Routine Opioids at End-of-Life

December 2018 – Many dying patients are unable to ask for comfort medicines.

More patients are dying in senior facilities without 24-hour staff able to assess nonverbal pain and dyspnea or use “as needed” medications.

We find scheduling low-dose, short-acting opioids (q 4 hours routine) or long-acting opioids help assure our actively dying patients are comfortable without the need to swallow pills.

Dosages for opiate naïve patients:

Morphine concentrated liquid (20mg/ml): 2.5-5 mg (0.125-025 ml) PO/SL q 4 hours routine
(equivalent to 15-30 mg Hydrocodone over 24 hours)

OR

Hydromorphone oral liquid (1mg/ml): 0.5-1.0mg (0.5-1.0ml) PO/SL q 4 hours routine
(equivalent to 15-30 mg Hydrocodone over 24 hours)

OR

Fentanyl 12 mcg patch q 72 hours (equivalent to 25 mg Hydrocodone over 24 hours)
A higher opiate dose would be required for opiate tolerant patients or severe symptoms.

For more information contact Dr. Leslie Estep or Dr. Anita Meyer at Hospice of the Northwest,
360-814-5550, or lestep@hospicenw.org or ameyer@hospicenw.org

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