Morphine Facts and Questions
Many people associate morphine with end-of-life palliative treatment for people with terminal cancer. It is indeed a pain-relieving drug with highly effective analgesic benefits for people suffering from severe cancer-related pain. Unfortunately, like all opioids, it is also subject to abuse by addicts for its euphoric effects. However, one does not have to be an addict to become dependent on morphine. The following morphine questions and answers dispel myths and will help you sort out fact from fiction.
What Is the Difference Between Morphine and Heroin?
Morphine (morphine sulfate) and heroin (diacetyl morphine) are both white, crystalline powders naturally occurring in the seedpod of the poppy plant, Papavar somniferum. Heroin may vary in color from white to dark brown or may appear as a black tar-like material due to impurities. Heroin is synthesized from morphine and acetyl chloride, so the primary difference is heroin has an acetyl molecule attached. The acetyl molecule allows heroin to cross the blood-brain barrier more quickly than ordinary morphine, making heroin about three times stronger. One grain of heroin equals about three grains of morphine.1,2
Heroin is an illegal (Schedule I drug) while morphine is used routinely in medicine and is a Schedule II drug. Heroin is subject to far more abuse than morphine, with a recent epidemic claiming nearly 13,000 people in 2015.3
Are Dependency and Withdrawal Associated Only With Abuse?
Although morphine is a highly effective and frequently prescribed opioid analgesic to help manage extreme chronic pain, it can result in physical and psychological dependency. This is true whether it is taken clinically or abused. Physical tolerance to and or dependence on morphine may develop within a couple of weeks of using morphine regularly. The central nervous system (CNS) becomes accustomed to the presence of morphine and compensates for the chemical in the brain. When morphine is stopped, the CNS needs time to recalibrate its chemistry, thereby producing withdrawal symptoms even when only one dose is missed. In general terms, people who abuse morphine to “get high” and cope with daily life stressors experience more difficult withdrawal than those who use it as directed for its intended therapeutic purposes.4,5
How Is Morphine Taken?
The dosage of morphine is client-dependent. A typical adult oral dose of morphine is 60 mg to 120 mg daily in divided doses, or as much as 400 mg daily in opioid-tolerant clients. Morphine is administered by oral, intramuscular, intravenous, rectal, epidural and intrathecal means. Avinza extended-release capsules are manufactured in 30, 45, 60, 75, 90 or 120 mg concentrations. Kadian extended-release capsules are available in 10, 20, 30, 40, 50, 60, 70, 80, 100, 130, 150 or 200 mg concentrations.1,5,6,7
Subcutaneous administration is typically 2.5 mg to 20 mg every few hours. Intravenous (IV) dosing is usually given slowly over an approximate five-minute window with doses up to 15 mg every four hours. IV administration is the most common method used in hospice care for end-of-life cancer associated with severe pain.5
How Is Morphine Intentionally Abused?
People who abuse morphine often crush the pills, turn them into powder and snort them with a small tube. Abuse increases both one’s tolerance and the risk of overdose. Doses of morphine over 200 mg are considered to be lethal to a person who is not opioid tolerant. Hypersensitivity to the drug can cause even 60 mg morphine doses to result in permanent impairment, coma or death. Some addicts who abuse morphine long term have extremely high tolerance for opiates and may be able to tolerate up to 3000 mg of morphine per day. Snorting is considered the most dangerous method and can damage the nasal tissues and the membrane between the nose and the brain, as well as result in overdose or death. Some people abuse morphine to get high by taking it with other narcotic pain medications, antidepressants, sedatives, tranquilizers, sleeping pills, muscle relaxers or alcohol, making the likelihood of overdose or death even greater.8,9
- 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 the difference between heroin and ordinary medical morphine? DRC Net Library website. http://www.druglibrary.org/gh/what_is_the_difference_between_h.htm Accessed February 16, 2017.
- Heroin Overdose Data. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/data/heroin.html Published January 26, 2017. 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.
- Morphine Withdrawal: Symptoms + How Long Does It Last? Mental Health Daily website. http://mentalhealthdaily.com/2014/08/01/morphine-withdrawal-symptoms-how-long-does-it-last/ Accessed February 16, 2017.
- RX List website. http://www.rxlist.com/avinza-drug.htm Updated December 6, 2016. Accessed February 16, 2017.
- RX List website. http://www.rxlist.com/kadian-drug.htm Updated December 6, 2016. Accessed February 16, 2017.
- Morphine overdose: How much amount of morphine to OD? Addiction Blog website. http://drug.addictionblog.org/morphine-overdose-how-much-amount-of-morphine-to-od/ Published August 9, 2014. Accessed February 16, 2017.
- Snorting morphine. Addiction Blog website. Published November 29, 2013. http://drug.addictionblog.org/snorting-morphine/ Accessed February 16, 2017.