Morphine Addiction: Need a Doctor's Opinion

Factual Questions
1

My SIL, who has advanced breast-to-bone cancer, has been on liquid morphine, some sort of pain pills, and fentenyl patches since April or May. Every time I talk to her she says the pain is horrible, but she sounds cheerful (exceedingly so!) and really up. She says the hospice people are giving her as much pain medication as they can.

To tell you the truth, I think her pain is under control and she is experiencing symptoms of addiction, which she may subconsciously be interpreting as pain. Is that possible? She doesn’t sound the way she did before she began treatment (she sounded like she was miserable at that time).

I’ve got no problem with the addiction thing. She’s dying and as long as she’s not writhing, we’re happy. I’m just curious if this is what prescription addiction looks like. Will she need more to control the pain or will the current amount keep her comfortable, even if she’s jones’n’ for a little more? Thanks.

2

IANAD, but have been addicted to prescription drugs before, and very heavily I might add, MS Contin (Morphine) included. Addiction isn’t really physical pain so much as it’s mental. Granted, heroin, morphine and other heavy opiates do cause sickness if they are suddenly stopped. Sickness is profuse sweating, nausea, vomiting and tremors. But never any pain, pain meaning; pain like a toothache, back pain etc… It’s more emotional and mental anguish.

3

[QUOTE=diggleblop]
IANAD, but have been addicted to prescription drugs before, and very heavily I might add, MS Contin (Morphine) included. Addiction isn’t really physical pain so much as it’s mental. Granted, heroin, morphine and other heavy opiates do cause sickness if they are suddenly stopped. Sickness is profuse sweating, nausea, vomiting and tremors. But never any pain, pain meaning; pain like a toothache, back pain etc… It’s more emotional and mental anguish.
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Well, I’m not referring to withdrawal symptoms. She gets the medication and will continue to until she dies.

The issue is whether or not she is interpreting the need for higher doses as pain, or if she’s just saying she has bad pain so they’ll give her more.

4

Pain is whatever she says it is. The pain cocktail she’s taking may have a euphoric agent as well as analgesics.

Yes, she is physically addicted, but if she were to be free of pain, the physical withdrawal would take about 3 days.

Yes, she will require more medication as time goes on. Because, her pain will increase, and she will develop a tolerance to the morphine.

Bone pain is some of the worst there is. It doesn’t get better without complete remission. People are amazing, we can get used to just about anything, even dying slowly. She is living her life as best she can, it sounds like.

Please, enjoy whatever time you spend with her. Believe she has pain when she says she does. She’s busy dying by inches, please don’t make her feel guilty about what little relief she gets.
I’m sorry for what you and your family is going through.

5

[QUOTE=Kalhoun]
The issue is whether or not she is interpreting the need for higher doses as pain, or if she’s just saying she has bad pain so they’ll give her more.
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I don’t know if this can be determined by her or anybody else, and even if it could I don’t see how it could affect anything but how people treat her on an interpersonal level, so perhaps it’s an avenue you’d rather not walk down? Pain medication is mostly meant to remove discomfort associated with pain, if the discomfort is associated with withdrawal instead of pain, or withdrawal combined with pain then this is only relevant if the patient is expected to no longer be in pain and still requires the pills. If there is a good medical reason for reducing dosage or discontinuing pain medication, then again, the discomfort has to be gauged against necessity and it’s not too important initially what the source of the discomfort is.
The way your OP is phrased it sounds like she is not expected to stop being in pain, nor are they planning to reduce her dosage or take her off medication. My IANAD WAG is that you can’t determine the answer easily, and if you could you probably shouldn’t.

6

[QUOTE=picunurse]
Pain is whatever she says it is. The pain cocktail she’s taking may have a euphoric agent as well as analgesics.

Yes, she is physically addicted, but if she were to be free of pain, the physical withdrawal would take about 3 days.

Yes, she will require more medication as time goes on. Because, her pain will increase, and she will develop a tolerance to the morphine.

Bone pain is some of the worst there is. It doesn’t get better without complete remission. People are amazing, we can get used to just about anything, even dying slowly. She is living her life as best she can, it sounds like.

Please, enjoy whatever time you spend with her. Believe she has pain when she says she does. She’s busy dying by inches, please don’t make her feel guilty about what little relief she gets.
I’m sorry for what you and your family is going through.
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That sounds like the answer I’m looking for…the euphoric agent. Can you elaborate on that? She is SO up, cheerful, happy, laughing, chatty, etc., that it is difficult to believe her pain has increased, even though we know it must be. She’s always available to chat on the phone, her appetite is voracious, and she appears to be on top of shit for the most part; news, life details, etc.

So, is this a separate drug they put in her medication or does it just hit people that way sometimes?

7

[QUOTE=picunurse]
…please don’t make her feel guilty about what little relief she gets.

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I’m not sure why you mentioned this. Did I give the impression I was laying a guilt trip on her? As I said, no one cares whether she’s addicted or not. We just want her to be pain free.

8

Has the attitude toward pain medication changed in the last ten years or so?

My friend died of bone cancer in 1992. She was fourteen years old. She told me that the people caring for her (hospice? I don’t know) were “afraid she would get addicted” to her pain medication, even though it was obvious she was dying. There were times she would just lay there and* scream.*

I remember feeling so angry about this. For crissake-- give the girl *heroin *if that’s what it takes!

9

Addiction psychiatrist weighing in… I agree with the other respondents that it sounds like this is a case where the whole concept of “addiction” may not be relevant; she has an excellent reason to be in pain, she won’t be around long enough to worry about any long term consequences…my vote is to back up the Fentanyl truck if that’s what it takes. The fact that she’s alert enough to chat about current events indicates to me that she isn’t overmedicated (although there may come a time when her pain can’t be controlled without sedation). The euphoria could be partially due to the opiates, I’d bet there is also an element of psychological defense mechanisms working. My condolences on your impending loss, but it sounds like she is receiving excellent hospice care.
Lissa, the Nineties were before my time, but it is my impression that attitudes about these matters have indeed changed, and considerably for the better if you ask me. Sorry it came too late for your friend.

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[QUOTE=Kalhoun]
Well, I’m not referring to withdrawal symptoms. She gets the medication and will continue to until she dies.

The issue is whether or not she is interpreting the need for higher doses as pain, or if she’s just saying she has bad pain so they’ll give her more.
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I understand, but I’ve never heard of that, but it doesn’t mean it’s not possible.

You wrote:

Which is why I responded with what I did. Very sorry to hear about this as well. My condolences.

11

Thanks all for your kind thoughts. We’ve been slogging through the illness and accompanying red tape (she has no money), and I do believe she’s getting good hospice care. I was just curious if it was possible to be in severe pain and still be so cheerful, and it appears it is indeed possible. Like I said, we don’t care if she’s addicted, as long as she’s not hurting. She fell a couple days ago (hard enough to crack the wall she fell into) and she’s extremely bruised. I assume because her ribs, spine, and pelvis are full of cancer, she most likely endured numerous hairline fractures (the doctors are very concerned about her bones breaking). So I am surprised, to say the least, that she is so happy. Yay drugs!

12

Then you have people on the opposite end of the spectrum: my grandmother, when she was dying of colon cancer, refused pain medication because she was afraid she’d get addicted. My mother and her siblings pointed out to her that addiction was the least of her problems at that point, but my grandmother still adamantly refused.

I’m with the others in saying that whatever your SIL needs or wants, she should get. Let her time left be as pleasant as it can be, and don’t worry about addiction.

13

Obviously I don’t know what all your SIL is taking, but back when I was a pharmacy technician at a hospital, at times we’d have a doctor prescribe a concoction called Brompton’s Mixture for terminal patients. This mix consisted of morphine, cocaine, whiskey and honey. In Britain, where this stuff originated, heroin was usually used in place of the morphine, and sometimes other forms of sweetener and alcohol are used.

The bottle would be given to the patient and they could take some whenever they wanted. The purpose of it was not only to control pain, but to make the patient feel happier and more sociable (I’m sure that’s what the cocaine was for). So, maybe your SIL is getting something that is specifically to make her feel happier; or maybe one of the pain relievers just has that effect. Either way, it’s something to be incredibly grateful for, that she is able to live out at least some of the rest of her life happily. I wouldn’t wish bone pain on my worst enemy.

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[QUOTE=Kalhoun]
I’m not sure why you mentioned this. Did I give the impression I was laying a guilt trip on her? As I said, no one cares whether she’s addicted or not. We just want her to be pain free.
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Ok, I guess, I was just being a bit defensive. I fought for years to educate doctors and families on the need for pain relief, so when someone asked the “addiction” question, I assume they’ve bought the media “war on drugs” hype.
I don’t advocate recreational drug use, but I’m in the “more is better” camp when it comes to pain relief.

Now, for your previous question. Morphine and other opiates have a euphoric effect. The amount of euphoria varies person to person. There are several other drugs that can induce it as well.
Since I haven’t worked with cancer patients in over two decades, I can’t tell you what they might be using today. Back in the '70s the most common euphoric agent our docs perscribed was cocaine. Somehow, I doubt it’s still used. I imagine some bureaucrat killed it’s use.
Hopefully, someone with more current experience will come by.

There’s also the psychological side of coming to accept one’s own mortality. I’ve seen it often. A dying patient reaches a point of serenity after struggling with the grief of losing themselves. Possibly, you SIL has accepted her inevitable demise.
I don’t know why it makes their pain easier to bear, but it seems to do so.

15

I’m sorry to hear about your SIL.

Some kinds of physical pain aren’t managed by opiates.