Can Morphine kill you?

Can Morphine kill you?

We are often afraid of the unknown, and although approaching an unfamiliar situation with hesitation is a normal reaction, this feeling can prevent us from choosing the best options. 

One of the best tools that hospices possess in their arsenal is Morphine. Unfortunately, there are a lot of myths about morphine—which may limit its administration to patients in the moments they need it the most.

It is not uncommon for family members or even healthcare workers to hold the incorrect belief that Morphine accelerates death when simply it is not the case. A painful death is not a dignified end to a loved one's life, a painful death can strain the heart which can cause a cardiac event. Morphine simply relieves the symptoms caused by a failing body.

No alt text provided for this image

What do the experts say?

In a conversation with Dr. Robert J Wielenga, we further explored the effects of Morphine and the myths surrounding this useful medication. It is important to note that our goal is to palliate the symptoms, we do not wish to sedate unnecessarily nor cause harm to our patients.

There are many possible routes of administration of the drug: as a tablet form both short and long-acting (MS IR vs MS Contin), rectally, subcutaneously, intramuscularly, intravenously, transdermally, sublingually (many are familiar with this easy-to-use, hard-to-overdose method of administration called Roxanol) 

"Our job is to control the pain-- we always aim to start low and go slow" Dr. Wielenga stated in our interview. Morphine continues to be the standard for pain management due to this medication's rapid onset of action, its safety, scalability, and reliability. The Centers for Disease Control recommends the calculation of all opioids in a 24hr period to be done in Morphine Milligram Equivalents (MME) 

No alt text provided for this image

When dosed appropriately there are very little side effects

To give a point reference Morphine has a one to one equivalency with Hydrocodone (this is the opioid used in Norco and Vicodin which more people are familiar with). 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 do I mention this? because essentially the starting dose of Roxanol (Liquid Morphine) for hospice is the same as one tablet of Norco 5/325, and the highest possible dose contained in the dropper or sublingual syringe is two tablets of Norco 10/325. These are not dangerous doses

As Dr. Wielenga mentioned, "as long as the patient has the pain that requires morphine there are very little side effects to it”. One of the advantages of the use of this narcotic is that "it's extremely effective" and "you can titrate it to where the pain is controlled but they're not having too many symptoms."

No alt text provided for this image

Effective pain management

The University of Pennsylvania Oncolink explains that Roxanol [Liquid Morphine] "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 use the starting dose of 5mg of Roxanol every 4 hours as needed. Hospices attempt to use the least effective dose first but if the suffering is not relieved then, a sound approach to pain management is to increase the dose before increasing the frequency. Again, this explains most hospices' approach to move to 10mg every four hours as needed, then 20mg every four hours as needed if the pain is uncontrolled. 

It is interesting to point out that in a conversation with Sameh Mounir -— Pharmacist in charge/ President at Trinity Care Rx— it is recommended that the patient does not eat or drink for 15 minutes after the administration of sublingual Roxanol as to allow enough time for the drug to absorb into the oral mucosa.

No alt text provided for this image

Our loved ones deserve a pain-free life and a dignified death

The National Center for Biotechnology Information published the article named "Killing the Symptom Without Killing the Patient" written by Romayne Gallagher MD CCFP, where he showed reported studies that point to the fact that appropriate use of opioids (like morphine) do not cause respiratory depression- In 27,000 patients the instances of respiratory depression were less than 0.5%. No significant relationship has been found between opioid dose, change of dose, use of sedatives, and time of death. 

I, however, per my time on the field as a nurse, have witnessed that when families withhold the use of Morphine on a suffering patient fearing that giving the drug will hasten the death-Or they wish to stop giving morphine in an attempt to "wake up" the patient in hopes for a lucid goodbye. The suffering, moaning, grimacing, agitation, shortness of breath, and air hunger are unbearable.

When Morphine is used appropriately the patient's quality of life improves. Pain affects many aspects of a person's life physically, emotionally, and psychologically. Appropriate pain management can lead to increased appetite, increased strength, and movement (many patients isolate themselves and are afraid to move as much due to fear of pain) improved social interactions as patients' moods are overall better when pain is controlled. Adequate pain management decreases blood pressure, decreases shortness of breath, improves oxygen -CO2 exchange, improves sleeping patterns. 

Sometimes we mean well, and our love blinds us, our hopes, our fears can overwhelm us, 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, dignified death.

Mary Belinda

Herbalist at Tree of life

3 年

My husband was diagnosed of Parkinsons disease 2 years ago, when he was 59. He had a stooped posture, tremors, right arm does not move and also a pulsating feeling in his body. He was placed on Senemet for 8 months and then Siferol was introduced and replaced the Senemet, during this time span he was also diagnosed with dementia. He started having hallucinations, lost touch with reality. Suspecting it was the medication I took him off the Siferol (with the doctor’s knowledge) and started him on PD natural herbal formula we ordered from TREE OF LIFE HEALTH CLINIC, his symptoms totally declined over a 3 weeks use of the TREE OF LIFE HEALTH Parkinson's disease natural herbal formula. He is now almost 61 and doing very well, the disease is totally reversed!?(w w w. treeoflifeherbalclinic .com)

回复

What a great article about Morphine. Thank you Jose and Dr. Wielenga and our excellent pharmacist Sam Munir.

回复

Thank you for this important work.

回复
Jasmine El Nabli MS, RDN, LDN

Senior Registered Dietitian | Nutrition and Science Expert | Strategic Partnerships and Physician Relations | Product & Media Communication

4 年

Such a great article! Thank you for this highly needed information!

回复

要查看或添加评论,请登录

Jose Escobar的更多文章

  • Nausea and vomiting impact quality of life- so how do we treat it?

    Nausea and vomiting impact quality of life- so how do we treat it?

    Imagine sitting still afraid that if you move, the overwhelming feeling of your stomach content desperately trying to…

  • We all poop...until we don't

    We all poop...until we don't

    There are many things we take for granted in life We don't know how important they are until we lose the ability to do…

  • Hospice Volunteer Program

    Hospice Volunteer Program

    I would like to share an article written by our Volunteer Coordinator here at Parentis Hospice. Mrs.

  • Spiritual Support

    Spiritual Support

    Pain, suffering, and discomfort are not always physical. When we are faced with such a daunting situation such as a…

    1 条评论
  • How does someone qualify for Hospice?

    How does someone qualify for Hospice?

    One of the most common questions people ask me is "How does someone qualify for Hospice?". This question is at the…

    2 条评论
  • Hospice is not what you think…you may be surprised

    Hospice is not what you think…you may be surprised

    She was lying down in a room with a nasal cannula blowing oxygen lightly into her nose, unable to get out of bed. Her…

    3 条评论
  • A Trojan Horse with devastating consequences

    A Trojan Horse with devastating consequences

    This year has been unusual for Joey to say the least. Seems like a lifetime ago when little Joey would pretend to be…

  • Compassion Fatigue

    Compassion Fatigue

    Florence was sitting in her car staring blankly at the windshield in front of her, she could hardly remember if she had…

  • This is how I entered the Medical Field

    This is how I entered the Medical Field

    It was my Senior year in high school when I was confronted with the very real thought that I would be graduating soon…

  • 08/01/1996.. My Life Changed Forever

    08/01/1996.. My Life Changed Forever

    A ten-year-old boy sitting in a plane flying on the way to Tijuana, as I look towards my parents and my two-year-old…

社区洞察

其他会员也浏览了