“Medications are driven by pain levels and docs. It may seem that too much is being given but it is not given to kill people. If someone is doing that they get arrested.”
I agree with you 100%. In reality, there is a fine line between suppression of pain and suppression of the respiratory/cardiac systems. My experience is that in hospice situations, most/but not all nurses err on the side of pain relief and if the respiration stops, so be it as it was a peaceful process.
It is a double edge sword as the pain can also cause muscle contraction and create difficulty breathing. Thus morphine can help by relaxing the muscle tension but also hurt breathing function.
In addition to relieving pain, morphine also effects:
Respiratory depression - The breathing mechanism can become suppressed in response to low blood oxygen. In healthy individuals, as blood oxygen falls and blood carbon dioxide rises, the drive for breathing increases. However, morphine suppresses this drive in the brain, potentially causing this very dangerous side effect. Respiratory depression is more common with higher doses.
Sedation - Named after Morpheus, the Greek god of dreams, morphine is one of the most powerful sedative opioids.
Skin changes - Morphine may lead to the release of histamine in the skin leading to warmth, flushing and urticaria or allergic eruptions across the skin. Skin may appear cool and clammy and a severe chill called hypothermia may develop.
Gastrointestinal side effects - These include nausea, vomiting, abdominal cramps and constipation. Opioid receptors for morphine are present in the gastrointestinal tract and their activation may lead to a slowing of gut movement, leading to constipation. Long-term use leads to severe constipation. In addition, morphine stimulates the vomiting centre of the brain causing nausea and vomiting. Morphine and codeine cause more nausea than other opioids. There may be drying of the mouth as well.
In the last case I worked with, the patient was on high doses of morphine long term relating to hip replacement pain. There is considerable research showing that opoids actually increase the cancer growth. (http://www.uchospitals.edu/news/2012/20120321-opioid.html)
The long term use possibly caused Transitional cell cancer of the kidney (renal pelvis) or ureter which was masked by the morphine until it spread to the bone, lungs and liver resulting in a very quick uncomfortable death process.
Your last case is an interesting one. Opioids are indeed s mixed bag
My daughter recently had a stage four lung cancer patient. She was giving him large amounts of fentanol and dilaudid through out her shift He passed the next morning but even that really wasn’t helping much