Hospice teams typically provide a small set of medications focused entirely on comfort: relieving pain, easing breathing, reducing anxiety, and managing other symptoms that arise in the final days and weeks of life. Most families receive what’s called a “comfort kit” or “emergency kit” kept at home, stocked with premeasured amounts of these drugs so relief is available quickly when symptoms appear. The medications inside aren’t meant to cure anything. They exist to keep the dying person as comfortable as possible.
What’s in a Comfort Kit
A standard hospice comfort kit contains a small supply of medications covering the most common end-of-life symptoms. A typical kit, like those used by Kaiser Permanente hospice programs, includes:
- Liquid morphine concentrate for pain and shortness of breath
- Lorazepam (Ativan) for anxiety, agitation, seizures, and shortness of breath
- Haloperidol (Haldol) for nausea, vomiting, and agitation
- Atropine drops for excess secretions in the throat and airway
- Phenobarbital for agitation and seizures
- Bisacodyl suppository for constipation
- Acetaminophen suppository for fever and mild pain
The kit sits in the home so caregivers can give a dose when the hospice nurse instructs them by phone, rather than waiting for someone to arrive. Each medication targets a specific symptom, and the hospice team walks families through exactly when and how to use them.
Pain and Shortness of Breath
Morphine is the cornerstone of hospice comfort care. It treats both pain and the sensation of air hunger, which is one of the most distressing symptoms at the end of life. In hospice, morphine is usually given as a concentrated liquid, often placed under the tongue or inside the cheek when a person can no longer swallow pills. A typical starting dose for someone who hasn’t been taking opioids is in the range of 5 to 15 mg, given every few hours as needed, then adjusted upward based on how the person responds.
When morphine is placed under the tongue, only about 18 to 20 percent is actually absorbed through the tissue there. Most of the effect comes from the liquid being swallowed with saliva and absorbed through the gut. This matters because as a person becomes less conscious and swallowing slows, the hospice team may switch to other delivery methods, like a small needle placed just under the skin that can deliver medication continuously or in small doses without requiring the person to swallow at all.
For certain types of pain, particularly nerve pain caused by tumors pressing on nerves, hospice teams sometimes add secondary medications. Low-dose steroids can reduce swelling around tumors and ease breathing when airways are partially blocked. Older antidepressants in the tricyclic class are occasionally used for their separate pain-relieving properties against nerve pain, not for mood.
Anxiety and Restlessness
In the final days, many people experience a state called terminal restlessness or terminal agitation. This can look like pulling at bedsheets, trying to get out of bed, calling out, or appearing frightened. It’s different from ordinary anxiety. It often reflects changes happening in the brain as organs shut down, and it can be deeply distressing for families to witness.
Lorazepam is typically the first medication used. It calms anxiety and can also help with shortness of breath by reducing the panic response that makes breathing feel worse. If the restlessness involves confusion, hallucinations, or agitation that doesn’t respond to lorazepam alone, the hospice team may add haloperidol or another antipsychotic. In cases where a person is actively endangering themselves, such as pulling out medical lines or striking caregivers, stronger sedation with a combination of these medications is considered appropriate when the person’s prognosis is very short.
The goal is always to relieve suffering, not to sedate someone unnecessarily. Hospice teams titrate these medications carefully, using the lowest effective dose first and increasing only when the person’s distress clearly warrants it.
The “Death Rattle” and Secretions
As death approaches, many people develop noisy, gurgling breathing caused by saliva and mucus pooling in the throat. The person is typically unconscious or semi-conscious and not bothered by it, but the sound can be alarming for family members. Hospice staff often call this “the death rattle.”
Medications that dry up these secretions include atropine drops (originally made as eye drops, but placed under the tongue in hospice care), scopolamine patches applied to the skin and changed every two to three days, and glycopyrrolate given by mouth or by injection under the skin. Atropine is the most common because it’s easy to give: just one or two drops under the tongue, repeated every several hours as needed. These medications work by blocking the nerve signals that tell glands to produce fluid, so they’re most effective when started early, before large amounts of secretion have already accumulated.
Nausea and Vomiting
Nausea at the end of life can come from many sources: the disease itself, medications (especially opioids), a bowel that has slowed or stopped moving, or pressure from tumors. Haloperidol, already in the comfort kit for agitation, doubles as an effective anti-nausea medication at low doses. Hospice teams may also use ondansetron or prochlorperazine depending on the cause of nausea, and in some cases olanzapine for nausea that resists other treatments.
How Medications Are Given When Swallowing Stops
One of the biggest practical concerns families face is what happens when their loved one can no longer swallow pills or liquids. Hospice teams plan for this transition well in advance, and several alternative routes are routine in end-of-life care.
Sublingual and buccal delivery, placing liquid drops or dissolving tablets under the tongue or between the cheek and gum, is the most common first step. Concentrated morphine solution works well this way, as do lorazepam and atropine drops. Rectal suppositories are another option: acetaminophen and bisacodyl suppositories are standard comfort kit items for exactly this reason. Scopolamine patches deliver medication through the skin over two to three days without requiring the person to do anything.
For patients who need continuous pain control, hospice teams can set up a small subcutaneous line, a thin needle placed just under the skin, usually on the abdomen, upper arm, or thigh. Medication flows through this line either continuously via a small pump or in periodic doses. The site is rotated every day or two to prevent skin irritation. This approach avoids the need for IV access, which is rarely used in home hospice settings.
Are These Medications Safe?
A common fear among families is that morphine or other medications will hasten death. This concern is understandable but generally not supported by clinical experience when these drugs are used as directed by hospice professionals. Opioids given in appropriate doses for symptom relief do not shorten life in the vast majority of cases. The doses used are calibrated to relieve pain and breathlessness, not to suppress breathing to a dangerous degree.
That said, certain medical conditions do require extra caution. People with advanced liver disease, for example, process opioids and sedatives much more slowly, which raises the risk of drug accumulation and excessive sedation. Research from the Veterans’ Health Administration involving nearly 1.9 million patients with opioid prescriptions found that liver disease was one of the strongest risk factors for opioid-related complications, including respiratory depression. In these cases, hospice teams use lower doses, extend the time between doses, and monitor more closely.
The combination of opioids and sedatives like lorazepam also warrants careful management, since both can suppress breathing. Hospice clinicians are trained to balance the benefits of comfort against these risks, and in the final hours of life, the ethical priority shifts firmly toward relieving suffering.
What Families Should Expect
The comfort kit usually arrives early in hospice care, often at enrollment, and sits unopened until symptoms arise. The hospice nurse will label each medication clearly and explain its purpose. Families don’t make dosing decisions on their own. They call the hospice team, describe what’s happening, and receive specific instructions on which medication to give and how much.
As the person moves closer to death, the medication regimen often simplifies. Drugs that were managing chronic conditions, like blood pressure pills, cholesterol medications, or diabetes drugs, are gradually discontinued because they no longer serve the person’s comfort. What remains are the comfort-focused medications: something for pain, something for anxiety or restlessness, something for secretions, and something for nausea if needed.
The shift can feel jarring for families who have spent years managing complex medication schedules. But the narrowing of focus reflects the core philosophy of hospice: at this stage, the only thing that matters is whether the person is comfortable.