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Morphine and morphine addiction are part of the drug-abuse epidemic, what addiction professions refer to as a ‘perfect storm.’ Since 1999, deaths from opioid overdose have tripled. In 2007, nearly 100 people died every day from opioid abuse. In 2010, opioid addiction was so widespread that almost 5% of the U.S. population over the age of 12 was taking an illegally obtained opioid. Clearly we are in the middle of a national crises which affects millions of people throughout the country. Rural communities and suburban neighborhoods, once seemingly protected from inner city drug problems, report increasing opioid abuse across all demographics.

Morphine History

MorphineThis is actually morphine’s second ‘perfect storm’. The first crises occurred not long after it was isolated. Morphine comes from the poppy plant and was probably used for thousands of years in the form of opium. Its modern history dates to 1803 when a German pharmacist, Friedrich Serthurner first separated it from the poppy plant (Haemmig & Tschacher, 2001). After conducting an initial and failed animal trial (all his test subjects died), Serthurner rashly decided to conduct the second trial on himself and two teenaged recruits. The results, Serthurner claimed, were miraculous. Not only did they experience an immediate euphoria, but morphine proved more effective at pain management than even opium.

The real storm came when the syringe was perfected: this route of administration produced more potent results than when the drug was taken orally and doctors began to use it regularly. Suddenly, morphine was available everywhere and it was advertised to treat everything from sore throats to diarrhea. Babies were given morphine to calm colic. Soldiers were so commonly given the drug during the Civil War that addiction to morphine was called ‘soldier’s disease.’ Eventually, the problem became so wide-spread that the government stepped in and developed legal controls. Today it is considered a Schedule II narcotic, subject to governmental oversight.

Clinical Uses

Pharmacologically speaking, morphine is an opioid or narcotic, because it is derived from opium. It is sold as both a generic and brand name drug under a variety of names such as Kadian, MS Contin, MSIR, Oramorph SR. Medical professionals prescribe it orally, intravenously and in suppository form. It is most commonly used preoperatively as a sedative or as a pain management analgesic in either short acting or slow release formulations. Clinicians have found it very helpful in terms of managing severe pain, particularly with patients who are terminally ill. Even when it is prescribed by a medical professional, however, it is carefully supervised because its addictive properties are well known.

Neurochemistry

Morphine interferes with the normal functioning of neurons. The neurons are involved in sending communications about our feelings, our thoughts, and our actions. When morphine interrupts that process, it can either enhance those sensations or interrupt them. Morphine produces euphoria by ‘hyper-arousing’ these feelings, thoughts and actions. This is a pleasurable ‘high’ that addicts crave. At the same time, it ‘deadens’ the pain response by preventing communication about pain symptoms. The pain is actually still there, but the person doesn’t experience it.

Side Effects

When morphine is managed by a medical doctor, the patient is carefully monitored for negative side effects. The unintended consequences of morphine use can range from simple gastrointestinal problems all the way to death. A list of common side effects include the following:

  • Shallow breathing
  • Low blood pressure
  • Dizziness/light-headedness
  • Drowsiness or weakness
  • Inability to concentrate
  • Mood changes (such as anxiety or fear)
  • Agitation
  • Nausea
  • Vomiting
  • Constipation
  • Sexual dysfunction
  • Blurred vision (especially night vision)
  • Suppression of the cough reflex

Very Serious Side-Effects

The most serious consequences for morphine addictions are seizures, coma, cardiac arrest and, of course, death. Because morphine depresses the Sympathetic Nervous System and affects breathing, the most common cause of death is by suffocation.

Pregnancy

Women who are pregnant while abusing morphine are at very high risk to deliver their babies prematurely. These women are also more prone to have a breech birth, caesarean section and even stillbirth. Babies that are born to mothers dependent on morphine will also be born dependent, needing treatment in the intensive care unit, often for weeks. Some of these babies do not survive.

Addiction

Some people think that they can use morphine without getting addicted, but the simple truth is that all long term users of morphine will experience the symptoms of addiction. So powerful and so addictive is morphine, that long-term use can be best described as only a few weeks.

Exposure to morphine affects brain circuitry, particularly circuits in the following three areas: learning and memory, reward and motivation and impulse control. This means that all essential daily activity is hijacked. Whereas an individual once had a normal pattern of sleeping, eating and working, now much of the addicts time is focused on obtaining the drug. Even normal sexual activity ceases. Morphine changes the way that the brain functions: prolonged drug use makes the behavior compulsive, rather than volitional.

Dependency

Morphine is very dangerous because addicts become dependent on the drug very quickly. As this happens, their tolerance levels increase. This means that an addict will require more and more drug to produce a ‘euphoric’ feeling. Over time, even the way that the body metabolizes morphine will change, so that more of the drug is needed to produce the desired effect. This process is called metabolic sensitization.

An addict will continue to try to achieve the pleasurable ‘high’ that they first experienced from the drug so they will take more and more, trying to break through the new tolerance level. Addicts call this ‘chasing a high.’ Long-term addicts say that they achieve this with diminishing results at first, until finally they are unable to get back that ‘high.’ Ultimately, they find themselves using the drug more to prevent withdrawal than anything else.

Special Risks for Medical Professionals

Morphine is a particularly difficult problem among both medical personal and para professionals in the field. Estimates from the American Nurses’ Association find that between 10-20% of nurses will abuse drugs within the workplace during their career.   Physician addiction is estimated at similar levels ( between 10% and 12%). Because morphine is so widely prescribed, medical professionals are more exposed to the drug, and therefore more likely to abuse it.

Social and Health Consequences

Drug addiction is life altering and extremely damaging. Morphine addicts are at high risk for a variety of physical illnesses related to their lifestyle. They become increasingly negligent, forgo sleep and skip meals. Their lifestyle can become full of risk and many addicts eventually face legal problems. They are also at high risk for mental health problems, including anxiety, depression and even suicide. Long-term addicts lose their careers, lose stable housing, and destroy social relationships.

Polysubstance Use

Opioid addicts are especially prone to polysubstance use, with means that they will use a variety of other illegal substances along with the morphine. They are at especially high risk for abusing cocaine and alcohol. Combining morphine with other drugs puts an addict at especially high risk for over-sedation and cardiac arrest.

Opioid Withdrawal Syndrome

When someone dependent on morphine suddenly stops taking the drug, they go into opioid withdrawal. This occurs quickly, within four to six hours of their last dose. The symptoms are often described as similar to the flu, but more debilitating. Among the common symptoms are the following:

  • Runny nose
  • Abdominal cramps
  • Nausea and/or vomiting
  • Diarrhea
  • Weakness
  • Difficulty sleeping
  • Dilated pupils
  • Sweating
  • Muscle twitching and muscle aches and pains
  • Anxiety

This syndrome is at the heart of the addiction cycle. An addict wants to do whatever he or she can to avoid these symptoms. No longer are they just seeking the ‘high,’ now they are trying to avoid the ‘low.’

Drug addicts will spend a great deal of time and money trying to obtain the drug. If they do not have the money to purchase the drug, their behavior can become desperate and they become willing to take enormous risks. Long-term addicts are frequently involved in illegal behavior and are frequently incarcerated.

This also takes a toll on major social responsibilities. If the addiction is unchecked, they risk seriously damaging their personal relationships and face financial chaos and ruin.

Treatment

Treatment for all addictions is complicated, though morphine is arguably one of the more difficult addictions. Because of this, it is important to interrupt the cycle of abuse. Most addicts have a better chance of success if the treatment is in-patient. Some studies suggest that their odds are nearly doubled.

Why are inpatient morphine addiction treatments so much more successful? Part of the problem with morphine addiction is that the addict’s habit has probably affected so many areas of functioning. Addiction is a psychosocial illness as well as a physical addiction. Recovery therefore needs to be structured and comprehensive. An in-patient facility is simply more capable in this regard.

Among the benefits of in-patient care are the following:

  • Trained professionals who are knowledgeable about addiction and the addiction process. In the early days of recovery, addicts often need professionals who are available 24 hours a day. An in-patient environment is simply more able to meet this need.
  • Addicts need structure. Much of the process of early recovery is simply moving the addict back into a normal daily cycle. An in-patient treatment is reorients a client back into a routine while providing therapeutic activities.
  • Group and individual treatment. People in recovery often need significant individual focus. In addition, they benefit from the intensity of group treatment. A good recovery program will provide both resources, to maximize treatment success.
  • For an addict who has damaged family or social relationships, there is often group support, family work and planning about social supports. This is vital to helping a patient succeed.

Finally, few things feel as supportive to an addict as a community of recovery. By working with other individuals who are in recovery, an addict greatly enhances their chances at success.

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