For decades, patients, caregivers, and sometimes even hospice staff have erroneously believed that morphine use hastens death. However, these same people have continued to use morphine believing that the provision of a pain-free death is more important than extending the dying process. After the death of a loved one who was treated with morphine or other opioids at the end of life, too many caregivers are left with feelings of unrest regarding having allowed the opioids to be used. In order to prevent caregivers from carrying around guilt years after the death of their loved one and to eradicate these long-standing, widespread myths, education regarding the erroneous nature of these ideas should be provided to all hospice staff, patients, and caregivers, regardless of whether they verbalize belief in such myths or not.
Several common myths can be easily countered by the facts surrounding morphine and its appropriate use.
Myth: Caregivers are at high risk of expediting death if administering morphine as needed to control the patient’s pain.
Truth: Morphine would have to be administered at doses that would cause bothersome toxic effects such as distressing agitation and/or myoclonic twitching before causing death. Morphine has a wide therapeutic range, making actual overdose rare. Even when high doses of morphine (greater than 300 mg/day) are necessary for pain control, patient survival is not affected.
Myth: Morphine will make patients comatose.
Truth: Morphine can cause some sedation initially, but this effect decreases within a few days. Due to its actions to decrease pain and ease shortness of breath, hospice staff often observe that morphine enables patients to catch up on sleep that has been lost as a result of these distressing symptoms. Thus, patients will likely sleep more once morphine is initiated but not because the drug is inducing a comatose state.
Myth: Morphine will cause respiratory depression along with pain control, expediting death.
Truth: Studies show that if opioids are titrated against symptoms, they do not hasten death. Also, patients develop a tolerance to the potential respiratory depression effects of morphine at oral doses of 60 mg per day or greater, such that respiratory depression rarely occurs in patients who have been on morphine for more than seven days.
References:
- Bercovitch M, Waller A, Adunsky A. High dose morphine use in the hospice setting. A database survey of patient characteristics and effect on life expectancy. Cancer. 1999 Sep 1;86(5):871-7.
- Bercovitch M, Adunsky A. Patterns of high-dose morphine use in a home-care hospice service: should we be afraid of it? Cancer. 2004 Sep 15;101(6):1473-7.
- Stokowski, L. (2010, Dec 6). Adult cancer pain: part 2. Medscape Multispecialty. Retrieved from http://www.medscape.com
