Morphine is one of the best tools a hospice has for managing pain. Unfortunately, myths about morphine harm patients and prevents them from receiving care when they need it most. It is not uncommon for family members or even healthcare workers to believe, incorrectly, that morphine accelerates death. This is simply not the case. When people ask “Can morphine kill you?” I tell them what years of research and experience have taught us. In proper dosage, morphine is an effective way to relieve the symptoms and suffering caused by a failing body.
We are often afraid of the unknown and it is normal to hesitate in an unfamiliar situation, especially when it involves a loved one. However, this feeling can prevent us from choosing the best option for them. If not carefully managed, pain can strain the heart, triggering a cardiac event. A painful death is not dignified, and robs patients of peace and serenity in their final days.
What Do the Experts Say? Can Morphine Kill You?
To explore the effects of morphine and the myths surrounding it, we spoke with Dr. Robert J. Wielenga, a board-certified physician specializing in family medicine and geriatrics.
“Our job is to control the pain – we always aim to start low and go slow,” said Dr. Wielenga. He told us there are four reasons why morphine continues to be the standard for pain management.
- Rapid Onset of Action
There are many possible was to administer morphine:
- Tablets, both short and long-acting (MS IR vs. MS Contin)
- 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.
It is important to note that our goal is to alleviate symptoms. At every stage, we act to prevent harm and avoid sedating patients unnecessarily.
When Dosed Appropriately, Morphine Has Few Side Effects
Healthcare providers give morphine in the same dosage as hydrocodone, the opioid used in Norco and Vicodin. Two of the most common doses of Norco are 5/325 (5mg of hydrocodone with 325mg of Tylenol [acetaminophen]) and 10/325 (10mg of hydrocodone with 325mg of Tylenol [acetaminophen]).
Why mention this? Because essentially the starting dose of Roxanol (Liquid Morphine) is the same as one tablet of Norco 5/325. The highest possible dose for dropper or sublingual syringe is two tablets of Norco 10/325. These are not dangerous doses.
As Dr. Wielenga notes, “as long as the patient has pain that requires morphine, there are very little side effects to it.” One of its advantages is that it is “extremely effective. You can titrate it to where the pain is controlled, but they’re not having too many symptoms.”
Effective Pain Management
According to the University of Pennsylvania Oncolink, Roxanol “will begin working to relieve pain in 15 to 30 minutes and reaches its peak effect in 1 hour. It will continue to work for 2 to 4 hours”.
This is mainly why most hospices start with the least effective dose: 5mg of Roxanol every four hours as needed. If this does not receive the patient’s suffering, then the best approach is to increase the dose before increasing its frequency. Standard procedure in most hospices is to move to 10mg, then 20mg, every four hours as needed, if the pain is uncontrolled.
Sameh Mounir, Pharmacist in Charge/ President at Trinity Care Rx, recommends patients do not eat or drink for 15 minutes after the administration of sublingual Roxanol, to ensure it is absorbed into the oral mucosa.
Our Loved Ones Deserve a Pain-Free Life & a Dignified Death
In 2010, the National Center for Biotechnology Information published the article named “Killing the Symptom Without Killing the Patient” written by Romayne Gallagher MD CCFP, which reviews studies indicating that appropriate use of opioids (like morphine) does not cause respiratory depression. In 27,000 patients, instances of respiratory depression occurred in less than 0.5% of cases. No significant relationship has been found between opioid dose, change of dose, use of sedatives, and time of death. The question is not “Can morphine kill you?” but “Can morphine help you?”
In my time in the field as a nurse, I have seen that when families withhold morphine from a suffering patient, fearing that giving the drug will hasten the death, or stop it in an attempt to wake the patient up, in hopes of a lucid goodbye, the suffering, moaning, grimacing, agitation, shortness of breath, and air hunger are sometimes unbearable.
When used appropriately, morphine improves a patient’s quality of life. Pain affects a person’s physical, emotional, and psychological well-being. Morphine is the best tool we have to manage pain. Properly administered, it can lead to increased appetite, strength, and movement. (Many patients isolate themselves and are afraid to move due to fear of pain.) Controlling pain puts patients into a better mood, which improves social interactions. Adequate pain management also decreases blood pressure, reduces shortness of breath, boosts oxygen -CO2 exchange, and improves sleeping patterns.
Can Morphine Kill You?
When it is administered by qualified caregivers, morphine will not kill you. Instead, it can be an invaluable tool to help care for patients with advanced illnesses. By helping them cope with their symptoms, morphine gives them the opportunity to see their life through with dignity.
Deciding how to care for a loved one with a life-limiting condition is never easy. It is ok to be scared. This is hard, but we have to advocate for our loved ones and respect their wishes of a pain-free life and peaceful end.
Questions? Visit Parentis Hospice Care to learn how we work with families to provide dignity and comfort to patients facing life-limiting illnesses.