Category: Opioid Epidemic

Posted on

Does Morphine Speed Up Death At The End Of Life?

— What We Know

By Jennifer Anandanayagam

Morphine, an opioid medicine that is prescribed for pain relief, is not without controversy. When there are strong concerns about substance abuse and addiction to the narcotic, people often wonder things like “Is it safe to take morphine?” or “How long does morphine typically stay in your system?”

If you were to talk to hospice care workers, you’d probably hear that this powerful pain relief medication also gets a bad rap in their world. One of the common concerns is if giving morphine to your dying loved actually brings about their death sooner.

According to palliative care professionals, when proper dosage and timeliness of administration are followed, there is no basis for this fear. In fact, according to Hospice of the Chesapeake‘s Director of Education and Emergency Management, Elisabeth Smith, giving the right amount of morphine to someone who’s having trouble breathing might actually help them breathe better. For someone with breathing difficulty brought on by conditions like terminal lung disease, “it can feel like you’re drowning, gasping for air,” explained Smith. “Morphine opens the blood vessels allowing more blood circulation within the respiratory system. This makes it easier for the lungs to get the bad gases out and the good gases in. The patient becomes calm, their breathing slows down.”

Morphine doesn’t speed up death

It’s easy to see how the notion of morphine bringing death sooner to someone who’s dying came about. We can blame creative outlets like movies and books and also the lived experiences of some people who report seeing their loved ones’ lives slip away while on the opioid.

But morphine, when administered correctly, can bring a lot of relief and improve the end-of-life experience of someone, mainly because it blocks pain signals and helps with a lot of distressing sensations someone might be feeling in the final moments before death (per Crossroads Hospice & Palliative Care), like shortness of breath, pain, restlessness, and agitation.

Palliative care professionals are well-versed in how to start, sustain, and increase (when needed) morphine dosage according to the requirements and comfort levels of their patients (per Canadian Virtual Hospice). When someone is first put on the narcotic, the dose is very low and this dosage is maintained until the person gets used to it. Only a large dose can prove harmful (a fatal overdose might require 200 milligrams). That being said, morphine, like other pain medications, comes with its own set of side effects like drowsiness, digestive issues, stomach cramps, and weight loss (per Mayo Clinic). As explained by Elisabeth Smith from Hospice of the Chesapeake, sometimes suffering can prolong death too and it can look like the person passed away sooner when morphine was administered to them, simply because their discomfort was taken away and death was allowed to come in its own time.

Should you be concerned about administering morphine?

Ultimately, no one can answer that question but you, but hospice care workers urge loved ones to be correctly informed of the intricacies of why morphine is given in the first place and how it’s done in a professional setting. 

Pain is part of the dying process and if pain medications such as morphine can relieve some of the suffering, it might be one of the kindest things you can do for your loved one. You might be giving them a little more independence to be able to eat and drink without discomfort, sleep better, and even maintain better cognitive capabilities (per Vitas Healthcare). Ask questions from healthcare professionals and have them explain what the drug does exactly. Sometimes, having the right knowledge can assuage some of your fears. 

Dr. Daniel Lopez-Tan from Legacy Hospice shared that the idea that morphine speeds up death could have arisen because the opioid is commonly associated with end-of-life care. “The patient is dying of other causes and morphine only softens the symptoms of the last moments of life … One of the effects of morphine called respiratory depression does not occur with small, controlled doses of short-acting opioids, especially when under the supervision of a healthcare professional,” added the doctor.

Complete Article ↪HERE↩!

Posted on

Fear of ‘perfect storm’ with opioid prescribing and terminally ill patients

A prominent academic wants to alleviate GPs’ concerns about potential professional repercussions – and prevent them from leaving palliative care.

By Matt Woodley

Dr Geoffrey Mitchell, Professor of General Practice and Palliative Care at the University of Queensland, recently wrote an article on the ‘very public’ debate relating to opioid use, and tension between standard end‐of‐life care and voluntary assisted dying, as a ‘perfect storm’ that is impacting GPs and other health professionals.

‘Some are choosing to abandon end-of-life care altogether rather than risk professional ruin should they persist in the use of any opioid therapy,’ Professor Mitchell said.

Professor Mitchell cited previous newsGP articles as evidence doctors are worried. He said he was motivated to write his article in order to help alleviate concerns and prevent a wave of GPs from leaving palliative care.

‘[GPs responding like this was] no surprise to me. I’m aware of the risk-averse nature of a lot of GPs and the fear of litigation is quite high with some of my colleagues,’ he told newsGP.

‘The fear is that the use of medicines to minimise suffering and distress at the very end of life may hasten death and be construed by critics as euthanasia by stealth.

‘The reality is that the person is dying. While treatments such as opioids may theoretically shorten life marginally, it is the disease that causes death, not the treatment.’

In a recent ABC interview, RACGP President Dr Harry Nespolon agreed with this position and reiterated that the college is alarmed about the impact increased scrutiny on opioid prescription is having on doctors providing palliative care.

‘Good palliative care does require the use of high-dose opioids, and that’s what patients deserve,’ he said.

‘They deserve a good death and a painless death. All this is doing is asking doctors to prescribe fewer opioids for patients who really should be getting them.’

According to Professor Mitchell, the increased emphasis on opioid diagnosis, combined with incoming voluntary assisted dying laws, has emboldened critics of palliative care and led to misinformation that can actually harm patients.

‘If [terminally ill patients] need strong opioid medication and can’t get it because their doctor won’t prescribe it, well then that’s the other side of the coin – the person is going to be suffering unnecessarily in their final days and hours, and that is unacceptable,’ he said.

‘Critics of palliative care think it’s quite often assisted dying under a legal guise, which is not true.

‘It’s just wrong, but it’s out there and so people who might not be feeling particularly confident about what they’re doing will say, “Well, I don’t want a bar of it”.’

However, despite the current climate of fear, Professor Mitchell believes a study he co-authored last year should go some way towards alleviating litigation concerns and help ensure patients receive proper medical care.

‘Of all case law online and all tribunals, all settings, we found 12 cases. Of those, only two had adverse findings recorded, and neither led to criminal proceedings,’ he said.

‘What that says is that if your case is looked at, if you’ve shown due care and attention, the likelihood of getting into trouble is negligible.

‘Many of the cases were … findings which were more to do with system issues, rather than personal issues.

‘Things go wrong, obviously, and they have to be looked at, but because people by and large know how to use opioids or are cautious about their use, when things go wrong it’s usually not the person, it’s something else.’

Complete Article ↪HERE↩!

Posted on

Memorial Map Offers Way to Mourn, Remember

After his own addiction-related loss, one man created a tool to help others heal.

Family members embrace in a cemetery on March 6, 2016, in Plantsville, Conn., to commemorate the first anniversary of the fatal heroin overdose of a loved one.

By Steve Sternberg

Jeremiah Lindemann’s “Celebrating Lost Loved Ones” project is a map of lost lives, a moving collection of crowd-sourced tributes from family and friends to those who have died of drug overdoses.

A digital mapmaker by training, Lindemann understands the geography of grief. More than a decade ago, he lost his kid brother to a drug overdose. Jameson Tanner Lindemann – J.T. to his family and friends – may have been introduced to opioids not by a dealer on the street, but by the well-intentioned dentist who removed his wisdom teeth.

J.T. died Sept. 13, 2007, shortly after finishing his second round of drug rehabilitation. He was 22.

Lindemann, seven years older than J.T., was away pursuing his career as his brother sank deeper into addiction. After J.T.’s death, Lindemann mourned but kept his feelings to himself. He couldn’t shake the stigma associated with drug abuse that might have led others to think of J.T.’s life as squandered in a desperate stew of escapism and dependency.

“It was nothing I wanted to talk about,” Lindemann says.

But as time passed, he became increasingly distressed at the opioid crisis’ mounting death toll, often ensnaring celebrities and other public figures. It became startlingly clear that many of the victims come from good homes and loving families, and that the vortex of addiction was sucking in individuals from every walk of life.

Around three years ago, Lindemann, a geographic information systems engineer for the digital mapmaking firm Esri, decided to tap into his expertise and create a crowd-sourced map to serve as an outlet for the scores of people who were grieving alone, reluctant to share their feelings with others who had experienced similar tragedies.

The goal: to celebrate the lives of those now gone.

Lindemann’s map enables loved ones to post pictures of absent friends and relatives, along with a brief tribute. Alongside the photo gallery is a map that displays where lives were lost, as well as a tally of the death toll in a given community. So far, more than 1,900 people have posted photos and shared stories of loved ones who have died, most of them in the United States, but a few in farther-flung locations such as England, Ireland, South Africa and Australia.

“These deaths are the tip of the iceberg,” Lindemann says. “There are so many more people now that are going through this. There’s got to be hope for them, too.”

Before long, Lindemann found himself overwhelmed by the number of people who regarded him as someone to whom they could pour out their feelings. He wanted to offer comfort, he says, but he didn’t know how. Plus, he had a day job, providing a variety of client support services for Esri.

A reprieve came when the National Safety Council offered to take over hosting the website as part of a comprehensive effort to curb opioid addiction and support those who have suffered losses from it.

“We realized that that in addition to pushing for legislative and policy changes – and changes around prescribing practices – we also needed to connect families so that they know they’re not alone,” council spokeswoman Maureen Vogel says. “That was one of the things that drew us to the map. There are stories behind each one of the data points.”

It is reminiscent, she says, of the AIDS Memorial Quilt, a massive folk-art memorial made up of festive, grave-sized panels commemorating those who have died from HIV/AIDS.

Jeremiah Lindemann’s map enables loved ones to post pictures of absent friends and relatives, along with a brief tribute.

Among those with a spot on the opioid map is Salvatore Marchese, 26, whose courtship with drugs began at 13 when he began smoking marijuana.

“We never knew, because he played sports and had friends,” says his mother Patty DiRenzo, of Blackwood, New Jersey. But on the inside, something wasn’t right for Sal. “I guess he was probably medicating himself.”

Soon, DiRenzo says, Sal began taking pills: “When he couldn’t afford the pills, or steal them from us, he tried heroin.”

DiRenzo, a single mother, did everything she could to help her son, who was in and out of rehabilitation programs. In the end, heroin triumphed.

“He had been sober for 90 days,” DiRenzo says. “He probably thought he could use whatever amount he had been using previously, and overdosed.”

Marchese’s last months were a roller coaster of hope and despair. “In June 2010, he was in a very dark place, using very heavily, 20 to 30 bags of heroin a day. He called his sister from a parking lot and said, ‘I’m scared, I’m sick, I can’t live this way anymore,'” DiRenzo says. His sister took Sal to a local emergency room to flush the drugs out of his system. The next day, after a mad scramble to find an available bed, he was admitted into a treatment facility. Seventeen days into the program, he was released.

“He cried,” DiRenzo says, “‘I’m not ready to come home.'”

That summer, Sal got into an intensive outpatient program. He got a job working for a heating, air conditioning and ventilation company. “He started looking like himself again,” DiRenzo says. “His face looked healthy, he was healthy. We had a great summer with him.”

Then, on the night of Sept. 22, Sal didn’t come home. “It was devastating to me,” DiRenzo says. “What happened when he walked out that door? Did he hear a song on the radio? Did he go to Wawa to get coffee and meet someone he knew?

“When the police knocked on my door, I couldn’t believe what had happened,” she says. “They woke me up at 2:30 in the morning. My daughter said, ‘Oh, crap, the police are here.’ We thought he’d been arrested. Now I’d give anything for that news.”

Sal is survived by his mother, sister, longtime girlfriend and a 9-year-old son, also named Sal, who lives with his mother in his grandmother’s house.

Today, DiRenzo consoles herself with the photo and the legend on the “Celebrating Lost Loved Ones” map.

“When I saw Jeremiah’s map, “I said, ‘Oh my God, it’s amazing.’ I can look at the other pictures and know I’m not alone. And Sal wasn’t alone. There are other people going through it,” DiRenzo says. “My son was a beautiful person, and so are all the other people’s children who are struggling with this disease.”

On the map, underneath Sal’s photo, there’s this written reminder of how such tragedies echo through generations:

“Sal gave us one of the most precious gifts that anyone could give, his beautiful son. Baby Sal is a piece of his dad that will continue to shine his light and give his love to everyone around him, for the rest of his life.”

Complete Article ↪HERE↩!