In 2016, more than 500,000 U.S. adults misused a morphine product, per the National Survey on Drug Use and Health (NSDUH). Morphine is a powerful pain reliever derived from the opium poppy plant that is prescribed to treat moderate-to-severe pain. It is also highly addictive and can cause physical dependence even when used as directed under medical supervision for as little as a few days.
When morphine is taken, it binds to special receptors in the brain, called opioid receptors, which helps to interfere with pain sensations. Morphine also causes a flood of dopamine in the brain, which creates a mellow and pleasant feeling.
The stress response is turned down, and functions of the central nervous system are depressed. Heart rate, blood pressure, respiration, and body temperature all go down, as thinking, movement, and emotions are all affected as well.
The morphine high can be very desirable, and the crash that can follow when morphine wears off and processes out of the body can be unpleasant, causing a person to want to take more morphine. Morphine dependence can set in with very few uses, and the cravings and difficult withdrawal symptoms make it difficult to stop taking morphine and more likely for the drug to be misused.
Morphine addiction is the result of a lack of control over morphine use. The American Society of Addiction Medicine (ASAM) publishes that more than 2 million people in the United States battled addiction involving an opioid painkiller like morphine in 2015.
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Withdrawal is a set of symptoms that occur when morphine processes out of the body after physical dependence has been established. This can occur with regular use for several days. The more morphine that is taken and the more often a person takes it, the higher the level of physical dependence is likely to be and, therefore, the more significant withdrawal will be.
Morphine is dispensed as an injectable, in oral solutions, as tablets and capsules, and in suppository form for legitimate prescription-strength pain relief, the U.S. Drug Enforcement Administration (DEA) reports. It also has a high potential for abuse.
When abused, morphine may be injected, swallowed, snorted, or smoked, and the method of abuse can also impact the level of physical dependence and, therefore, withdrawal. Using other drugs in conjunction with morphine can complicate withdrawal and enhance the possible side effects, as can the presence of a co-occurring mental health or medical disorder.
In general, opiate withdrawal begins within about 12 hours of stopping a drug like morphine. Once morphine is stopped after dependence has formed, the timeline for withdrawal typically looks like this:
Days 1 to 3: Symptoms begin.
Days 3 to 5: Side effects peak.
Days 5 to 7: Symptoms begin to ease, though some persist.
After the first week, morphine withdrawal symptoms typically begin to taper off; however, mood swings, emotional lows, cognitive difficulties, sleep issues, fatigue, irritability, trouble feeling pleasure, and cravings for morphine can persist for several weeks to months. The Substance Abuse and Mental Health Services Administration (SAMHSA) (PDF download) explains that this is called protracted withdrawal.
Withdrawal symptoms can vary in intensity and duration, depending on biological, genetic, and environmental factors. Individual metabolism and personal or family history of addiction as well as stress in the home can all play a role.
Morphine withdrawal can be managed through a comprehensive detox program. Detox is the process of allowing morphine to move out of the brain and body, and a specialized detox center can provide a safe environment and helpful methods of smoothing withdrawal. Proper treatment can even potentially condense the withdrawal timeline.
The U.S. Food and Drug Administration (FDA) explains that morphine is a medication that should not be stopped suddenly once physical dependence is established. Instead, a slow and controlled taper is preferable.
Medical detox programs can help to set up a tapering schedule that weans morphine slowly out of the body to minimize withdrawal symptoms. In this way, the body is not shocked by the sudden discontinuation of the drug and can slowly get used to it not being there.
Morphine may also be substituted with a long-acting opioid like methadone or buprenorphine during detox. These drugs still activate the opioid receptors in the brain, but they can be dispensed in doses that are more spread out since they remain active in the bloodstream for longer than morphine does. Buprenorphine is also only a partial opioid agonist with a ceiling effect, so it stops working after a certain point, making it less desirable as a drug of abuse.
Other medications can be beneficial during morphine detox to address particular symptoms, such as sleep difficulties, mood swings, pain, and stomach upset.
To ease withdrawal, it can be helpful to keep the mind occupied. Art therapy or creative expression can provide a healthy outlet. Physical exercise can be good as well. Eating healthy meals and getting a good amount of sleep can also relieve withdrawal symptoms by providing the body with what it needs to recover and heal. Hot baths, spa treatments, massage therapy, acupuncture, and chiropractic care can all provide a physical release that can be beneficial for managing pain and lowering stress during morphine withdrawal.
A medical detox program can provide the highest level of care during morphine withdrawal. When seeking a detox center, it is important to understand exactly what it is offering.
Comprehensive medical detox programs are typically inpatient where a person will remain on site for five to seven days while morphine safely processes out of the body. Outpatient detox programs may provide substitute medications once per day or so.
A detox center should perform a detailed assessment before admission to tailor the program to the individual. Any co-occurring disorders will need to be addressed, and integrated care, as well as simultaneous treatment, will need to be arranged. Staff at a detox center should be highly trained, licensed professionals, and the center itself should also be licensed and accredited.
Personalized care is important. Addiction is a disease that impacts each person in their own way, and treatment should address this level of individuality. The goal of detox is not just for morphine to safely process out of the body, but also to provide a strong foundation for recovery. In this way, a detox program should be followed with a complete addiction treatment program focused on minimizing relapse and providing tools for doing so.
Detox programs that are seamlessly integrated into comprehensive treatment programs can offer a full continuum of care. In a safe and secure environment, morphine withdrawal can be completed, helping to pave the way to recovery.
(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm
Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine. from https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
Morphine. Drug Enforcement Administration. from https://www.dea.gov/factsheets/morphine
(April 2016). Opiate and Opioid Withdrawal. U.S. National Library of Medicine. from https://medlineplus.gov/ency/article/000949.htm
(November 2011). Highlights of Prescribing Information. U.S. Food and Drug Administration. from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/202515s000lbl.pdf