For Providers

Dr-2-Dr: Morphine Use in Hospice Care — Myths Versus Truths

By Dr. Tiffany Richter, Chief Medical Officer

September is Pain Management Month.  Pain management is a key component of hospice care, along with other symptom management, emotional, and spiritual care. 

Morphine is one of the most commonly prescribed opioids in hospice care, with over 60% of hospice patients being prescribed opioids.

In hospice settings, morphine is commonly used to manage pain, shortness of breath (Dyspnea), and other distressing symptoms. Morphine is a preferred opioid at the end of life for several reasons. It is the least potent of all opioids which allows for use in patients who have never needed opioids previously. It also can be given in many forms such as long-acting pills, short acting pills, liquid, liquid concentrate, IV, and subcutaneous. This is vital at the end of life as patients’ ability to swallow changes and pain or symptoms can change quickly.

There are several myths about the use of morphine in hospice care that can contribute to misunderstandings or reluctance in using
it appropriately.

Myth: Morphine will hasten death.
Truth: Morphine may improve comfort, making the dying process more peaceful, but it does not speed up death when titrated appropriately.

Myth: Morphine causes addiction in hospice patients.
Truth: Hospice care uses morphine to manage symptoms. The goal is comfort, not to prolong life or induce dependency.

Myth: Morphine makes patients “too sedated” and unresponsive.
Truth: Morphine is used to provide comfort, and the goal is to manage pain and symptoms without over-sedating the patient.

Myth: Using morphine means the hospice team has “given up.”
Truth: The use of morphine does not indicate the team has “given up;” it reflects a commitment to ensuring that the patient is as comfortable and pain-free as possible in their final days. Patients’ goals change as time shortens.

Myth: Morphine is only given when a patient is actively dying.
Truth: Morphine can be given as part of ongoing symptom management, starting when the patient first needs it, rather than waiting until death is imminent.

The use of morphine in hospice care requires open and honest communication between the healthcare provider, patient, and family. Our hospice teams are trained to have these sensitive conversations, ensuring that the patient’s wishes and comfort are the highest priority.

Patient satisfaction in hospice care is notably higher when pain is well-managed with morphine or other opioids.

Studies show that up to 90% of hospice patients experience significant pain relief with opioid medications like morphine.

Research indicates that appropriate morphine use in hospice care can significantly improve the quality of life for terminally ill patients by reducing pain and anxiety.