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Morphine was the earliest discovered of the psychoactive opiate alkaloids. It was first extracted from the opium poppy more than two centuries ago, and it has been in use as an opioid painkiller for much of that time. Though morphine has played a huge role in pain management ever since its discovery, it also has a long history of abuse. And, although it is primarily abused for its subjectively positive effects (euphoria, sedation, feelings of relaxation), its use can also lead to a number of concerning health issues, including:

  • Slowed heart rate.
  • Low blood pressure.
  • Respiratory depression.
  • Nausea/vomiting.
  • Coma.
  • Addiction.
  • Overdose.

Morphine Abuse

Black and white pills of morphine scatteredMorphine is a narcotic painkiller. As an opioid medication, its primary interaction in terms of pain relief is with the mu subset of opioid receptors in the brain and spinal cord. In addition to its receptor activity in the central nervous system, opioids like morphine also bind to and activate certain opioid receptors in the gastrointestinal tract. The use of morphine decreases a person’s perception of pain, thus alleviating some of the discomfort associated with it.1

In addition to pain relief, morphine can lead to mood changes and severe drowsiness.1 And as an opioid, one of its most dangerous side effects is its impact on respiration. Morphine can slow the breathing rate to dangerous levels and even stop it, depending on the dose and whether it is combined with other substances that similarly depress our respiratory drive, such as alcohol and sedative medications. Respiratory depression is a serious side effect of opioid medications and can be life-threatening.1

Other potentially life-threatening side effects or morphine use include:2

  • Apneic episodes (intermittent periods of halted breathing).
  • Respiratory arrest.
  • Circulatory depression.
  • Cardiac arrest.
  • Cardiogenic shock.

Excluding alcohol, morphine was the first drug isolated from a natural source (crude opium poppy) in 1806. Friedrich Wilhelm Serturner, the German pharmacist who discovered morphine, reportedly experimented with the drug himself and nearly died as a result.3

For more than 200 years, doctors have prescribed morphine to cure certain ailments. Due to the drug’s distinct potential for abuse and dependence, it did not take long for patients to develop morphine addictions. One of the first studies to document addiction to morphine was published in 1875. During this time, researchers started to realize that morphine had addictive potential.

Eventually, public perception shifted from seeing morphine in a positive light. By the time of World War I, morphine addiction was becoming increasingly associated with careless physicians. The Federal government eventually enacted the Harrison Anti-Narcotics Act of 1914, in part to control opiate distribution in the United States.4

Today, the use of morphine and other opioids has again ballooned out of control. It is well known that prescription opioids such as hydrocodone, oxycodone, and morphine are contributing to a national opioid epidemic. Nearly half of all opioid deaths in the United States involve a prescription opioid, and in 2015 more than 15,000 people died as a result of overdosing on opioid medications.5

Initial Short-Term Effects

In the short term, morphine can produce pleasurable effects such as euphoria and relaxation. Some users may also experience delusions or hallucinations, which, depending on the person, may or may not be a desired effect. The rewarding opioid high contributes to alarming rates of morphine abuse.

Woman scratching red backThe pleasurable effects of morphine don’t come without a downside, however, and the risks can be significant. Morphine’s side effects include:2

  • Itching.
  • Flushing of the skin.
  • Sweating.
  • Nausea.
  • Vomiting.
  • Severe constipation.
  • Headache.
  • Faintness.
  • Weakness.
  • Dizziness.
  • Slowed heart rate.
  • Slowed breathing rate. 

Morphine negatively affects the body in many ways. Its use may result in suppression of the immune system and can lower the body’s natural defense against infections. Because of this, doctors have to determine whether the benefit of prescribing morphine to certain patients, such as those with severe burns or cancer, outweighs the risk.6

Dangers of Long-Term Abuse

Over the long term, morphine can cause serious problems to a person’s physical and mental health and lead to or exacerbate interpersonal problems. Underlying conditions, age, and mental health contribute to the severity of these health effects.

Physical consequences that can occur acutely but are even more likely to result from long-term morphine abuse include:2

  • Spasm of the sphincter of Oddi and potential biliary/pancreatic dysfunction.
  • Paralytic ileus and potential intestinal obstruction.
  • CNS toxicity, resulting in seizures and convulsions.
  • Hypotension.
  • Overdose.
  • Coma.
  • Death.

Injection use is associated with an increased risk of disease transmission (e.g, HIV and hepatitis), collapsed veins, and endocarditis (inflammation of the heart lining).7,8,9

Continued use of morphine can lead to a cycle of addiction, signs of which include:

  • Tolerance: If a person uses morphine repeatedly over time, they may develop a tolerance to the drug’s effects. Tolerance is characterized by a person’s need to take increasingly higher doses of a drug in order to achieve the effects they’re seeking.10
  • Dependence: Dependence is a state in which a person only functions normally when they have the drug in their system. When physical dependence becomes significantly severe, an acute withdrawal syndrome is likely to arise when the drug is no longer used.

The main marker of addiction is the incessant use of a drug despite the physical, psychological, and social harm that it causes. An addiction to a drug like morphine can lead to a number of stressful issues for a person, including:

  • Job loss.
  • Dropping out of school.
  • Financial problems.
  • Debt.
  • Arrest.
  • Conflict with loved ones.
  • Divorce.
  • Loss of child custody.

Prolonged use of morphine can also lead to alterations in the brain. One study found that daily morphine use for just one month led to changes in certain regions of the brain, including the amygdala and hypothalamus, and reduced gray matter. Even after stopping morphine use, these changes persisted for, on average, nearly 5 months.11

Morphine Use Among Pregnant Women

Women are not advised to use morphine during pregnancy. Studies show that in-utero morphine exposure may negatively affect a child’s health and lead to a reduction in brain volume, small birth size, and increased risk for sudden infant death syndrome (SIDS).

In addition, infants born to mothers physically dependent on opioids are also likely to be physically dependent and experience withdrawal symptoms after birth (neonatal abstinence syndrome).2

How Addictive Is it?

Morphine is an opioid agonist and a Schedule II controlled substance. Morphine is similar in chemical structure and mechanism of action to heroin, an illegal opioid well known for its powerfully addictive high.

Like many opioid painkillers, morphine may be diverted for illegal use. People who are addicted to the drug will engage in drug-seeking behavior to obtain more of the drug and may employ a variety of tactics including “doctor shopping” to get more prescriptions. They may also lie and say that they have repeatedly lost prescriptions in order to get additional ones.12

According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), certain criteria indicate the presence of an opioid use disorder, or addiction. You might be addicted to morphine if:13

  1. You’ve been taking it for a longer time or in higher doses than you intended to.
  2. You want to quit and you’ve tried but you haven’t been successful.
  3. You spend a lot of time trying to get morphine, using it, and trying to recover from the effects of it.
  4. You crave morphine when you don’t have it.
  5. You’ve been neglecting your home, work, or school obligations because you’ve put morphine use above all else.
  6. You’re noticing your close relationships are suffering because of your morphine use.
  7. You’ve stopped engaging in hobbies or other activities you used to enjoy.
  8. You use morphine even when doing so could cause serious harm or kill you or others, like before driving.
  9. You can’t stop using even though you see how destructive doing so has been to your health or other aspects of your life.
  10. You have to keep taking more and more to get high.
  11. You suffer withdrawal symptoms when you’re not using. (See below.)

What Are the Withdrawal Symptoms?

Someone dependent on morphine can expect to experience an uncomfortable and trying withdrawal period that some describe as feeling like an intense flu. Morphine withdrawal symptoms include:14Sad man trying to sleep on his side, concept of insomnia

  • Insomnia.
  • Anxiety.
  • Agitation.
  • Yawning.
  • Goose bumps.
  • Sweating.
  • Runny nose.
  • Racing pulse.
  • Increased blood pressure.
  • Muscle aches.
  • Nausea.
  • Vomiting.
  • Abdominal cramping.

These withdrawal symptoms typically begin in the first 12 to 30 hours after the last morphine use. Although these symptoms are not usually life-threatening,14 they are severely distressing and commonly lead to the user relapsing. A supervised medical detox program can allay the discomfort of withdrawal with medications and provide a safe and substance-free environment for the recovering individual.

The Current Opioid Crisis

Every day, more than 1,000 people require treatment in the ER due to misuse of opioid medications.The abuse of opioids including morphine is a rampant public health problem. After marijuana use, prescription painkiller misuse is the second most common form of illegal drug use in the United States.15 In 2015, 12.5 million people reported misusing opioid prescriptions, and 33,091 people died from an opioid overdose. According to the Centers for Disease Control and Prevention, the total economic burden of prescription opioid misuse was $78.5 billion in 2013. This total was calculated to include the costs to lost productivity, addiction treatment, health care, and criminal justice involvement.16

The following stats further illuminate the magnitude of the current epidemic:5,17

  • Between 4% and 6% of people who abuse prescription opioids transition into using heroin.
  • Every day, more than 1,000 people require treatment in the ER due to misuse of opioid medications.
  • Between 1999 and 2014, overdose rates were the highest among people between 25 to 54 years of age. Overdose rates were higher among Whites and American Indians compared to Hispanics and blacks.

Treatment for Morphine Addiction

Treating a morphine addiction begins with detoxification. Detox can be conducted in an inpatient or outpatient setting depending on the severity of your morphine addiction.

Many people detoxing from morphine opt for a medically assisted approach which provides an environment where doctors, nurses, and clinicians who specialize in drug detox can monitor your condition and provide medications to allay your symptoms. Detox can be a profoundly uncomfortable time for many people, and having medical supervision can help ensure your safety and comfort during the process.

Depending on your situation and your viewpoint on the use of medications during recovery, you may want to try a social detox, which is a non-medical approach to ending your morphine use. A social detox setting allows you to be in a facility with a treatment professional as well as other people who are going through the same struggle so that you can support and encourage each other during the entire process. Social detox utilizes only social support and does not offer medication.

After completing detox, you will transition into the next tier of treatment. Depending on your situation, your doctor or treatment support specialist may recommend any of the following treatment settings:18

  • Inpatient or residential treatment programs: Inpatient treatment programs are places where you can live while receiving treatment. These programs offer around-the-clock supervision and a completely sober environment. These programs typically last for 30 days but individuals have the option to extend their stay to 60 or 90 days (sometimes more). These programs tend to offer a number of treatment services like cognitive behavioral therapy (CBT), group therapy, family therapy, and more.
  • Partial Hospitalization Program (PHP): In a PHP, a person can receive treatment in the hospital for up to 20 hours a week during the day with no overnight stays. A PHP is a mix of group counseling and individual counseling in a medical setting.
  • Intensive Outpatient Program (IOP): IOP is a type of outpatient program that provides more structure and a more intensive level of care than many standard outpatient offerings. IOP allows you to live at home so you can continue going to work or school, while also receiving treatment services.19
  • Outpatient treatment programs: Standard outpatient treatment may consist of weekly or biweekly sessions. You will travel to the facility for individual and group counseling. Outpatient programs are often preferred by those who have relatively less severe addictions or who have completed more intense tiers of treatment and are ready to transition into a less intensive care setting. In general, outpatient programs last at least 90 days.20

Before, during, or after treatment, you are welcome to join a 12-step support group in your community. In a group, you can create a community of clean and sober individuals who can support your recovery. To get started, you could look into Narcotics Anonymous, SMART Recovery, or Dual Recovery Anonymous. There are also smartphone apps that you can download to help you meet your treatment goals.

The thought of changing your lifestyle can be scary, but deep down you probably know that it is the best thing for you. If you or someone you love is dealing with an addiction to morphine or other opioids, there are resources available. Remember, it is brave to reach out for help and it’s never too early, or too late.


References

  1. DrugBank. (n.d.). Morphine.
  2. Food and Drug Administration. (2011). Highlights of Prescribing Information: Morphine Sulfate Injection. 
  3. Stolberg, V. B. (2016). Painkillers: History, Science, and Issues. ABC-CLIO.
  4. Institute of Medicine (US) Committee on Opportunities in Drug Abuse Research. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington (DC): National Academies Press (US); 1996. B, Drug Abuse Research in Historical Perspective.
  5. Centers for Disease Control and Prevention. (2017). Prescription Opioid Overdose Data.
  6. National Institute on Drug Abuse. (2008). Morphine-Induced Immunosuppression, From Brain to Spleen.
  7. Centers for Disease Control and Prevention. (2017). HIV and Injection Drug Use.
  8. Pieper, B., Templin, T. N., Kirsner, R. S., & Birk, T. J. (2009). Impact of injection drug use on distribution and severity of chronic venous disordersWound Repair and Regeneration : Official Publication of the Wound Healing Society [and] the European Tissue Repair Society17(4), 485–491.
  9. Moss, R., & Munt, B. (2003). Injection drug use and right sided endocarditisHeart89(5), 577–581.
  10. National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction: Definition of tolerance.
  11. Younger, J. W., Chu, L. F., D’Arcy, N. T., Trott, K. E., Jastrzab, L. E., & Mackey, S. C. (2011). Prescription opioid analgesics rapidly change the human brainPAIN®152(8), 1803-1810.
  12. Teater, D. (2015). The psychological and physical side effects of pain medicationsNational Safety Council.
  13. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association.
  14. U.S. National Library of Medicine. (2016). Opiate and opioid withdrawal.
  15. Substance Abuse and Mental Health Services Administration. (2016). Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health.
  16. U.S. Department of Health & Human Services. (n.d.). About the Epidemic.
  17. National Institute on Drug Abuse. (2017). Opioid Overdose Crisis.
  18. Johns Hopkins Medicine. (n.d.). Center for Substance Abuse Treatment and Research: Treatment Settings.
  19. McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance Abuse Intensive Outpatient Programs: Assessing the EvidencePsychiatric Services (Washington, D.C.)65(6), 718–726.
  20. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
Last updated on December 6 2018
2018-12-06T22:39:26+00:00
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