Do Hospices Overuse Morphine

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Last Updated on September 6, 2021 by Frank Davis

Several studies report that Hospices use Morphine in between 66-93% of patients. Many types of opioid medications are currently available, but morphine is perhaps the most widely used and commonly prescribed pain reliever in hospice care.

A common misconception is that hospices overuse morphine, which is not true. This myth may have developed as a result of its common usage during the end stages of life. It is often the case that as a disease progresses, the pain will increase. Family members may observe nurses administering pain medication more frequently and assume that the medication is the cause. When in fact, it is the disease which is the problem and the medication is used to relieve the pain.

In this article, we will discuss why it is unlikely that hospices will overuse or overmedicate their patients.

Morphine is given as needed

A prescription for morphine is usually written on an “as-needed” (PRN) basis. Morphine is not given unless specifically asked by the patient to relieve pain. This implies that the administration of morphine will not be given at the discretion of the hospice staff, but at the discretion of the patient. Why is this important? Well the hospice nurse and other staff can not just give the medication when they hospice staff feels like it, rather it is given when the patient is feeling pain and he asks for it.

When it comes to managing the pain of most terminal illnesses, it is usually best to try to prevent the pain in the first place. This is a much better approach rather than allowing the pain to strike and as a result take in extra doses. To do this the patient can provide a schedule of when to take the medication. For example, if the patient knows that medications effect will wear off every 5 hours. The patient can tell the nurse to administer the medication every 4 hours, in order to prevent pain. Again, this is at the discretion of the patient.

When giving Morphine to a patient the physicians usually goes over the benefits and risks that it may have. The patient is assessed if the medication can be given safely. Morphine is generally administered at lower doses then progressively increased only as needed to achieve appropriate comfort levels. When given appropriately Morphine is safe and there is a very low probability of an overdose.

Family and close friends assist in giving medication

In households, the primary caregiver usually handles all the patient’s non-medical home care needs, and assists with giving medication as needed. The primary caregiver, who is usually a family member or close friend, spends a majority of the time with the patient. Typically, the patient and caregiver are in charge of the medication when the nurse is not there. Over 90% of the time it will be the caregiver who will assist in giving the medication as need.

Nurses are on call 24/7, however, they come by periodically for one hour visits about three times a week. Regular visits are usually conducted to assess the patient’s condition and measure the effectiveness of their medication. Once the nurse visits she normally records the pain levels, when the last does was given, and the patient’s vitals signs.

Asking questions is one of the most important things you can do to learn why a medication is given to your loved one. Feel free to ask, if you have any questions regarding the medication. In any case, the staff should have no difficulty in answering your questions. After all, it can help clear up any misunderstandings you may have.

Patient Controlled Analgesia (PCA)

A patient controlled analgesia (PCA) pump lets you give yourself IV pain medicine when you need it. The pump contains your medication, normally morphine, but others medications can be used as well. When you receive pain you can press the button which will give you a controlled dose of medication. The PCA pump will not allow you to give yourself more than what is prescribed, the pump is set to prevent that. It is usually given to patients after a surgery or if they have very bad cancer pain. PCA pump works well because you can give yourself medication before the pain gets too bad. These pumps can often be used at home.

Overdose Reversal With Naloxone

There is a new law in California that became effective on January 1, 2019. The law requires prescribers to educate patients regarding the prevention of overdose, along with prescribing Naloxone if necessary. This is good because Naloxone is the antidote to Morphine; it reverses its effects. Those with difficulty breathing, difficulty concentrating or other symptoms of an overdose are given Naloxone.

It is important to know the difference between opioid toxicity and the symptoms of actively dying. They both have similar effects in which the breathing and concentration changes. This is why nurses are trained to be able to tell the difference. Because if Naloxone is given and there is no opioid toxicity, it can in turn make the patient feel severe pain.

In most cases, Naloxone is prescribed when one or more of the following conditions are present:

• The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day
• An opioid medication is prescribed concurrently with a prescription for benzodiazepine
• The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant

Conclusion

There are many misconceptions about hospice care, one misconception is that Hospices overuse Morphine. This is simply not true. Morphine is commonly used as a pain reliever and to treat shortness of breath. It is very effective in treating pain in people who have a terminal illness. As stated earlier, it is extremely unlikely that hospices will overuse morphine, as morphine is prescribed as needed, and medications are usually under the watchful eye of family and friends. Also a patient control analgesia pump will not allow the patient to give themselves a higher dose than prescribed. When the patient shows signs of opioid toxicity, Naloxone is available to reverse the effects of Morphine.

False myths about drugs could cause patients to suffer more than they already have. If you have a family member or friend who believes this myth, share this information or educating them is the best course of action.