Research findings contradict longstanding bias against morphine

November 30, 2005

PORTLAND, Ore. - A report written by an OHSU physician with more than a half century of medical experience contradicts both public and professional bias against the use of morphine in the final stage of life for patients with breathing difficulties. Because large amounts of morphine slows breathing, doctors have avoided prescribing the drug to dying patients with breathing difficulties for fear it would shorten life. However, the author of this new case series suggests that some patients who receive an appropriate level of morphine live a little longer because their fear and struggle for breath are reduced. The research is published in the current issue of the Journal of Palliative Care.

"Much has changed in health care since the initial concerns about morphine and breathing difficulties were documented in the 1950's," said Miles Edwards M.D., Professor of Medicine Emeritus in the OHSU School of Medicine and a clinical consultant the Center for Ethics in Health Care at OHSU. "For decades, physicians have been advised to avoid prescribing even small doses of morphine to dying patients with breathing difficulties based on the traditional belief that the drug made breathing more difficult and hastened death. However that line of thinking seems to be a medical urban legend. In fact, this age-old advice should likely be reversed for some patients. By slowing down breathing with morphine and controlling panic, patients become fatigued less quickly. They are breathing at a slower pace, but they also require less oxygen so the condition and the drug don't act in conflict with one another as one might think."

The research paper focused on five case examples involving patients who had been given appropriate doses of morphine to control their suffering in the final stage of life after a ventilator was removed. This case series focused on patients who were on ventilators at the end of life and who wanted the ventilators withdrawn. The major finding of this case series was that each of the patients lived longer than predicted by their physicians when morphine and sedation were provided. The paper provides details about each of these cases, contradicting the longstanding beliefs that moderate doses of morphine hasten death by suppressing breathing.

"Overall, the appropriate use of morphine in the final minutes, hours or days of life is becoming a more accepted practice by doctors nationwide," explained Susan Tolle, MD., Director for the Center for Ethics in Health Care at OHSU. "If a person feels that they are suffocating, they struggle for oxygen and panic sets in. Much like a scuba diver who panics, these patients are trying to use more oxygen than is available to them. What Dr. Edwards has learned is that an appropriate level of morphine can suppress this anxiety allowing a person to survive on less oxygen and live longer. It also allows these patients to live out their final minutes, hours or days of life in a more peaceful manner."
-end-


Oregon Health & Science University

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.