Morphine is an opiate analgesic, which means it works by binding to opioid receptors in the central nervous system and minimizing the body’s perception of pain. In addition to relieving pain, morphine can also promote feelings of euphoria and relaxation, and that is often why individuals start abusing it. Like other prescription opiates, the body can build up a tolerance to morphine quickly, and eventually, with consistent use, a physical dependence will develop.
Who Abuses Morphine?
According to the US National Library of Medicine (NLM), morphine is available as a regular tablet, an extended-release tablet, a liquid solution, and an extended-release capsule. Individuals who need morphine to treat moderate to severe pain will typically take the oral solution or regular tablet every four hours. Extended-release capsules, on the other hand, are much stronger and can be taken every 8-12 hours. Some brands of morphine, like Avinza and Kadian, only need to be taken every 24 hours.
According to the Global Information Network About Drugs (GINAD), the United States consumed roughly 55 percent of the world’s morphine between 1990 and 2010. GINAD also reports that studies suggest morphine is more addictive than cocaine, tobacco, and even alcohol, and the people who inject it are most likely to be males who are unemployed and homeless. It is important to remember, however, that ultimately anyone can develop an addiction to morphine.
There are a variety of ways to abuse morphine. Some people chew or snort extended-release tablets, while others prefer to inject the dissolved powder. Because morphine is so powerful, individuals can experience a variety of negative side effects when they take it, and they run the risk of overdosing every time they use. The Centers for Disease Control and Prevention reports that more than 60 percent of fatal drug overdoses in 2014 involved an opioid.
Common side effects of morphine include:
- Respiratory depression
- Dry mouth
- Nausea and vomiting
- Abdominal pain
- Chest pain
Even individuals who take morphine for legitimate medical reasons as directed by a doctor can develop a dependence on the substance and eventually start abusing it in order to keep withdrawal symptoms at bay.
Signs and Symptoms of Morphine Abuse
Taking morphine consistently for an extended period of time affects the body in a variety of ways, including physically, psychologically, and behaviorally. There are signs and symptoms that loved ones can look for if they suspect an individual is abusing morphine. Physical signs of morphine abuse include:
- Dilated pupils
- Slurred speech
- Difficulty concentrating
- Shallow or slow breathing
- Nodding off frequently
Individuals who develop an addiction to morphine will also experience behavioral changes. According to the National Institute on Drug Abuse, some behavioral signs of addiction are:
- A loss of interest in old hobbies and passions
- A lack of desire to socialize with friends or family
- Strange sleeping habits
- Dramatic mood swings
- A lack of basic hygiene
- Difficulty maintaining relationships
- Difficulty meeting obligations
Addiction treatment often involves three stages: detox, recovery, and maintenance. Many people are frightened to take that first step and enter a detox program because morphine withdrawal can be uncomfortable, but with the right approach, it is entirely manageable.
Morphine Withdrawal Timeline
When an individual develops a dependence on morphine, the body becomes accustomed to functioning with it in its system. That means when people enter a detox program and stop taking morphine, they will experience withdrawal symptoms as their bodies readjust to life without it. The duration of withdrawal and the severity of its symptoms vary among individuals based on a variety of factors. Some variables that affect the intensity of withdrawal include overall health, regular dosage, dosage of the last use, typical route of administration, and frequency of use.
Morphine withdrawal symptoms typically arise within six hours of the last dose. According to the Drug Enforcement Administration, early opioid withdrawal symptoms are fairly mild and include sweating, yawning, watery eyes, and runny nose. As more time passes, the symptoms worsen and peak until they eventually subside, which is usually within five days. A general morphine withdrawal timeline looks like this:
- 6 hours after the last dose: Cravings for morphine may start within six hours of the last dose. At this stage, depression, anxiety, and mood swings may also occur.
- 12 hours after the last dose: Depression may persist 12-14 hours after the last dose, and individuals may also experience excessive sweating and congestion.
- 16 hours after the last dose: At this stage, the physical symptoms become more uncomfortable. Muscle cramping and twitches may occur, and many individuals lose their appetite.
- 24 hours after the last dose: After going one day without morphine, diarrhea is common, as are trouble sleeping, high blood pressure, cramping, and rapid breathing.
- 36-48 hours after the last dose: Symptoms typically peak on the second day of morphine withdrawal. The most uncomfortable symptoms at this stage are involuntarily limb movement, vomiting, diarrhea, muscle cramps, pain, and insomnia.
- 72 hours after the last dose: By the third day of morphine withdrawal, the worst of the physical symptoms have usually passed. Individuals are left to face the psychological symptoms of withdrawal, like depression, anxiety, and cravings.
Most of the withdrawal symptoms for morphine subside within one week, but some individuals may experience protracted withdrawal. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), protracted withdrawal is the persistence of symptoms beyond the generally expected timeline. Common protracted withdrawal symptoms of opioids include anxiety, depression, insomnia, fatigue, and irritability. These symptoms can last for weeks or even months following detox.
Treating Morphine Withdrawal Symptoms
Detox is a natural, necessary part of quitting morphine, but there are still ways to ease the worst withdrawal symptoms. In an ambulatory detox program, clients have access to medication that can help to minimize physical symptoms and reduce cravings. In addition, they will be monitored by healthcare professionals for any complications that might arise.
The medications that are typically used to treat morphine withdrawal work by binding to the same receptors in the brain that morphine does; however, they are less potent than morphine, making them safer to take for an extended period of time. Ultimately, they help individuals taper off morphine gradually to minimize the discomfort caused by withdrawal.
Methadone is an opioid agonist that is commonly used to treat heroin addiction, and it can help those who are suffering from morphine withdrawal as well. According to the National Survey of Substance Abuse Treatment Services, the number of clients in opioid treatment programs receiving methadone increased by nearly 80,000 from 2003 to 2011, highlighting its popularity for addiction treatment.
Two other medications that can ease morphine withdrawal are buprenorphine and naltrexone. Buprenorphine is a partial opioid agonist that can relieve cravings without producing the high that morphine does. Naltrexone is an opioid antagonist, which means it blocks the action of opioids. It is not addictive and does not result in dependence.
After Ambulatory Detox
Going through morphine withdrawal is hard, and individuals who try to do so on their own often relapse because the symptoms are painful. For those who enter treatment and make it through the ambulatory detox phase, a program that consists of various types of therapy typically follows.
Recovery does not start and end with withdrawal because people still need to address why they started abusing morphine in the first place. Behavioral therapy helps individuals identify and change negative behavioral patterns. It also contributes to the third stage of recovery: maintenance. While attending therapy in a treatment program, clients will gain the tools needed to avoid or manage triggers in the future that will make them want to relapse. Ultimately, they will learn how to cope without morphine and find more effective ways to handle the stressors of everyday life.