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What Is Morphine?

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An alkaloid of opium, (1) morphine is derived from the poppy plant, or papaver somniferum. It is a psychoactive drug that binds to several opiate receptors in the brain to induce analgesia, or pain relief, as well as sedation and euphoria. While it is typically prescribed short term for severe pain after injury or surgery, there are instances when doctors may prescribe extended-release tablets (2) for long-term pain that is not effectively treated by other analgesics.
Morphine is one of the most powerful narcotic opioids available. Its name pays homage to Morpheus, (3) the Greek god of dreams, thanks to its ability to induce euphoria and relaxation in those who ingest it. It is a relative of heroin and almost as addictive.

When taken long term or in bigger-than-prescribed doses, there is a risk of mental and physical dependence. As such, distribution of morphine in the UK, as well as in many other countries around the world, is restricted.

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Medical Uses of Morphine

Morphine is prescribed to help alleviate severe pain. It is usually prescribed after surgery or to individuals suffering from severe injuries such as muscle tears, bone fractures or dislocations. In some cases, morphine is prescribed to those with advanced cases of rheumatoid arthritis or osteoarthritis when their pain can’t be treated with other narcotic opioids or analgesics. Cancer patients are also commonly prescribed morphine to help relieve pains and aches associated with certain types of cancer. (6)

Although morphine is indicated and approved by the FDA in the US strictly for acute or chronic pain in adults, may doctors there choose to prescribe it off-label. (7) This includes all forms of pain such as abdominal pain, headaches and chest pain. Additionally, some doctors will choose to administer morphine with lorazepam to induce a sedative effect during minor procedures in place of using general anaesthesia.

Available Forms of Morphine

When prescribed legally, morphine comes in a number of forms that can be taken by injection, orally or rectally. Morphine is sold under several brand names, which include Kadian and Avinza. (4) There are several other opiate drugs that have pharmacology and effects similar to morphine as well. These include hydrocodone, oxycodone, oxymorphone, hydromorphone, codeine and fentanyl.

Purchasing morphine illegally can be risky, as it is not uncommon for those who sell it on the black market to alter its chemical makeup. Morphine purchased illegally has been known to contain methamphetamines, laxatives and even fentanyl, another opiate narcotic that has caused epidemics around the world. Fentanyl (5) is 50 to 100 times more potent than morphine and is extremely addictive, even for those who use the drug only occasionally.

Legal Status (UK)

In the UK, morphine is considered a controlled drug. (8)

This means that a prescription is required to obtain it and doctors are limited in how and when they are permitted to prescribe it. Controls on drugs such as morphine are in place to avoid or reduce the risk of the drug being abused or obtained illegally and to prevent overdoses and death that occur from misuse.

Morphine is considered a schedule 2 controlled drug, which means several things for those who are prescribed it at home. When collecting their medication, the pharmacist will ask for photo identification to confirm who the medication is being given to, and the patient or person collecting the medication on their behalf is required to sign their prescription, confirming that they’ve received it.

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Patients are required by law to ensure safe storage of all controlled drugs and to keep their medication away from children and others who may abuse the drug. They are also required to return any unused portion of their prescription to the pharmacy for safe disposal.

Any person in the UK who is caught misusing or illegally manufacturing or distributing morphine may face up to six months of jail time for a summary conviction or up to 14 years of jail time for an indictable offense.

Routes of Administration

Morphine can be administered (9) in a number of ways, including:

  • Intravenous injection
  • Subcutaneous injection
  • Intramuscular injection
  • Epidural injection
  • Extended-release oral capsule or tablet
  • Oral solution or oral solution concentrate
  • Rectal suppository

The method of administration varies depending on the patient receiving the drug. Those who are unable to tolerate it orally may be prescribed a rectal suppository, while those in hospital are more likely to be offered the drug by intravenous or subcutaneous injection, provided an injection site has already been established. In most cases, doctors who prescribe morphine for home use will offer an extended-release tablet or capsule or an oral solution.

Pharmacological Actions of Morphine

Morphine’s pharmacological actions (9) are plentiful.

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Most notably, the drug interacts with the central nervous system to induce an analgesic effect. It is known to be most effective in relieving dull and continuous pain. While still effective, the drug has a lesser ability to treat superficial pain, while it is even less effective at treating neuropathic pain. When used against neuropathic pain, morphine has been reported to lessen its intensity, but in most cases, it does not completely relieve it. Other central nervous system actions caused by ingestion of morphine include drowsiness and sleepiness, as well as euphoria. In some cases, when taken without pain, morphine may induce restlessness and agitation as an alternative to euphoria.

Some patients have also reported the presence of hallucinations when taking morphine.

In terms of the cardiovascular system, morphine is known to result in mild bradycardia, which is a reduction in heart rate. A mild reduction in blood pressure typically occurs in all patients who ingest morphine as well. Those who abuse the drug by ingesting more than the prescribed amount are likely to experience intensified cardiovascular symptoms.

Other pharmacological actions of morphine may vary depending on the individual and the amount ingested but have been known to include:

  • Respiratory depression
  • Cough suppression
  • Induced nausea and vomiting
  • Prolactin and gonadotrophic hormone inhibition
  • Increased anti-diuretic hormone
  • Itching and hypotension
  • Depression of the immune system
  • Muscle rigidity

All opioids, including morphine, are known to cross the placenta when taken during pregnancy. Pregnant women who use morphine regularly during pregnancy put their foetus at risk of physical dependence. New-born babies born with a physical dependence may experience withdrawals at birth that can lead to death. During labour, administration of morphine, while necessary to relieve pain for some mothers, can lead to respiratory depression in infants.

Chemical formula – C17H19NO3

Morphine carries the molecular formula C17H19NO3 (1). This molecular structure is also found in similar opioid medications, including codeine and norcodeine.

Morphine Brand and Street Names

Morphine is sold under several brand names (12) by several pharmaceutical companies. Morphine sulphate extended-release capsules may be sold under the names Avinza, Embeda or Kadian, while MS Contin is a morphine sulphate controlled-release tablet.

Morphine is sold under several brand names (12) by several pharmaceutical companies. Morphine sulphate extended-release capsules may be sold under the names Avinza, Embeda or Kadian, while MS Contin is a morphine sulphate controlled-release tablet.

Injectable morphine is sold under several brand names as well, which include Astramorph, Duramorph and Infumorph. (13) Generic morphine is sold by several pharmaceutical companies worldwide.

Those who use morphine illegally may refer to it by any number of street names, which include the following:

  • Dreamer
  • God’s drug
  • MS
  • Emsel
  • First Line
  • Hows
  • Miss Emma
  • Monkey
  • Mister Blue
  • Unkie
  • Morpho
  • White stuff
  • Auntie Em
  • Goodfella
  • TNT
  • Tango and Cash
  • Morf

Morphine Addiction and How It Develops

In most cases, morphine addiction is unintentional. It may be prescribed to a patient for short-term, acute pain. As the patient begins taking the medication, dependence can occur quickly.

Dependence refers to what happens when their brain and body start to adjust to the dosage of medication and require the drug to function normally. Addiction, which is the act of compulsively taking the drug, whether in appropriate dosages or not, is also a risk in any morphine user.

When someone ingests morphine, it travels through the blood and into the brain. (14) When they inject it, this process occurs quite quickly. Once the morphine reaches the brain, it binds to opiate receptors in the cerebral cortex, the thalamus, the brain stem and the spinal cord. These opiate receptors release dopamine into the bloodstream, (15) which is what provides the analgesic effect and, in many cases, a sense of euphoria.

Tolerance (16) describes what happens when the user no longer responds to the effects of the drugs in their typical dosage. To experience the desired effect, the patient has to increase the dosage. Abuse occurs when the dosage is increased without a doctor’s guidance or supervision. As the dosage increases, so does the tolerance, and as a result, addiction and dependence often occur.

It’s important to note the differences between addiction and dependence. (17) While dependence may occur independently from addiction, a patient who is addicted is usually also physically dependent on the drug. As mentioned earlier, dependence is physical and occurs when the body depends on the drug to function, while addiction refers to a compulsion. Unless a user takes the drug compulsively, they are not considered addicted. While dependence requires tapering off the drug under medical supervision, addiction requires more intensive treatment methods that address both the physical and psychological effects of the drug.

Although morphine has highly addictive properties, it can be safe when administered properly. The risk of addiction is low when the drug is received in hospital under the care and supervision of trained medical professionals.

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Why is morphine addictive?

Morphine’s effect on the brain’s reward pathway and pleasure centres (17) is what makes it so addictive. Users become psychologically dependent on the drug to achieve the euphoric and sedative effects that are induced by its ingestion.

What Is the Typical Journey of a Morphine Addict?

Typically, morphine addicts are completely average people. They start out living normal lives and working in normal careers.

They become ill or injured and visit their doctor, who prescribes them NSAID (nonsteroidal anti-inflammatory) medications or another form of analgesic to combat their post-operative pain or pain related to their injury. They may find that the prescribed medications don’t work to relieve their pain and return to their doctor, who offers morphine as a solution.

As the patient begins using morphine, their pain subsides and they find they feel euphoric and comfortable when taking the drug. As time passes, the morphine becomes less effective in combating their pain. The patient sees no harm in increasing their dose slightly in hopes that more morphine will result in less pain. in some cases, the doctor may have even offered a prescription with a higher dose and requested that the patient start with a half dose and increase as needed. As the patient increases this dose, their tolerance slowly increases as well. Again, they increase the dose slightly, chasing the analgesia and euphoria they felt in the beginning. This cycle may continue for weeks, months or even years.

As the patient continues to increase their dosage, their body and brain become increasingly dependent on the drug. While some users may remain functional while abusing morphine, most become consumed by their addiction.

Morphine becomes their priority and takes precedence over their job, their relationships and their hobbies. Eventually, the patient will ultimately realize their addiction problems and seek help, or they may overdose on the drug, which can be fatal.

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Common Drug Combinations with Morphine

Many drug abusers who use morphine may take the medication along with other psychoactive drugs. In some cases, when purchasing morphine illegally, the drug is already combined with other drugs such as amphetamines or methamphetamines, other opioids such as fentanyl or codeine, or even over-the-counter medications such as laxatives, acetaminophen or caffeine.

Alcoholism is also common in people with substance abuse and opioid abuse problems. Unfortunately, the consequences (18) of mixing opiates such as morphine with alcohol can be incredibly dangerous. Alcohol may amplify the effects of morphine, leading to extreme drowsiness and impaired motor skills, as well as low inhibitions and a lack of coordination. Those who mix morphine and alcohol in large amounts risk overdose, which may result in coma or death.

Co-Occurring Disorders with Morphine Addiction

Many individuals who struggle with substance abuse or substance dependence also struggle with mental health issues.

There are some people who abuse morphine who may be putting themselves at risk of developing a mental health disorder, while others may have a mental health disorder and abuse morphine to numb the symptoms they experience.

In addition to alcoholism, there are several co-occurring disorders that are commonly seen in morphine addicts. These include:

  • Schizophrenia
  • Depression
  • Anxiety
  • Post-traumatic stress disorder
  • Bipolar disorder
  • Borderline personality disorder
  • Antisocial personality disorder
  • Conduct disorder

The link between mental health disorders and addiction is complex. When a mental health disorder occurs simultaneously with addiction, it’s important for users to find a treatment centre that can address both issues in a dual-diagnosis (19) treatment program.

Signs and Symptoms of Morphine Addiction

There are several signs (20) that should raise a red flag when someone is using morphine or another form of opioid narcotics. These include changes in behaviour, as well as physical and psychological symptoms.

Short-term effects of morphine on the body

Morphine’s short-term effects on the body and the brain include:

  • Sleepiness
  • Unconsciousness
  • Constipation
  • Slowed breathing
  • Nausea
  • Coma (in extreme cases)
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Physical signs and symptoms of morphine abuse and addiction

When an individual is physically dependent or addicted to morphine, they tend to experience several physical symptoms while taking the drug. These include:

  • Decreased appetite
  • Increased drug tolerance
  • Impaired motor skills
  • Irregular menstrual cycles in females

Long-term effects of using morphine

Those who use morphine or other opioids for an extended period of time may experience dependence and/or addiction. As the body and brain get used to morphine’s effects, users begin to experience withdrawal symptoms if they stop taking the drug.

Their tolerance for the drug will increase with continued use, which generally leads to the need for higher and/or more frequent doses to achieve the desired effect.

Psychological signs and symptoms of morphine abuse and addiction

Psychological addiction can result in many changes in a person’s psyche and behaviour. Noticeable mood symptoms may include:

  • Impaired mental and cognitive performance
  • Inattentiveness
  • Preoccupation with morphine
  • Poor judgment
  • Euphoria
  • Compulsion to use morphine despite acknowledging addictive or dependent behaviour

Behavioural changes might include

  • Spending time with new groups of friends or spending time alone
  • Losing interest in hobbies and activities
  • Changes in hygiene, such as failing to bathe or change clothing on a regular basis
  • Changes in mood such as agitation, irritability or sadness
  • Sleeping more often and at odd hours
  • Calling in sick to work or school frequently or missing appointments
  • Sudden financial hardship with no obvious explanation
  • Attempting to obtain multiple prescriptions from different doctors
  • Hiding morphine or lying about using it
  • Lying or stealing in order to obtain more morphine

Identifying Morphine Abuse in the Elderly

Drug abuse in senior citizens aged 65 and older is becoming more common than ever before; (21) however, there is evidence that substance abuse among the elderly has been an unidentified problem for decades.

Major life changes and more frequent and chronic illness in older adults may lead to late onset addiction. Triggers such as retirement, nursing home placement, a decline in mental or physical health or the death of a loved one can lead to mental health issues. When combined with prescription medications such as morphine or other opioid narcotics, these mental health issues lead to an increased risk of addiction.

While the symptoms of drug abuse in the elderly are generally similar to those of any age group, they can be more difficult to identify and are often mistaken for health disorders such as depression and dementia. Symptoms to watch for in elderly individuals include:

  • Appetite changes
  • Unexplained bruises
  • Memory problems
  • Insomnia or sleeping at odd hours
  • Mood changes such as depression or irritability
  • Losing touch with family members and friends
  • Poor hygiene
  • A desire to be alone
  • Chronic pain with no reasonable explanation

Senior citizens with addiction problems should seek treatment in a centre that specializes in elderly addiction, as they often require increased social support and psychiatric resources that aren’t always part of standard addictions treatment programmes.

Impact of Long-Term Morphine Abuse on the Brain

Long-term morphine abuse is known to alter the brain’s plasticity, (22) which essentially refers to the brain’s ability to rewire itself. In the brain’s excitatory postsynaptic sites, which are involved in learning and rewards, an alteration in plasticity may lead to changes in the way dopamine receptors operate and react to stimuli. Discontinuing use of morphine doesn’t typically help the brain to recover, and these effects are often permanent.

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Morphine Overdose Explained

Users who take large amounts of morphine are at a high risk of overdose, (23) which can lead to coma or, in extreme cases, death. While overdoses often occur after ingesting too much of the drug, they can also happen in other situations such as taking morphine that’s prescribed for someone else, taking morphine with the intention of getting high, taking morphine too often or taking it with other medications that are contraindicated such as fentanyl, codeine, Valium, Xanax or amphetamines. Overdose can also occur when morphine is used along with alcohol.

When an overdose occurs, the user’s heart and breathing slow down and in some cases may come to a complete stop. Other symptoms of overdose may include:

  • Clammy, pale skin
  • Going limp
  • Purple or blue fingernails
  • Vomiting, gagging or gurgling
  • Inability to wake up
  • Inability to speak
  • Pinpoint pupils
  • Pulmonary oedema
  • Hypotension

To prevent overdose, it’s crucial to take morphine only as prescribed and keep the medication out of reach of children. Morphine should never be mixed with alcohol or illegal substances and should only be combined with other medications when under the direction of a doctor.

Signs and Symptoms of Morphine Dependence

Dependence, or the need to take morphine to function normally, is common in those who continually use morphine. Dependence (24) is characterized by symptoms of withdrawal upon stopping the drug, which may include:

  • Irritability, restlessness and anxiety
  • Backache
  • Joint pain
  • Weakness
  • Excessive yawning
  • Abdominal cramps and diarrhoea
  • Insomnia
  • Nausea and vomiting
  • Increased blood pressure
  • Increased heart rate
  • Chills
  • Perspiration
  • Dilated pupils
  • Excessive production of tears
  • Muscle pain
  • Rhinorrhoea (runny nose)

Morphine Addiction Medications

In many treatment programs, opioid addicts are prescribed medications to combat their withdrawal symptoms and/or block the effects of opioids to reduce tolerance and dependence on the drug.

It’s important that these drugs are used in combination with therapy and social support in order to effectively recover from morphine addiction.

Methadone

Methadone (26) has long been used to combat the symptoms that are associated with opiate withdrawal symptoms. It’s an opiate narcotic; however, its effects are less intense than morphine or heroin and the risk of methadone addiction is less. The drug is typically administered as part of a treatment program to help patients taper off of morphine. It produces a similar effect to morphine, which can help the patient to detox and go through withdrawals with less discomfort. Methadone is typically only prescribed during the detoxification phase and in some cases, for a short period of time after.

Naltrexone

Naltrexone (25) is commonly used to treat alcohol and opiate addictions. To be effective, it’s recommended that doctors prescribe the drug in combination with counselling, lifestyle changes and behavioural therapy.
Naltrexone is an opiate antagonist, which means that it prevents the analgesic and euphoric effects of opiates when they are taken, as well as decreasing cravings for opioid narcotics such as morphine. Typically, a dosage of 50 milligrams of naltrexone is prescribed once per day as part of a complete rehabilitation plan. It should not be taken within seven days of any opiates and should be taken with food.

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Buprenorphine

Buprenorphine (27) is in a class of drugs called opiate partial antagonists, which means that it works in a similar way to naltrexone; however, the drug still produces some analgesic and euphoric effects. It’s used during detoxification to help reduce withdrawal symptoms, as well as to reduce cravings for morphine.

Therapy for Morphine Addiction

There are several approaches to therapy that have proven successful for those who are addicted to opiate narcotics such as morphine, fentanyl, heroin and codeine.

While in a morphine addiction treatment program, clients can expect to first experience detoxification. During this process, clients are medically supervised and may be administered medications to help them cope with their withdrawal symptoms, which are the strongest during this period.

After detoxification, clients will be treated with a variety of behavioural and psychological therapy techniques. Therapy is the most important part of the client’s treatment plan. It helps the client to avoid future relapse and teaches them to understand the behaviours and issues that led them to addiction.

After detoxification, clients will be treated with a variety of behavioural and psychological therapy techniques. Therapy is the most important part of the client’s treatment plan. It helps the client to avoid future relapse and teaches them to understand the behaviours and issues that led them to addiction.

Individual counselling

Individual counselling may consist of a variety of techniques, but it always takes place during one-on-one meetings between the client and their assigned counsellor. During individual counselling, clients may discuss their addiction and the issues that led them to develop it. Counsellors are trained to guide the conversation in a way that leads the client to self-discovery. The counsellor is also trained to provide techniques for overcoming morphine cravings and to recommend alternative ways for dealing with stress and anxiety, which may lead to relapse.

Support groups

In support groups, morphine users meet with a counsellor and other rehab clients to discuss their addictions and the methods they’re employing to overcome them. During group therapy, the counsellor typically leads the discussion. Clients share stories about their addiction and drug abuse and are given the opportunity to share advice with other clients. Group therapy can be helpful as it provides clients with insight from a variety of other people who are going through a similar experience.

Family therapy

Family therapy usually occurs once per week during a rehabilitation program. The client’s family or close friends are invited to attend family group therapy to receive support and advice. In many cases, family members of clients are the ones who must deal with the aftermath of the addicted behaviour, such as financial problems and damaged relationships. That’s why it is often important for those who are closely tied to the client to attend treatment as well.

Other Kinds of Intervention

While many people choose to check themselves into a drug treatment programme, there are other methods of intervention that can be used to encourage the user to seek help. Often, a friend of family member of the person struggling with addiction may choose to stage an intervention, which consists of sitting the individual down in a group of close friends and/or family members, along with a trained intervention counsellor, to encourage them to attend treatment.

During an intervention, attendees may read letters or share stories of how the person’s behaviour is affecting them, or alternatively, they may provide the user with insight as to how they are hurting themselves by abusing morphine. The counsellor guides the discussion and helps the person’s loved ones to encourage them to attend treatment immediately.

Morphine Addiction Statistics

In the UK and across the world, morphine and other opiates have caused an epidemic. More doctors seem to be prescribing the drug, despite a rise in the number of overdoses and deaths that are being reported as a result of opiate abuse. (26)

  • In 1999, more than half of accidental overdoses were linked to opioid narcotics.
  • In England and Wales, nearly 5,000 drug-related deaths between 2000 and 2004 were opiate-related.
  • Approximately 10% of Americans have admitted to abusing opiates at least once.
  • In Australia, doctors handed out 89% more morphine prescriptions between 1995 and 2003 than in previous years.
  • In 2010, 94% of all morphine consumed worldwide was accounted for in the UK, the US, Canada and five other countries.
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Cost of Morphine Addiction in Society

While morphine addiction is expensive to the user and typically costs thousands of pounds per year, society pays an even larger price. Substance abuse results in increased costs in health care, crime and even lost productivity. It has been said that in the US, the estimated cost of prescription drug abuse in 2018 was more than $78 billion, and costs are comparable in the UK.

Workplace productivity is decreased as a result of morphine abusers thanks to a reduction in workdays and premature deaths. Incarceration due to prescription drug abuse and illegal distribution also increases costs to the criminal justice system, while overdoses and treatment programs increase healthcare costs.

Get Help for Your Addiction Today

If you or someone you love is suffering from morphine or prescription medication addiction, help is available.

At UK Addiction Treatment Centres, we offer 160 detox and rehab beds throughout the UK and employ proven addictions treatment methods. We offer inpatient treatment programmes that range in duration from seven days to 28 days, as well as outpatient treatment, family counselling and physical health recovery from those who are trying to discontinue morphine use. Our detoxification programs are medically supervised 24 hours per day.

You or your loved one will be treated within a safe and nurturing environment as part of our bespoke private treatment options. Contact UKAT today at 0808 278 9461 to speak to one of our trained professionals and get started on the path to recovery today.

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