End of Life Concerns Pain & Symptom Control Morphine: Forms, Use, Side Effects, and How It's Given What you need to know about morphine at the end of life By Angela Morrow, RN Angela Morrow, RN LinkedIn Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. Learn about our editorial process Updated on February 03, 2021 Medically reviewed by Jenny A. Dhingra, MD Medically reviewed by Jenny A. Dhingra, MD Jenny A. Dhingra, MD, is board-certified in anesthesiologyy. She currently serves as the medical director at One Day Surgery which is part of Atrium Health in Charlotte, North Carolina, is a member of the American Society of Anesthesiologists, and an executive board member of The Dhingra Family Foundation. Learn about our Medical Expert Board Fact checked by Marley Hall Fact checked by Marley Hall LinkedIn Marley Hall is a writer and fact checker who is certified in clinical and translational research. Her work has been published in medical journals in the field of surgery, and she has received numerous awards for publication in education. Learn about our editorial process Print Many people wonder about the uses, forms, and side effects of morphine, especially since morphine sulfate is perhaps the most misunderstood and the most feared of all the medications used to treat pain. Commonly used in hospice and palliative care settings to treat people nearing the end of their lives, different concerns often arise than when morphine is used for surgery or in non-hospice settings. This article explores how and why to use liquid morphine (as well as other forms) at the end of life, and the possible side effects you may expect. Science Photo Library - ARNO MASSEE / Brand X Pictures / Getty Images Liquid morphine is often provided in a hospice kit so that family or friends can treat their loved one who is dying. It's important to note that you can always contact your hospice nurse or healthcare provider if you have questions about the use of morphine. Uses Morphine may be used for more than one symptom near the end of life. Pain In palliative care and hospice settings, morphine is one of the most commonly used pain medications because it generally treats pain effectively, and is usually well-tolerated. Moreover, morphine is readily available in most areas and is usually cost-effective. Is Dying Painful? Shortness of Breath Morphine is also effective in treating dyspnea, or shortness of breath, a symptom experienced by a very large number of people at the end of life and sometimes more distressing than physical pain. Morphine can reduce the anxiety associated with shortness of breath but actually improves breathing by dilating blood vessels in the lungs and deepening breaths. Other medications in the hospice kit may reduce anxiety, but can actually worsen dyspnea. Side Effects Morphine is usually tolerated well, but can also cause some troublesome, and even serious, side effects. Common Side Effects Relatively common but not usually emergent side effects include: ConstipationDiarrheaDizzinessDrowsinessFeeling lightheadedUpset stomachVomiting If your loved one experiences any of these symptoms, it's important to talk to your hospice nurse or healthcare provider. Often times these side effects can be controlled or alleviated with other treatments, so your loved one can continue to get the pain-relieving benefit of the drug. Examples include using an anti-nausea medication for nausea and vomiting, or a stool softener with or without a laxative for constipation. Serious Side Effects All serious side effects of morphine use should be reported to your healthcare provider immediately, and can include: Slow, shallow, or irregular breathingBlue or purple color to the skinFast or slow heartbeatSeizuresHallucinations (seeing things or hearing voices that do not exist)Blurred visionFaintingHivesRashItchingTightness in the throatDifficulty swallowingSwelling of the arms, hands, feet, ankles, or lower legs It's important to note that many people appear to hallucinate at the end of life whether they are receiving morphine or not. Forms and Administration Morphine comes in several forms, including liquid or tablet form, which makes it the pain-relieving drug of choice in many end-of-life situations. The forms of morphine can include: Oral Morphine Solutions Oral (liquid) morphine solutions are commonly used in palliative care and hospice settings, and often are included in the "hospice kit" provided to loved ones to administer if or when needed. Advantages Liquid morphine is relatively easy to give and can be concentrated in order to administer larger doses of the drug using smaller amounts of liquid. In addition, some people are unable to swallow pills because of their illness, due to a decreased level of consciousness, or because of morphine's side effect of sedation. In these situations, people can usually tolerate the smaller amount of liquid needed to alleviate their pain and/or make them feel comfortable. Time to Onset and How Long it Lasts An oral/liquid morphine solution typically starts working quickly—usually within 15 minutes—and lasts for roughly 4 hours, although some people might find they require morphine more often. Morphine tastes bitter, which is most noticeable in the liquid form in contrast to pill form. Because the concentrated liquid is usually given in small amounts, it is recommended that morphine not be mixed with other liquids. Most people tolerate receiving the medication alone or by "chasing it" with a drink of their choice. Method of Administration Oral morphine solution should be given only with a dosing spoon or dropper provided by the pharmacy. Because it is highly concentrated, it's important to get the dose as accurate as possible. If you are unsure about the right dosing, ask your nurse or another healthcare provider to demonstrate for you. Some hospice nurses carry a "sample bottle" of morphine (without the drug) with them that allows them to demonstrate how to draw up the correct dose and use the dropper. If you have any questions at all, ask your hospice nurse to show you how it is done. Tablet or Capsule Morphine Morphine tablets come in both rapid- and extended-release forms. Rapid Release Tablets The rapid-release tablets work similarly to an oral/liquid morphine solution in that they have a relatively rapid onset of action but last for only around four hours. Rapid-release tablets can be crushed and mixed with applesauce or pudding for people who have difficulty swallowing tablets. They can also be crushed and administered through a nasogastric (NG) tube. Extended Release Tablets Extended-release (ER or XR) tablets can be taken every 12 hours, or even once per day. Extended-release morphine is only used for people who are experiencing continuous moderate to severe pain. You should always check with your healthcare provider or pharmacist before crushing an ER tablet or opening an ER capsule. A Word of Caution with Extended-Release Morphine With some extended-release formulations, the capsule functions as a way to slowly release the medication to be absorbed over time, and crushing the tablet could result in a dose that is much too high and toxic. Other Methods of Delivery In addition to liquid and solid forms, morphine can also be delivered as an injection into a muscle (intramuscular injection), as an injection into the fatty tissue just under the skin (subcutaneous injection), or through an intravenous infusion (IV). While these methods of delivery aren't usually the first choice in palliative care or hospice setting, morphine administered in these alternative ways can still prove effective relief of pain. Morphine can also be delivered as a suppository (inserted into the rectum) for people who need a longer-acting dose but who are unable to swallow morphine in liquid or tablet form. If this is the form of delivery your healthcare provider recommends, ask your healthcare provider or nurse to demonstrate how to administer the suppository. A Word From Verywell If you have concerns about using morphine for pain or shortness of breath (dyspnea), it's important to talk to your hospice nurse or healthcare provider. Everyone is different, and your hospice team can help you find the best form and method of delivery to control your loved one's symptoms. Caring for a loved one at the end of life can be challenging, but is one of the most loving and rewarding things a person can do. How to Care for a Dying Loved One 5 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Leigh AE, Burgio KL, Williams BR, Kvale E, Bailey FA. Hospice emergency kit for veterans: a pilot study. J Palliat Med. 2013;16(4):356-61. doi:10.1089/jpm.2012.0304 Krzyżaniak, N, Pawłowska, I, Kuźbicka, K. An overview of the use of drugs in palliative care settings worldwide. Palliat Med Pract 2019;13(3):134-141. doi:10.5603/PMPI.2019.0017 Tian C, Wang JY, Wang ML, Jiang B, Zhang LL, Liu F. Morphine versus methylprednisolone or aminophylline for relieving dyspnea in patients with advanced cancer in China: a retrospective study. SpringerPlus. 2016;5(1):1945. doi:10.1186/s40064-016-3651-x MedlinePlus. Morphine. Kestenbaum MG, Vilches AO, Messersmith S, et al. Alternative routes to oral opioid administration in palliative care: a review and clinical summary. Pain Med. 2014;15(7):1129-53. doi:10.1111/pme.12464 Additional Reading Knaul F, Bhadelia A, Rodriguez N, Arreola-Omelas H, Zimmerman C. The Lancet Commission on Palliative Care and Pain Relief—Findings, Recommendations, and Future Directions. Lancet. 2018. 6(S5-S6). doi:10.1016/S2214-109X(18)30082-2 National Institute on Aging. Providing Comfort at the End of Life. By Angela Morrow, RN Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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