every four hours as needed. If the lowest dosage doesn’t relieve the patient’s suffering, the dosage is increased rather than its frequency. The standard procedure in most hospices is to move to 10 mg, then 20 mg. This is given every four hours as needed if the pain is uncontrolled.

And, most importantly, when used in a controlled setting, administered by qualified caregivers, morphine is an invaluable drug for patients with advanced illnesses.

By helping them cope with their symptoms, morphine gives them the opportunity to see their lives through with dignity. This affords them more quality time with friends and family as they remain as comfortable for as long as possible.

Final thoughts

In conclusion, morphine is a safe and effective medication that is commonly used in hospice. When used appropriately, it can ease a patient’s symptoms and give them comfort and dignity.

Rather than passing on misinformation, it’s important to be educated about the uses of morphine.

¹https://www.uchicagomedicine.org/forefront/news/as-morphine-turns-200-drug-that-blocks-its-side-effects-reveals-new-secrets#:~:text=Since%201805%2C%20morphine%20and%20its,illness%20and%20post%2Doperative%20analgesia. Accessed 3 November 2021.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902941. Accessed 3 November 2021.