We’re going to tackle five common morphine myths that tend to circulate around the internet. Let’s dive right in!

Myth #1: Hospice gives morphine because it kills people. Reality is lots of things can kill people and yes that includes morphine. However, this notion that hospice uses morphine for this reason is just not true. Morphine, along with every other opioid, is dosed using equianalgesic dosing, meaning one opioid is dosed equivalent to another. So, if one takes a hydrocodone/acetaminophen (Vicodin) for a dental procedure, taking an equivalent dose of morphine yields the same result. Now that is vastly different than taking an entire bottle of morphine, or even Vicodin for that matter. It’s extremely helpful to remember these opioid steps. As the dose of an opioid goes up you generally get analgesia; then sedation; then loss of consciousness; then respiratory depression; then death. So as long as morphine, or any opioid for that matter, is being dosed and titrated appropriately, then hastening death with opioids is just a myth.

Myth #2: I have to reserve morphine for the end. This myth stems from fear. As we noted above, equianalgesic dosing is standard practice so this should never be the worry. Tolerance on the other hand, can occur with all opioids, and opioid rotations are very effective. So, this idea of leaving morphine on the sidelines till the last play in the game doesn’t clinically hold any weight; morphine can be used to manage symptoms at any time.

Myth #3: We increased their morphine from 5mg to 10mg and they took their last breath. Did we end their life? Absolutely not! If you remember from the steps above in the opioid path from analgesia to death, incremental titrations that are clinically appropriate will not hasten a patient’s death. It goes without saying, inappropriate dosing i.e. morphine 5mg then next dose you gave 1000mg, that is an overdose and separate from this conversation. Overall, we find that it is not uncommon for a patient to “let go” during a stage of relief (pain, anxiety, shortness of breath etc.). So that bump in opioid yielded some symptom relief and allowed the patient to pass away peacefully.

Myth #4: Morphine is more addicting than other opioids. This is not true, addiction is a complex medical process, far more than can be discussed here. However, in the face of true physical pain, development of addiction is very rare and would not be a concern with a patient at end of life.

Myth #5: Morphine will slow my breathing causing me to die. No this is not true. It is true that morphine is used at end of life for shortness of breath/dyspnea. We also know that the sensation of dyspnea at end of life does not always correlate to a low oxygen (O2) saturation. The mismatch that the body produces centrally between drive to breath harder and faster vs. the actual oxygen exchange is at play here. Morphine does calm the body’s ability to perceive the need i.e. central mediated drive and brings it back into line with the physical needs of oxygen exchange. Remember from above, the opioid steps from analgesia to death and remind yourself under normal dosing guidelines you are not treating dyspnea in someone who entered the sedation and loss of consciousness phase, and you need to enter those before respiratory depression and death.

Note: This is part 2 of the morphine mini-article series.