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Morphine Addiction Treatment

Morphine (M, Miss Emma, Monkey, White Stuff, God’s Drug, MS, Morf, Morpho, Dreamer, First Line, Emsel, Unkie and Mister Blue) is the most abundant opiate (narcotic) analgesic found in opium. It is a potent pain reliever used legally in the clinical setting, although it is also abused illicitly. Morphine is an opium agonist, which means it blocks the transmission of pain signals to the brain by binding to nervous system proteins called opioid receptors. The U.S. Food and Drug Administration (FDA) first approved morphine in 1941. Multiple companies manufacture the drug under different brand names.1,2,3 Some of the clinical applications of morphine include:

  • Post-surgery
  • After major trauma or injury except head injuries
  • In advanced, terminal cancers for severe pain
  • To reduce severe coughing associated with lung cancer

The oral solution of morphine (Roxanol) with the highest concentration (100 mg per 5 ml) and Avinza capsules containing 90 mg should be prescribed only to people who are opioid tolerant or used to the effects of opioids. Morphine may cause severe low blood pressure in people who have low blood volume, anemia or who were administered general anesthetics or an antipsychotic class of drug called phenothiazines. Morphine is contradicted for head injuries and intracranial pressure because taking it may exaggerate the drug’s respiratory depressant effects and further increase intracranial pressure.1

Brief History of Morphine

In the early 19th century, a pharmacist’s assistant named Friedrich Wilhelm Serturner isolated a yellowish-white crystalline compound from crude opium after immersing it in ammoniated hot water. He observed small doses resulted in pain relief and euphoria, while high doses could lead to psychiatric effects, nausea, vomiting, cough suppression, constipation and slowed breathing. Pain relief was 10 times greater than that of opium. Serturner named the compound morphine, after the Greek God of dreams, Morpheus. It was discovered that morphine was more addictive than either alcohol or opium, although accounts of as many as 400,000 American Civil War soldiers being addicted to morphine have been largely debunked. There is not a single report during the Civil War of a soldier using morphine for pleasure and a neurologist at the time berated the medical profession for its reluctance to administer morphine to soldiers with gruesome wounds. The first documented use of the phrase “soldier’s disease” was associated with World War I in 1915.3,4

Morphine Abuse

Morphine can be highly effective in managing severe pain, although its euphoric effects, potential for tolerance and severe withdrawal symptoms are associated with a high risk of addiction and relapse. Morphine directly targets the central nervous system and changes the way in which the body feels and responds to pain. Like other opioids, it binds to opiate receptors in the brain and changes the neurochemical activity in the brainstem, thereby altering some automatic body functions. It also impacts regions in the brain responsible for pleasure, binding to opiate receptors within the reward pathways. Specific reinforcing brain patterns may develop as a person obsesses over taking the drug, causing them to compulsively seek it out. A number of studies have provided an improved understanding of morphine addiction by clarifying the morphine-specific functional and molecular changes in multiple reward-related brain regions.5,6

Misusing morphine by taking excessive doses or combining it with street drugs, alcohol or other prescription drugs can have dangerous consequences and may be fatal. Treatment for morphine addiction is challenging, which becomes even more difficult with co-occurring use of other illicit and prescription drugs, whether intentional or unintentional. Most experts recommend inpatient detox due to the severity of morphine withdrawal symptoms and risk of relapse.6

Stats and Facts

  • Emergency department (ED) visits involving morphine increased by 120% from 15,762 visits in 2005 to 34,593 visits in 2011, although no changes occurred between 2007 and 2011.7
  • Among females, ED visits for morphine doubled from 2005 to 2011.7
  • Morphine ED visits by age group in 2011 were as follows: 4,347 (ages 18 to 25); 3,444 (ages 26 to 34); 4,757 (ages 35 to 44); 8,228 (ages 45 to 54) and 12,984 (ages 55 and older).7
  • Natural opioids (including morphine and codeine) and semi-synthetic opioids (including commonly prescribed pain medications such as oxycodone and hydrocodone) were involved in more than 12,700 deaths in 2015.8

Relapse Prevention

Overcoming addiction is extremely challenging and the risk of relapse is high. A promising study from the University of Minnesota Medical School, Department of Neuroscience identified a potential target for preventing morphine relapse in mice. This research pinpointed two different types of dopamine-receptive neurons (D1 and D2) located in the brain’s nucleus accumbens that could be driving addictive behavior. This part of the brain plays a role in motivation and reinforcement. In mice with repeated morphine use, researchers found D1 activity persistently increased while D2 activity decreased, implying dopamine-receptor cells may trigger relapse. By retuning D1 through manipulation, they were able to stop morphine relapse in the mice. Further studies are needed to assess the potential efficacy of this approach in humans. Identifying the mechanisms triggering relapse in humans is key to developing more efficacious addiction treatment modalities.9

  1. What Is Morphine? Everyday Health website. http://www.everydayhealth.com/drugs/morphine Updated January 12, 2015. Accessed February 15, 2017.
  2. What is Morphine? News Medical website. http://www.news-medical.net/health/What-is-Morphine.aspx Updated October 27, 2013. Accessed February 15, 2017.
  3. Morphine History. News Medical website. http://www.news-medical.net/health/Morphine-History.aspx Updated October 27, 2013. Accessed February 15, 2017.
  4. The Mythical Roots of U.S. Drug Policy: Soldier’s Disease and Addiction in the Civil War. DRC Net Library website. http://www.druglibrary.org/schaffer/history/soldis.htm Accessed February 15, 2017.
  5. Long term effects of morphine on the brain (INFOGRAPHIC). Addiction Blog website. http://addictionblog.org/infographics/long-term-effects-of-morphine-on-the-brain-infographic/ Accessed February 15, 2017.
  6. Morphine Abuse. Drug Abuse website. http://drugabuse.com/library/morphine-abuse/ Accessed February 15, 2017.
  7. The CBHSQ Report: Emergency Department Visits Involving Narcotic Pain Relievers. Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/data/sites/default/files/report_2083/ShortReport-2083.html Published November 5, 2015. Accessed February 15, 2017.
  8. New data show continuing opioid epidemic in the United States. Centers for Disease Control and Prevention website. https://www.cdc.gov/media/releases/2016/p1216-continuing-opioid-epidemic.html Published December 16, 2016. Accessed February 15, 2017.
  9. Research snapshot: New tools could help prevent relapse behavior in opioid addiction. University of Minnesota website. http://www.healthtalk.umn.edu/2016/01/29/new-tools-prevent-morphine-relapse-mndrive/ Published January 29, 2016. Accessed February 15, 2017.

 

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