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Treating chronic pain can be challenging for health care professionals since most of the time long-term pain is not relieved by routine analgesics and a stronger painkiller is usually advised such as morphine. Morphine is a super analgesic and has the potential for the development of addiction and dependence hence its sales are strictly regulated. According to Public Health England (PHE), the prescription for opioids has increased by 60% in the last ten years, most of which included morphine prescriptions.

Morphine is one of the earliest narcotic analgesics belonging to the opioid class of drugs. It has been used for more than 150 years in medical history by health care professionals to treat severe and chronic types of pain. Morphine is an alkaloid of opium and it was isolated from the poppy plant, known as ‘papaver somniferum’ in the 1800s by the German pharmacist, Friedrich Serturner who named it after the Greek god of dream- Morpheus due to the euphoric effect caused by this drug which makes the person enter a dream-like state.

Morphine is an opiate and its action is similar to heroin and it induces analgesia, or pain relief, as well as sedation and euphoria. Morphine produces its effect by acting on the opioid receptors present in the central nervous system thereby impeding the transmission of nerve impulses and alleviating pain. Moreover, morphine is also known to interfere in the brain’s reward system by releasing endorphins. Endorphins are happiness hormones that stimulate the release of dopamine and improves mood and cause a feeling of euphoria. 

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This effect often leads to the use of morphine as a drug of abuse as people use it for recreational purposes to attain a high and to enjoy the sedation and pleasurable state that ensues after consuming the drug. However, people who get addicted to morphine and abuse the drug remain oblivious to the potential side effects that manifest after taking the drug in excess as the outcomes can be even fatal. 

According to Office for National Statistics (ONS), 4561 deaths related to drugs poisoning were recorded in England and Wales in 2020 which is the highest number recorded since 1993. This number was a 3.8% increase as compared to the previous year and of these half of the deaths were associated with opioid misuse which is alarming statistics.

Morphine is prescribed for the treatment of severe pain when other analgesics have not been effective in alleviating the pain. It is usually prescribed for treating pain following surgery, pain caused by muscle tears, or pain after an injury, or bone dislocation. Morphine is also used in the management of myocardial infarction. Moreover, morphine is also used in the treatment of severe rheumatic arthritis and osteoarthritis. Morphine is also prescribed to alleviate cancer-related pain. 

Additionally, doctors also use morphine after combining it with lorazepam as a sedative in substitution of general anesthesia during minor procedures. 

Morphine is available in many formulations such as tablets, capsules, granules, suppositories, and injections. Morphine tablets are available as both immediate-release and extended-release for the management of acute and chronic or long-term pain. The British Pain Society recommends that people with chronic pain should not take more than 120mg of morphine in a day in any form such as capsules, tablets, or liquid formulations.

Morphine is available in the UK by different brand names. These include MST, Zomorph, Sevredol, Morphgesic, MXL, Kadian, Avinza, and Oramorph.

Morphine is available as a prescription-only medicine which means that it can not be assessed over-the-counter from pharmacies rather it is only dispensed when a person has a signed prescription of the drug from their general practitioner(GP). However, morphine is available illegally on the streets and through the dark web for illicit use and recreational purposes. On the streets, morphine is known by various names such as Dreamers, God’s drug, MS, Emsel, First Line, Mister Blue, and Morpho

Oramorph is a liquid form of morphine that is taken orally. It is the immediate-release or fast-acting formulation. The tablet form of fast-acting morphine is called Sevredol. The immediate-release formulation takes 30 to 60 minutes to work and its effect wears off after 4 to 6 hours. 

Slow-acting morphine takes a longer time to start working and it usually starts producing its effect after 1 or 2 days and hence it is given for the management of long-term pain. However, when morphine is administered through injection morphine it is the fastest way of pain relief as morphine acts rapidly after entering the blood directly through the vein. 

Morphine is not the first line of treatment to manage chronic and non-malignant pain due to the risk of dependence and addiction associated with prolong and unsupervised use of the drug. 

There are certain long-term side effects linked with the use of morphine. They are as follows:

It affects the gastrointestinal system and results in:

  • Constipation
  • Bloating
  • Poor appetite
  • Bloating
  • Weight loss
  • Dry mouth

It further affects the hormonal system in the body and results in:

  • Irregular menstruation
  • Inhibition of prolactin and gonadotrophic hormone
  • Increase in anti-diuretic hormone
  • Sexual dysfunction
  • Osteoporosis and risk of fractures
  • Hyperglycemia- increase in blood sugar level

One of the long-term side effects of morphine is the development of tolerance to the drug. This means that the person would have to take increased doses of morphine to achieve the same therapeutic effect for pain relief and the earlier prescribed doses will be no longer effective in relieving the pain. For this, your doctor might increase your dose slightly but you should never increase the dose by yourself without consulting the doctor since it can lead to serious dependence on morphine.

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In addition, morphine can also cause significant physical dependence. Dependence on morphine makes the person unable to function normally without taking the drug and hence the person may experience withdrawal symptoms if they miss a dose of morphine. 

However, the most feared of all is the risk of developing an addiction to morphine which has deleterious consequences. Being addicted to morphine means that the person feels a compulsion to take the drug even after knowing the potential hazards associated with the misuse of morphine. 

Morphine is the opioid that is most closely related to heroin in terms of its effects on the human body hence it is the most widely used drug of abuse and has a significant potential for addiction. Being psychoactive drug morphine enters the bloodstream and reaches the brain, irrespective of its route of administration and interferes in the brain signaling thus altering the entire brain chemistry. 

Morphine acts on the opioid receptors present on the brain, spinal cord, and thalamus- the area of the central nervous system involved in controlling the body’s responses such as pleasure and pain among many others. These opioid receptors release dopamine which is the key neurotransmitter for elevating a person’s mood and inducing a sense of well-being by regulating the brain’s reward system. This results in the feeling of analgesia and euphoria associated with the use of morphine and is the reason that morphine is addictive. 

However, when morphine is used for a legitimate medicinal purpose under the supervision of the health care professional, the chances to develop addiction are minimal and it is considered safe. The threat of significant addiction is linked with the duration and amount of morphine used. For instance, if a person is using morphine in greater doses and for a duration longer than prescribed for treating his pain even then he is likely to develop an addiction to morphine owing to the properties of the drug and the way it acts in the brain. Additionally, people often use morphine for recreational reasons to experience the feeling of euphoria and sedation that ensue after consuming the drug, and since the drug is available through prescription only so these people go to great lengths to obtain the drug through illicit means such as the dark web. 

Apart from the addictive potential of morphine, several other factors make a person prone to develop an addiction to morphine and these factors should be considered while prescribing morphine to such individuals. Firstly, genetics and family history of drug abuse is a widely accepted risk factor of developing an addiction to morphine as such individuals inherit it through their genes and have a higher tendency to develop abuse to addictive substances such as morphine. Secondly, prior history of drug abuse poses a serious threat towards the development of addiction to morphine and other drugs should be substituted with morphine for the treatment of such individuals. 

Moreover, environmental factors have a significant say in how a person develops and how they cope with life challenges as many individuals turn to drug abuse when they are tormented by life experiences and such individuals are at a greater risk of developing an addiction to morphine. 

Morphine addiction is on the rise in the UK similar to other opiates. According to the Office for National Statistics (ONS) number of deaths related to heroin and or morphine misuse in 2016 was reported to be 1209, which is an eight-fold increase since 1993 when only 115 deaths were recorded due to heroin and morphine misuse. This ever-growing trend in morphine addiction despite the strict regulation by the authorities in the UK is worrying since many people source the drug through the black market. 

Morphine is classified as a scheduled-II controlled drug in the UK which means that it has a significant potential for abuse and addiction and its use can lead to physical and psychological dependence which can have detrimental consequences.

Morphine is available through prescription only and when you collect your morphine medication, the pharmacist will take your photograph to make sure that you were prescribed the drug and will take your signature as a confirmation that you have taken hold of the medicine. Moreover, you are required not to share your medicine with anyone and to keep your medicine in a safe place to avoid easy access for others who are not given morphine. 

Morphine when sourced illegally is even more hazardous since the people who sell morphine in the black market alter the composition of the drug. Morphine that is available illegally is known to contain methamphetamines, fentanyl, and laxatives. Of these components, fentanyl is the most dangerous since it is 50 to 100 times more potent than morphine and can cause addiction even in people who rarely use the drug.

Morphine addiction has a myriad of findings that should be considered as red flags for addiction and should not be overlooked so that prompt management can be done to prevent the progression of morphine addiction. 

Following are the behavioural symptoms associated with morphine addiction that are usually the earliest to come into notice:

  • Preoccupied with the thoughts of arranging morphine and consuming it
  • Excessive use of morphine and inability to stop even after experiencing unpleasant side effects
  • Going to doctor shopping and manipulating doctors to prescribe morphine
  • Stealing, and lying to get morphine
  • Using illicit means such as the dark web to get hold of the drug
  • Hiding the tablets from everyone lest they might be caught abusing morphine
  • Poor personal hygiene and grooming
  • Isolating themselves from their loved ones and as a result, their relationships are suffering
  • Failing academically and/or at work
  • Using morphine simply to get high, long after the legitimate reason for the prescription is resolved
  • Taking morphine in greater doses and longer than the duration prescribed
  • Experiencing withdrawal symptoms of morphine
  • Mixing morphine with alcohol and other drugs to experience a greater effect of the drug
  • Experiencing cravings for morphine
  • Losing interest in hobbies

The physical signs and symptoms of Morphine addiction include:

  • Slurred or delayed speech
  • Looking drunk
  • Extremely drowsy
  • Sleeping excessively
  • Pinpoint pupils
  • Unexplained euphoria
  • Nausea and vomiting 
  • Difficulty in breathing

Oramorph when abused results in a plethora of side effects. These include:

  • Constipation
  • Nausea and vomiting
  • Dizziness and drowsiness
  • Feeling sleepy and/ or tired
  • Vertigo
  • Shallow or depressed breathing
  • Stiffness of muscles
  • Seizures
  • Confusion
  • Headaches
  • Itchiness or rash 
  • Suppression of cough 
  • Depression of the immune system

Morphine is also known to induce hallucination in certain individuals. Moreover, morphine also depresses the functioning of the heart which results in bradycardia that is slowing of the heart rate along with a reduction in blood pressure. 

Morphine can cross the placenta if taken by pregnant women and can cause intense physical dependence in the fetus which can manifest as severe withdrawal symptoms at birth that can even lead to the death of the baby.

As with any other psychoactive drug, discontinuing morphine also results in withdrawal episodes. This happens because morphine interferes in the pathways in the brain and impedes the signaling of certain messages such as pain perception and increases endorphins thus creating a calming effect that causes sedation, analgesia, and euphoria. The brain becomes dependent on the steady supply of morphine to function normally and as soon as you stop taking the drug there is an interruption in the brain signaling and the body tries to adapt to this change that is the lack of the desired stimulant, which in this case is morphine. The constellation of findings that present soon after the supply of morphine is interrupted are referred to as the withdrawal symptoms which are the body’s response to the absence of drug and it is a sign that the body has developed a dependence on the drug.

The withdrawal symptoms present as:

  • Irritability
  • Restlessness
  • Anxiety
  • Backache
  • Joint pain
  • Increase in blood pressure
  • Stomach upset
  • Nausea and vomiting
  • Increased heart rate
  • Chills
  • Sweating
  • Dilated pupils
  • Muscle pain
  • Inability to sleep
  • Fatigue 
  • Muscle aches
  • Runny nose
  • Cravings

It is best to go to a rehabilitation center or detox center to aid yourself in the withdrawal process under the team of highly skilled and professionals who will facilitate you in the journey to recovery. 

There is a higher probability that you can overdose on Morphine if you consume increase doses of the drug or if you mix Morphine with other substances that are contraindicated to use while taking the drug. However, if you continue taking morphine under the doctor’s supervision an overdose is unlikely.

Individuals who take morphine in doses greater than prescribed whether intentionally or by accident are at risk of developing morphine overdose. Moreover, individuals who take a huge amount of Morphine for recreational purposes, to achieve a high are also at an increased risk of morphine overdose which can lead to coma and even death. 

In addition, when people use alcohol and other CNS depressants such as benzodiazepines and other opiates, concomitantly with morphine then deleterious consequences ensue as such a combination is life-threatening and exacerbates the side effects associated with morphine and overdose develops quite rapidly. Hence it is advised to not use alcohol and other CNS depressants when you are taking morphine. 

Symptoms of Morphine Overdose

The most potential threat associated with morphine overdose is brain damage. Brain damage results when respiratory centers are depressed owing to the depressant action of morphine thereby reducing the oxygen supply due to pulmonary edema and hence vital organs like the brain receive an insufficient amount of oxygen to function normally and brain damage ensues. 

When an individual has had a morphine overdose he may present with some characteristic findings these include slurring of speech, clammy and pale skin, pinpoint pupils, pulmonary edema, the body goes limp, bluish discolouration of fingernails, lack of focus and confusion, extreme drowsiness, increase in blood pressure, increased thirst, vomiting, gagging, inability to move and speak, shallow breathing, muscle spasms, and pain. 

During an overdose of morphine, the heartbeat slows down gradually such that the heart may come to a stand-still, and death may result. In severe cases, unconsciousness, coma, and decreased breathing are present which ultimately leads to death. 

In order to avoid Morphine overdose, the drug should be used as prescribed by the physician and should never be mixed with alcohol and other illicit drugs to prevent these detrimental consequences. 



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