Patients with shortness of breath caused by advanced chronic obstructive pulmonary disease (COPD) can get significant relief and improve their quality of life by taking opioid painkillers, according to Canadian researchers. But many doctors are reluctant to prescribe opioids for that purpose because they fear adverse effects on patients and legal trouble for themselves.
“I mean when I went to medical school, we were taught to never consider opioids in people with COPD. We were going to kill them. It was like if you gave them one dose of morphine, they would be dead and it would be your fault,” one doctor is quoted as saying in the study published in the Canadian Medical Association Journal.
Researchers interviewed 8 patients suffering from shortness of breath (dyspnea), along with 12 caregivers and 28 physicians in Nova Scotia. The patients had shortness of breath so severe that they needed oxygen, could not leave their homes and could not perform simple tasks without becoming breathless. They had been using opioids to treat dyspnea from a few months to up to four years.
“All patients reported that opioids provided significant improvements to their quality of life, relief of dyspnea, or both, and cited this as their main reason to continue taking opioids over the longer term,” wrote study co-author Dr. Graeme Rocker of Dalhousie University in Halifax.
“It takes away a lot of the struggle, you know. You’re not struggling to catch your next breath. You’re more relaxed,” one patient told researchers. “I still lose my breath mind you if I overexert, and it doesn’t take much to overexert you know, just… it’s made my life more comfortable.”
Another patient said opioids help him relax and breathe easier. “It seemed to give me a whole new outlook. Even though I didn’t do much walking around and that kind of stuff, I could still do more because I felt better… just all over felt better,” he said.
Chronic obstructive pulmonary disease affects millions of people and shortness of breath is a major symptom that is difficult to treat. Typical treatments for COPD include broncobusters, antibiotics, oxygen and steroids. Although opioids are often used to treat pain and dyspnea associated with cancer and other malignant diseases, they are underused in COPD treatment, despite evidence that supports the use of the drugs for patients who are nearing death.
Some patients were initially fearful about taking opioids. “I’m scared to death of morphine,” is how one woman responded when she was approached by a group of physicians about the use of opioids. She was assured it would be given in low dosage and would ease the difficulty of breathing and the pain she was experiencing.
Caregivers noted marked improvements in patients who took opioids. “Well, she’s not worried. She’s not breaking down and crying. She’s happier. The look on her face is much, much better and I see her in the mornings when she comes out here to have her tea she looks great to me in comparison to what it was. Yeah, it’s unreal,” one caregiver told researchers.
Despite good reports from patients, caregivers and fellow doctors, many physicians are reluctant to prescribe opioids for dyspnea.
“Well part of the problem is they’ve been so taught that if they give any sedatives for bad lung patients they will kill them. You have to get rid of that kind of longstanding teaching,” one internist is quoted as saying in the study. “They’re frightened to death that they’re going to give someone a shot of narcotic or a shot of benzo and the patient will stop breathing immediately and they’ll be charged with murder.”
“I must admit, I would be leery even at this point… to introduce a narcotic. It would be a hard sell,” said another physician who does not prescribe opioids for dyspnea — even though he knows it would help his patients. “There will be people who will go to their deaths that perhaps could have received better comfort. So the long and short of it is, I think, that I would love to start using it. If I start using it, it will come under criticism. That’s how blind we are nowadays. And it will be under review. So, it’s a sad situation.”