Understanding Hospice and Morphine

Like the word hospice, the word morphine can be frightening—until you learn more about it.

“Truly,” says Maite Hernandez, RN, national director of sales training at VITAS Healthcare, “morphine is a medication that is given even in the acute-care setting in the hospital.”

Morphine is a mainstay of pain relief. Physicians use it to alleviate patients' discomfort in situations ranging from childbirth to advanced cancer, and a patient expected to recover may benefit from morphine just as much as a patient in hospice care.

But patients and caregivers who hear the word morphine sometimes fear that their physician has given up, that they or someone they love will be heavily sedated and left to die. And physicians who do not—in the normal course of their practice—routinely prescribe advanced pain medications can be leery of prescribing morphine.

In these cases, your doctor can consult with a hospice or palliative doctor for guidance. Hospice and palliative care physicians have both the expertise and experience in opiates to control their patients’ pain quickly using as little medication as possible. They then titrate, monitoring each patient’s dosage and symptoms to reach the right level of pain control with the fewest side effects for that patient.

No One Needs to Live in Pain

No one at any stage of life should live in pain. Almost all pain can be alleviated with medications. With pain reduced to a tolerable level, the person can eat and sleep, be mentally alert and maintain a level of independence, dignity, and self-care. Bottom line: morphine can improve quality of life.

Opiates, which can be taken by mouth or intravenously, include morphine, codeine, hydrocodone, oxycodone, hydromorphone, etc. Opiates are derived in nature from opium poppies. Opioids are manufactured drugs that have the same effect as the natural opiates. Both kinds of medications are strong, safe and effective painkillers when prescribed and used appropriately.

Morphine and Respiratory Distress

For hospice patients who have trouble breathing, small amounts of well-controlled and regularly titrated morphine can help ease respiratory distress by decreasing fluid in the lungs and altering how the brain responds to pain. Beyond slowing rapid breathing, morphine also eases the anxiety of struggling to catch one’s breath. Once breathing is controlled, physicians adjust doses regularly based on the type of morphine used, and each patient’s unique tolerance level and specific respiratory symptoms.

A 2019 study by two VITAS respiratory therapists in Chicago (Lukcevic, A., and McCoy, V., published in Symbiosis) found that small amounts of aerosolized morphine can also serve as a bridge to easier breathing in a select group of hospice and palliative care patients—most of them diagnosed with lung cancer, severe lunge disease, or respiratory failure linked to other diseases. This delivery method works best for patients who have few remaining options to treat respiratory distress or for whom conventional breathing treatments are no longer effective.

In most patients, small oral dosages of morphine titrated toward relieving respiratory distress is very successful and well-tolerated.

Things to Know

There are some valid concerns about taking morphine that can be addressed quickly and directly:

Sleepiness and lethargy: Morphine can cause some sedation initially, but this effect decreases within a few days. By easing pain and making breathing easier, opiates allow the patient to finally get some much-needed sleep. Once the patient is feeling more comfortable and rested, interest in normal life activities often increases.

Nausea: Nausea may initially occur but tends to wear off after a few days of taking morphine. In the meantime, nausea can be treated with a limited amount of additional medication. 

Constipation: Constipation should be expected with morphine and other opiates/opioids, and treated aggressively to ensure patient comfort.

Less effective over time: Tolerance is possible but not often a problem when morphine is used to control pain. It is more likely that the disease has worsened over time, a change that results in increased pain. The hospice physician can increase dosage if and when pain increases. Physicians generally start with low doses of morphine; if the pain increases, the dose can be increased. 

Addiction: Addiction is rare (less than 1%) in patients taking morphine for pain. However, it is true that after two weeks or more of taking morphine, it should not be halted abruptly. The body needs to be weaned off opiates so it can adjust, which is normal human physiology and not addiction.

If you or someone you love has a condition that causes acute or chronic pain and over-the-counter drugs like acetaminophen or ibuprofen are not effective, talk to your doctor about prescribing an opiate.

“One of the beautiful things that hospice can do is provide 24-hour care in the home when there's an acute symptom to manage,” says Maite. “So if a patient is started on morphine because there's an acute symptom such as pain or respiratory distress, there will be a nurse there to monitor that.”