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 Morphine for COPD treatment
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Maxfliray
Rookie

USA
4 Posts

Posted - Mar 12 2018 :  2:31:24 PM  Show Profile  Reply with Quote

Looking for some advice/feedback;

A little history first; My mom was diagnosed with lung cancer (Stage 3b)in January 2011 and COPD a few years before that. In March of 2011, her left lung was removed and chemotherapy followed. Graciously, her cancer has been in remission at each follow-up and scan. However, her quality of life has never been the same following the surgery and chemo. Although we have been blessed with an additional 7 years with her, she has had numerous trips into the hospital related to her breathing, falls resulting in broken bones, etc. The worst being approximately two years ago, shortly after being placed on Hospice Palliative Care, when she fell and suffered a compound fracture to her tibia, During days leading up to the fall, her health had deteriorated and discussion had begun about moving mom to our local Hospice House, This fall signified the beginning of the end to our father, us kids and the grandkids.

Long story short, she went under Hospice care and not only recovered, but over the last 14-16 months has enjoyed the best quality of life she has had in those 7 years since the original diagnosis. So good, that Hospice informed us last week that they will have to terminate moms Palliative Care program because she's simply doing "too good". Although we are disappointed, we also understand that there are others in much worse shape than mom and need their assistance.

While on the program, she was under the Hospice doctors care, who also set her medication list, dosages and times. Now were have visited her primary care physician again and discussed the current meds. The medication in question is Morphine 15mg extended release, taken twice daily. When originally prescribed, the Hospice doctor felt it would help prevent all of the hospital visits she was having due to breathing difficulties prior to going under his care. We have expressed our reluctance in changing any of her meds and requested him to leave them as is, considering how well she is doing. I understand is concern, but am also cautious optimistic that this is what's best for her. However, he is insistent on weaning her off of the Morphine slowly over the next 60-90 days, saying it isn't good for her to be on the medication long-term.

His current plan is at the end of her current prescription, to reduce her to a 20mg dose once daily (but isn't extended release) and then reducing her dosage the third month again, hoping to end it all together at the conclusion of that prescription.

Anyone out there with similar experiences willing to offer advice? Doctors/nurses with experience in this area?


judiwa
Member

USA
58 Posts

Posted - Mar 15 2018 :  11:52:27 PM  Show Profile  Reply with Quote
There was a regular on the forums named Bo who has since passed away and he was on morphine for at least the last three years of his life. He was prescribed it for the discomfort of shortness of breath, is that why your mom took it? I don't know how much he was taking. I would be a little concerned about that and wonder if the doctor is knowledgeable enough to make the right decision. Yhere also seems to be some push recently for doctors to not prescribe as many narcotics due to so much opioid addiction and I wonder if that has something to do with his decision. Can the hospice doctor speak to him or can she see a pulmonologist?

judi
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Mike MI
Rookie

USA
19 Posts

Posted - Mar 16 2018 :  3:58:28 PM  Show Profile  Reply with Quote
I was rushed to the hospital 2 years ago, there was a hospitalist doctor in the er visiting from san francisco, he injected me with morphine. It loosened up my chest within 15 minutes allowing me to breathe easily. I could not talk when first admitted, and was glad he was there, the local doctor wanted to int abate me. Sooo glad the Dr. from California had the foresight, and intuition to prescribe the correct procedure. I went home the next day. I think the pendulum has gone too far right, just because some ill advised moronic children are abusing opiods, does not mean that people with fatal diseases should be exempt from pain relief. I think it is probably the correct solution for some people, true there is a high associated with the drug, but better high than dead. If it works to make somebody's life better and easier. Why would they discontinue what was working so well? I'm not following the logic, to be politically correct?

Mike Hunt
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jmrommes
Contributing Member

1991 Posts

Posted - Mar 16 2018 :  4:22:13 PM  Show Profile  Reply with Quote
My understanding regarding morphine is that it doesn't really do anything to "open up the lungs", but it relaxes the impulse from the brain to gasp for air: you don't have the "air hunger" that many people describe. I've only heard of it being used as Bo was described using it; I have not heard of it being used as an alternative to intubation.

Exercise not only lets me live, it enables me to have a life.
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SEW4no
Member

209 Posts

Posted - Mar 16 2018 :  6:48:22 PM  Show Profile  Reply with Quote
Bo was a big help to me re dosing of morphine. Several studies in Canada addressed both the physiology & political aspects. It does have a central & brain effect. It doesn't 'open up the lungs' but based on my own use (Norco, not morphine)it does effect the rapid respiratory rate when struggling. It slows it enough to allow for easier inhalation and more prolonged exhalation. It helps to relax the accessory muscles of respiration and lesson accompanying anxiety. These effects might by why Mike was able to avoid intubation. Outside of the hospital, it is sometimes used for those with very advanced COPD in very low doses and under the care of a physician. My PCP provides my Rx and monitors. My pulmonologist provided her with the literature. I take 1/2 tab of Norco 1 or 2 times a day as needed, with or without a rest of an hour on my BiPap.

Max, perhaps you can get another opinion from a different Palliative Care doctor or pulmonologist more familiar with morphine/COPD. Many physicians are still reluctant to provide it out of fear and lack of education. But it is slowly being recommended more often. It has made a big difference in my life and I know Bo benefitted from it as well.
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muddleaged
Member

USA
62 Posts

Posted - Mar 17 2018 :  11:30:21 AM  Show Profile  Reply with Quote
I am glad some knowledgeable members have responded. I have no experience in this, but my first thought was, "Is s/he afraid she would become an addict?" Give me a break! My second thought was "where are the pulmonologist and the palliative care specialist on this?"
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Maxfliray
Rookie

USA
4 Posts

Posted - Mar 17 2018 :  2:47:24 PM  Show Profile  Reply with Quote
Thanks for everyone's feedback. We have since had another discussion with her pulmonologist who "reworded" his original notes that he is actually ok with her continuing her current Morphine dosage (15mg ER 2x daily). However her PCP is adamantly against it, even refusing to continue it for her and advising us that we will need to get it from her pulmonologist each month. No biggie, but requires us to take mom on a short out of town trip each month I'm told. I completely understand the opioid crisis, but I also understand how well she has done the last 18-24 months since she's been on it. However, the pulmonologist strongly suggested that in his professional opinion, he thinks mom may do even better going OFF of the Morphine and thinks that her finally giving up the cigarettes (3-4 cigarettes a day before quitting) during that same time frame may very well be playing a larger role in her success than the Morphine. One of these things I wish I had a crystal ball, but my biggest fear is a setback.

SEW4no mentioned below having success with Norco, but I'm unfamiliar with it. I read that it also is opioid based, but is it a milder form of Morphine?

Edited by - Maxfliray on Mar 17 2018 2:49:20 PM
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SEW4no
Member

209 Posts

Posted - Mar 18 2018 :  10:06:21 AM  Show Profile  Reply with Quote
Norco is Hydrocodone + acetaminophen (Tylenol.) It comes in 3 strengths; 5/325, 7.5/325, 10/325 and is not an extended release form. It might be worth a try or consideration. In the list of opoids, it is milder than Dilaudid, morphine. I get the 5/325, but remember I take only 1/2 tab when needed and rarely need the other half. Have been doing this for over 2 years now and never felt the need to increase that dose. I am 71 yr. old. I do agree that giving up smoking can have a huge impact even when down to 3-4 cigs. Been there, done that....

I don't know what your state laws are but in mine, they used to require a hand written Rx each time (no automatic refills) to take to the pharmacy. They now have changed that to mandatory electronic Rx. My PCP was great for the written one - I mailed SASE to her office and they would mail the Rx back to me. Check out you current state (maybe it is now Federal, I don't know) and see if your pulmy could send an electronic Rx to your local pharmacy to avoid a monthly trip. Perhaps you could agree to have him see her every 3 months as a compromise.

The age, and other health conditions, and activity level of your Mom makes a big difference re her opioid needs. Is she active? Does she do any regular exercise (lots of them for sitting in a chair on YouTube are available?) Since she didn't require increasing morphine dosage over time, you could try (with doc's guidance) to try a lesser dose, perhaps with Norco available for backup, and just see how she does.

Edited by - SEW4no on Mar 18 2018 10:10:01 AM
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Diane545
Member

USA
318 Posts

Posted - Mar 20 2018 :  10:57:30 AM  Show Profile  Reply with Quote
agree with you Mike, sometimes morphine can be a lifesaver when struggling for air. I had my first experience when I was at ER and couldn’t breathe. They gave me some morphine and I calmed down. It may not open the lungs but certainly helps air hunger. I am fro CA to. I understand all the hype about opioids but these drugs do have a purpose if used correctly. Nothing worse than not being able to breathe.
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Jan-KS
Member

USA
105 Posts

Posted - Jan 24 2019 :  1:00:13 PM  Show Profile  Reply with Quote
Frankly, I'm just furious that there are so many STUPID doctors out there. I'm also furious about the ridiculous rules there are regarding narcotics and barbituates There are two reasons for her primary care physician to refuse to prescribe morphine is 1. He/she is clueless about WHY a patient with COPD would take morphine - and 20 mg is not an addictive level for most people but it makes a HUGE difference in quality of life. Morphine for reasons not completely understood stops or reduces air hunger for most people. I am ALSO on Fentanyl and Xanax-obviously I have severe air hunger but until I went into "Stage 4 " COPD I didn't need all those drugs - so my anxiety drugs really are due to my COPD making me extremely anxious, I'm not a drug addict nor do I engage in "drug seeking behavior" nor have I ever really gotten "high" except when I first started Xanax so the morphine at that dose never made me "high". So this doctor basically doesn't understand that by taking your mother off of it he could be dooming her to a miserable life. 2. The other reason is that he is scared of getting on "the list" where they keep track of doctors that tend to prescribe a lot of narcotics and barbituates because they may be a drug addict themselves or they are solving every patients problem with a narcotic and a certain percentage of them WILL become addicts. I am now more under the care of a palliative care team than my pulmonologist and they are a group of doctors and nurses that would be EXPECTED to be prescribing a lot of narcotics because most of their patients are at a stage where they are close to death (or their disease is very severe) so they don't worry about being on "the list".

Doctors also get sick of all the rules they have to now follow - prescription must be hand signed by the doctor or other prescriber themself, must be picked up by hand by the patient (although when my husband was alive they would give them to him - which seems strange) and it must be hand carried to the pharmacy - they can't be faxed or emailed in. Although again, they always allowed my husband to take the RX to the drug store for me and get it filled. Now that my husband is gone this has made my life so difficult. For example we have a foot of snow on the ground and it's about 5 degrees out - there is NO WAY I would be well enough to go pick up a prescription. My daughter and her husband work long hours at this stage in their career and I get tired of asking them to do anything that I absolutely cannot do myself. I also try to watch the weather schedule and make sure I have sufficient supplies of all my medications. Other than them I have nobody else in my life that I know well enough to ask them to help me, plus my experience has been that MOST people don't really want to help because they have enough to take care of in their own life.


Jan C
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Maxfliray
Rookie

USA
4 Posts

Posted - Jan 24 2019 :  2:55:19 PM  Show Profile  Reply with Quote
Thanks everyone for your responses. She has done pretty good so far, but her breathing hasn't been nearly as good as before being taken off the morphine. Although she manages without it, her breathing is now more pronounced as if she's out of breath slightly. Although we've discussed this with her PCP, his only commentary is "seems like you're doing pretty good without it". Despite my mentioning that his "pretty good" isn't as good as before, he hasn't budged. I've discussed with mom moving to another PCP, but she isn't one to complain nor make many changes. Regardless, we're blessed that things have went as well as they have!
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bamagal73
Rookie

USA
10 Posts

Posted - Jun 14 2019 :  2:45:32 PM  Show Profile  Reply with Quote
If I did get addicted to a narcotic what difference would it make. Im 76 with COPD for 23 years. I worked in a psych/alcohol/drug detox unit as charge nurse for 12 years. There's a lot of difference in a young person in their 30's that takes 5-6 Norco, Lorcet, Lortab, or what ever you know it by, just to get out of bed in the morning and an elderly disabled person taking 1 tab a day. i'm on Morphine now but I take a very small dose and it does help a lot. I have been on Hospice for a year and since I haven't gotten any worse they are going to discharge me. I really don't understand why since I still need help with certain things but its their rules. They were furnishing my meds so now I have to find a doctor and see if he will write my meds for me. I've moved to a new city to be close to family and don't know any doctors here and I just feel lost. Family goes out of town to see a doc but I don't think I can make that trip so well. I'm pretty worried about it all. I just wish that things wouldn't have to change like that.

Linda Lee
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rjh-spokane
Member

USA
49 Posts

Posted - Jun 15 2019 :  04:21:53 AM  Show Profile  Reply with Quote
If a person ends up on a low dose will that restrict their driving?
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bamagal73
Rookie

USA
10 Posts

Posted - Jun 15 2019 :  9:34:59 PM  Show Profile  Reply with Quote
My nurse told me not to drive at all. I don't understand why not. I used to drink beer and I would drive then. I could feel the beer but the morphine doesn't make me dizzy.

Linda Lee
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