As the opioid addiction continues to grow, U.S. regulators are formulating new policy-based approaches to combat the crisis. Part of this effort focuses on preventing physicians from over-prescribing opioid medications. While it is true that drugs such as fentanyl and morphine are addictive and deadly if abused, they remain a critical component in treating the many patients who experience pain as they near the end of their lives. Effective pain management enables these patients to die peacefully and comfortably. We must ensure that any new solutions to the crisis do not cause terminal patients to lose access to vital treatment options. But with opioid medications now stigmatized, patients and their families hesitate to include them in their treatment plans.
So, importantly, healthcare providers must clearly explain the benefits of these medications and help end-of-life patients understand that while some risks are associated with standard opioid-based treatments, they are unlikely to cause addiction or hasten death when administered properly under physician supervision. These are the types of lessons I try to impart on future generations of health care professionals in my teaching at Maryville University in order to lessen the stigma and misinformation that can be prevalent in the healthcare industry.
Healthcare professionals take a variety of approaches to managing pain for end-of-life patients such as extended release agents applied to the skin and additional opioids to assist with breakthrough pain. The narcotics most commonly prescribed and administered to end-of-life patients are morphine and fentanyl. Breakthrough pain can also be managed with morphine drops or lozenges.
Pain can also be managed using several other medication classifications. Adjuvant medications may be prescribed in conjunction with opioid drugs or as a means to minimize their side effects. Non-steroidal anti-inflammatory medications combined with opioids decrease bone pain. Anti-seizure medications provide relief from nerve pain, which can result from chemotherapy agents or as a long-term effect of diabetes mellitus.
To manage pain effectively, the patient’s psychological, emotional, and spiritual needs must also be met. Support services from social work professionals and pastoral care will enhance the patient’s well-being. Massage therapy, acupuncture, and music therapy are also effective in relieving pain and stress. These are all important components of a comprehensive strategy to manage pain for end-stage patients. If new regulations limit doctors’ ability to prescribe standard opioid medications to patients at the end of their lives, providers will lose a critical tool to help patients die with dignity.