Discharge from Hospice Following Opioid Reduction

Figure

A male patient in his 70s, who was wheelchair-bound, drowsy, pain-free but orthopnoeic, was referred to an inpatient hospice for end-of-life care due to hypoxemia in the terminal stage of pulmonary fibrosis (oxygen saturation around 80% despite high-flow oxygen at 20 L/min) and cardiac decompensation with leg edema following myocardial infarction. He had been receiving long-term opioid therapy for L-dopa-refractory restless legs syndrome (RLS) as well as for back pain, most recently 48 mg/day hydromorphone (240–350 mg morphine equivalent dose [MED]). In the hospice, hydromorphone was reduced to 32 mg/day (MED of approximately 220 mg) over 10 weeks without withdrawal symptoms. Despite halving oxygen delivery, oxygen saturation increased to 88–90%. Opioid discontinuation was unsuccessful due to recurrent RLS symptoms. After 2 years, the now mobile patient only rarely required supplemental oxygen therapy and, in the meantime, had been able to marry his partner (Figure). This case demonstrates how high-dose opioids can lead to a physical decline that, in the presence of a known progressive underlying disease, may mimic a terminal stage.

Prof. Dr. med. Christoph Maier, Universitätsklinik für Kinder- und Jugendmedizin, Universitätsklinikum St. Josef-Hospital Ruhr-Universität Bochum [e-mail]

Dr. med. Maja Falckenberg, Das Palliativteam, Hamburg

Prof. Dr. med. Friedemann Nauck, Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Maier C, Falckenberg M, Nauck F: Discharge from hospice following opioid reduction.
Dtsch Arztebl Int 2026; 123: 195a. DOI: 10.3238/arztebl.m2025.0233