How can something that slows breathing be safe in somebody who is already dying?
Morphine and some other medicines can slow breathing if the dose is too high for that person.
Morphine and some other medicines can slow breathing if the dose is too high for that person. In palliative care, carefully prescribed opioids are used in a different way: they are adjusted to ease pain or the feeling of breathlessness, with monitoring for side effects.
This can sound confusing. A medicine that can be dangerous in overdose can also be helpful when the right dose is used for the right person. The difference is assessment, dose, timing, the person's previous opioid use, and clinical review.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
Breathing rate is not the whole story
Breathlessness is the feeling of not getting enough air. It can be severe even when oxygen levels are not extremely low. It can also become worse with fear, fatigue and weak breathing muscles.
Opioids can reduce the distress signal that makes breathing feel unbearable. The aim is not to make the person breathe as little as possible. The aim is to help them feel less air hunger and panic.
Palliative Care Australia explains that morphine can be used in low doses to ease difficult breathing and chronic cough when it has been properly prescribed.
Why overdose risk is different from palliative dosing
Healthdirect correctly warns that morphine can cause life-threatening breathing problems, especially after starting, after a dose increase, in older people, in people with lung problems, or when mixed with alcohol or other sedating medicines.
Palliative care teams take those risks seriously. They consider whether the person has taken opioids before, whether their kidneys or liver may clear the medicine slowly, and what other medicines they take. They review the person after changes and adjust the plan if sleepiness, confusion or slow breathing becomes a problem.
The same medicine can have different effects in different people. A dose that is too much for one person may be too little for another who has been taking opioids for a long time.
The goal is proportionate symptom relief
Good palliative care uses the least medicine needed to relieve distress. If breathlessness is mild, non-medicine steps may help: sitting upright, a cool fan on the face, calm coaching, treating reversible causes, or adjusting oxygen if it has been prescribed.
If breathlessness is severe or ongoing, medicine may be needed. For some people, avoiding severe air hunger matters more than staying fully awake. For others, alertness is a high priority. The team should talk with the person and family about what matters most.
What families can ask
Ask the team:
- What are we treating: pain, breathlessness, anxiety, or all of these?
- What breathing changes are expected in this person's condition?
- What side effects should we report?
- How will you decide whether the dose is right?
- Who should we call if breathing changes overnight?
These questions are reasonable. They help you understand the plan rather than guessing from the medicine name.
Do not make dose changes yourself
Do not give extra opioid medicine unless it is in the person's written plan or a clinician tells you to. Do not hold back regular medicine because you are frightened of the word "morphine" without calling the team for advice. Either choice can cause harm.
Store opioids safely, keep records of doses, and tell the team about all other medicines, including sleeping tablets, anxiety medicines, alcohol, cannabis products, herbal products and over-the-counter medicines.
When to get help now
Call the palliative care team urgently if the person is very sleepy, newly confused, twitching, or has breathing that worries you after a medicine change.
Call 000 if the person cannot be woken, is not breathing, has blue lips, or you think there has been an overdose. If the person is expected to die at home, follow the agreed plan unless the situation is outside that plan or feels unsafe.
You may also want to read
- Does morphine make someone die sooner?
- Why are they sleepier after medication?
- What do we do tonight if they become breathless, agitated or in pain?
- When should I call 000 for someone receiving palliative care?