Morphine Withdrawal and Detox
Morphine is associated with high physical and psychological dependence. With regular use, tolerance develops early and correlates to duration of use and the intensity of the euphoric and analgesic side effects. Withdrawal symptoms may occur if use is abruptly stopped or reduced because the brain adapted to the presence of the drug and became accustomed to it. When the drug is stopped, the brain recognizes its absence and compensates, thereby giving rise to withdrawal symptoms.1,2
Although withdrawal is generally not associated with life-threatening symptoms, it can be extremely difficult and feel like an excruciating case of flu. Withdrawal can begin within six to 12 hours after the last dose and may last five to 10 days. Major withdrawal symptoms peak between 48 to 72 hours after the last dose.1,2
Morphine Withdrawal Symptoms
- Watery eyes
- Runny nose
- Loss of appetite
- Severe sneezing
- Abdominal cramps
- Elevated heart rate
- Increased blood pressure
- Heightened risk of infection
- Chills alternating with flushing and excessive sweating
- Gooseflesh (goose bumps)
- Body aches
- Muscle and bone pain
- Muscle spasms
- Severe insomnia
- Malaise (feeling generally unwell)
- Dilated pupils
- Heightened sensitivity to pain
- Restless legs syndrome1,2,3
The physical withdrawal symptoms of morphine can last as long as 10 days. The psychological symptoms associated with addiction are more complex and can last longer. Craving, compulsion and obsession about using morphine can persist for weeks or months after cessation of use.2,3
- Severe depression
- Mood swings
- Panic attacks
- Dysphoria (an intense dissatisfaction with life)
- Memory problems
- Low self esteem
- Drug craving
- Suicidal thoughts2,3
Post-Acute Withdrawal Syndrome (PAWS)
PAWS causes an array of characteristic post-acute symptoms during recovery from opioid dependence. It is estimated that 90% of recovering opioid users experience PAWS to some degree. Symptoms of PAWS include mood swings resembling an affective disorder, anhedonia (the inability to feel pleasure from anything beyond use of the drug), insomnia, extreme drug craving and obsession, anxiety and panic attacks, depression, suicidal ideation, suicide and general cognitive impairment.4,5
Morphine Detox Treatment
Supervised medical withdrawal is recommended for people who are severely dependent on morphine or for those with a morphine addiction. During detox, structured and tapered opioid therapy is administered under the direction of an experienced addiction specialist. This can help alleviate the worst symptoms of morphine withdrawal and is recommended over abrupt cessation. The latter can result in more acute withdrawal and may trigger relapse. In many cases, a tapering regimen with morphine over a two- to three-week duration is effective. The daily dose should never be reduced by more than 50% at any given interval. General tapering guidelines suggest reducing every daily dose by 10%, by 20% every three to five days and by 25% per week.2
Other pharmacological options for tapering include buprenorphine or Suboxone. Suboxone is a combination of buprenorphine and naloxone (Narcan). The latter is a lifesaving drug used on its own to reverse opioid overdoses. As with morphine tapering, the dosage of buprenorphine or Suboxone is sequentially reduced over a predetermined amount of time to mitigate the extreme discomfort associated with opiate withdrawal. Clonidine, a medication prescribed for hypertension, has shown some success in the management of troubling opioid withdrawal effects such as anxiety and flu-like symptoms (e.g. sweating, aches and sweating).6,7,8
By itself, medically supervised withdrawal is typically not sufficient to produce long-term recovery. Drug craving will typically follow cessation of morphine use and is a natural, albeit challenging part of recovery. It is important to keep in mind that after a period of abstinence, the body loses its tolerance to the drug so previously tolerated doses may result in a morphine overdose. Rehab often includes a wide array of behavioral and alternative therapies to help clients deal with everyday stressors and learn healthier coping mechanisms. Among these are skills training, family therapy, 12-step programs, acupuncture, yoga, equestrian therapy and more. Sharing and talking about problems with a psychologist, psychiatrist, sober friend or others recovering from morphine abuse are positive ways to help ensure long-term recovery.2,6,7
- Morphine (And Heroin). National Highway Traffic Safety Administration website. https://one.nhtsa.gov/people/injury/research/job185drugs/morphine.htm Accessed February 16, 2017.
- What is morphine withdrawal? Addiction Blog website. http://drug.addictionblog.org/what-is-morphine-withdrawal/ Published January 6, 2014. Accessed February 16, 2017.
- What are morphine withdrawal symptoms? Addiction Blog website. http://drug.addictionblog.org/what-are-morphine-withdrawal-symptoms/ Published October 21, 2013. Accessed February 16, 2017.
- How to Isolate and Treat Protracted Withdrawal Symptoms. The Fix website. https://www.thefix.com/content/paws Published February 4, 2014. Accessed February 16, 2017.
- Post-Acute Withdrawal Syndrome (PAWS). Semel Institute UCLA Dual Diagnosis Program website. https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS Accessed February 16, 2017.
- Schuckit MA. Treatment of Opioid-Use Disorders. N Engl J Med. 2016 Jul 28;375(4):357-68. doi: 10.1056/NEJMra1604339.
- Volkow ND, McLellan AT. Opioid Abuse in Chronic Pain – Misconceptions and Mitigation Strategies. N Engl J Med. 2016 Mar 31;374(13):1253-63. doi: 10.1056/NEJMra1507771.
- Suboxone Withdrawal. Drug Abuse website. http://drugabuse.com/library/suboxone-detox-withdrawal/ Accessed February 16, 2017.