Methadone And Morphine For End Of Life Care

My Mom was diagnosed with Stage 4 Cancer - spindle cell sarcoma. They have given her 6 months to live. Right now the cancer has spread to her upper rib, right hip, lungs and brain. She also has a clogged artery. She wanted to spend her last months at home so we set up hospice there to care for her during these next months. They started her on morphine to control the pain on .25ml and raised it to .5ml. She started forgetting things and becoming anxious. She forgot one day to tell the nurse she was in pain and waited too long. That night it took a while to get her pain under control. Hospice raised her dosage to .75ml and began administering at least every 4 hours or as needed. Sometimes every 3 hours. Mom became more confused, tired, weak and was losing her memory. She couldn't finish thoughts. Today she was finally a bit more alert. She walked in her walker and read the paper. My sister just told me that hospice wants to put her on methadone and mix the dosage. So that they only have to use the morphine every 4 hours. I don't know what this mixture will do to her. I can't see it helping her condition but making things worse. I just don't want to keep seeing her suffer. Dying with dignity was Mom's wishes. I don't know what to do.

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Hello I'm very sorry to here about your mom. I posted a comment in another place but wanted to let you know my boss had this happen to him and he never took meds at all. He drank an smoked cigarettes and he wanted to be at home. He was on both types of meds. He had 4 total and at first when he took some he became out of it, talking to you and would just stop in the middle and just forget what he was saying. As the days went by he got use to the meds as they did help him with all his pain. It eased it up and he also lived almost a year longer than they had given him. Hope this helps some. Thanks

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Thank you so much Ken for your response. It did help me feel a bit more at ease. I was told methadone takes a few days to take effect. I am hoping she feels better or at least has no pain during this process. Thanks again.

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Her behavior may be caused by the cancer itself. Taking her off pain meds may only worsen her condition. Have they tried adding a benzodiazepine for anxiety and possibly an anti-psychotic to her meds? Talk to your hospice team, be assertive and advocate for your mom. Good luck.

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Hello Lucila,

I'm terribly sorry to hear about your mother. This situation has to be terribly taxing on you enough long before you had to worry about what kind of side effects her medication will potentially cause.

To ease your mind slightly this mixture of medication only has a mild interaction warning according to the NIH. The warning is that both of these drugs are sedatives and increase the effects of each other. In addition doctors will typically not prescribe medication that has negative interactions unless the benefits greatly outweigh the cons. In your mothers case they likely considered the potential downside of increase sedation as a low risk compared to the ability to provide her with the quality of life she deserves.

I know no words will ease the pain of what you're going through but I do hope that at least you can find some comfort in knowing that the medical team at her hospice is doing the best they can to provide her the most comfort they can. Best wishes.

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My uncle was dying of terminal colon cancer and was given 3 months and he died to the day. He wanted the same to die with dignity at home. Well he was at my house but close enough for home. Hospice came and started him on the morphine drip and he was fine. Then another nurse came to the house and started him on Demurral and he thought he was back in the war. Was talking to his troupes and at one time holding his gun. She then proceeded to give him an enema because he was constipated from the drugs and I mean buckets full but I heard him screaming out from pain so I went to the room and told her she had 10sec to get the hell out. She did. I don't believe in raising a hand to a woman but if there were ever going to be a time lol. Just saying that it's hard to know who's looking after your loved ones with actual caring feelings these days.

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When I deal with this issue I try to offer my patients a variety of opiate pain medications, especially in hospice. In my professional medical opinion, I think that you would benefit from a different mixture of pain meds. For breakthrough pain I would recommend Dilaudid 4mg tablet to take every 4 hrs as needed. For your long acting pain med I would recommend either Fentanyl patches 50mcg-100mcg and each patch lasts for 72hrs. I really hope this helps, if you need anything, please don’t hesitate to let me know.

Editor's note: we do not verify the credentials of our users and nothing stated is intended as medical advice.

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Re: Chris (# 6)

Dr excuse me but respectfully I would like to offer my opinion if u don’t take it wrong. Why not use time release morphine as the long-term with short acting morphine or Dilaudid for the breakthrough? Fentanyl has the MOST respiratory complication issues and with the new designed patches requires a much higher dose to get ACTUAL relief, I don’t care what they say. The fentanyl patch is only about 33% as effective today as it was before it was made into a no tamper patch. Not only do I speak from experience as someone who suffers long-term serious chronic pain from life altering medical issues, but I have also personally over sought the care of three family members at end-of-life. And I’m not saying you buy doctors who start out by saying drugs like hydrocodone are so so strong or that an oxycodone 5 mg tablet is a big dose, or that there’s even a cap on morphine dosages don’t really know what they’re talking about. For somebody who is not opioid tolerant functional in my opinion shouldn’t even be used unless a person cannot swallow or take an oral medication or take a medication rectally. And most times patients confusion or delay area is it caused by a morphine, it’s caused by the condition or about chemotherapy or other reasons. Please one making choices for end-of-life care, never jumped the gun to fentanyl until the last resort And I apologize if this has offended but it is only my opinion

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My husband was on Methadone for 2 years. He was not terminal but his pain was so bad he contemplated suicide. The methadone works differently than other opioids. It gave him pain relief and a feeling of euphoria. The mixture of morphine and methadone may give your mom her memory back.

(FYI: my husband now has an intrathecal pain pump that delivers a fraction of morphine directly to his spine)

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Lucila ~ Being a Chronic Pain patient myself for over 35 years; I found that the BEST regimen was a LONG-ACTING PAIN med like METHADONE & a SHORT-ACTING PAIN med, in this case the MORPHINE.

However, MORPHINE can also be RX'd in LONG-ACTING form & also keep using the SHORT-ACTING MORPHINE, since you know that she's tolerating it pretty well now. Talk to her Hospice Dr about it.

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They're shortening her life with these drugs. They'll tell you it’s for pain but she's become a financial burden. This is what is called the death panel that Obama created. They upped my nephew's meds and he died 2 days later. My opinion.

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I cannot tolerate morphine! It makes me have hallucinations bad, and very agitated!! I don't understand why they havernt chosen a different protocol ! Methadone is basically used as a withdrawels med and don't understand their reasoning behind this! Yes ,it's a opioid but not intended for end of life pain!! Why haven't her Drs chosen other/better end of life meds?? Diladid, oxycodone, oxycotin, even demerol over morphine! A lot of people are very sensitive to morphine. Find your voice and speak up for your loved one!! God Bless!

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I’m trying to understand because my husband had CHF END STAGE complicated by lung cancer, so no chance of a new heart and he was just 54 years old. My heart breaks for you. I personally hated the hospice people. In and out few words all medication. Calling them in the middle of the night only to be sarcastically given an answer on his breathing funny. He was given 6 months died in 3 weeks at Thanksgiving 2016. He never did drugs and was NEVER in pain! It was the fact he couldn’t breathe so hence the morphine. Then they left me alone to admit to him it under the tongue! I called my niece that was an EMS and she did it for me. The PTSD I suffer from seeing a strong wonderful man turn into a vegetable stays with me forever. He finally passed peacefully as I had 3 priests coming in and out (I am a devout Catholic.). But hospice did nothing to help me only the very minimal. I agree you are a burden and once they take over that’s that. But to give you some comfort, before he passed he said his mother told him not to be afraid. She passed 7 years before. I’m sorry for your loss as you will see her again. God Bless.

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Re: Janeway (# 7)

I’m not offended, not at all. The primary goal is to keep our loved ones out of pain and keep them as comfortable as possible, depending on their tolerance to opiates I try to choose a pain medication that binds to all receptors and one that binds specifically to the sedative part of the brain. The reason I choose Dilaudid and Fentanyl is because of the long duration and the sedative effect Fentanyl provides both. The reason I chose Dilaudid is because it provides quick relief of pain, and you can give it q4 hrs as needed. I appreciate and respect any and all comments and suggestions.

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Yes, that could possibly help her greatly for her pain. B/c the half life of Methadone(how long it actually works and stay in your body) is double or triple that of Morphine. That way, the Methadone can help with the pain longer and then have the Morphine for when the breakthrough pain arrives. I would say it is ok for her and may be worth trying!

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To everyone still commenting:

After i commented the other day, I noticed that the original question was from march 2017...Nearly 2 years ago. I imagine that any new comments won't be relevant to this lady's question.

So to "med chat", do you keep these old questions in the queue to help others or do you have a time limit? I really am interested; because lucila said that her mother only had about 6 months to live.

You can answer me without putting this in the lineup of answers, if it's inappropriate!!

Thank you~Sheri

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Re: MySheriAmore (# 15)

Thank you for writing in and that's a great question. In most cases, we leave our discussion threads open, even where the original message is from years ago. Our reasoning is because sometimes other individuals could have a similar question or be in a similar situation and adding new comments into older topics could help anyone else who comes across that page. Also, there are other cases such as when a drug is pulled off the market but then a suitable replacement is released later on, or when new information about a drug is presented, etc etc.

We hope that this has helped to clarify things, and please do not hesitate to write back or contact us if we can be of further assistance.

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MedsChat Admin (#16) --

YES, THANK YOU!! I kinda figured that was why...I appreciate you answering so quickly.

Sheri

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I take 70 mgs of methadone a day. It is just a synthetic morphine. I take it for my back . I had surgery and my back was never the same. It is long acting so you dont need as much. Try apricot seeds . They help. 3 a day.

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