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Morphine is one of the oldest opiates still in use, and it is made directly from opium. The drug is commonly prescribed by doctors to manage pain or processed into other medications or drugs. Generally, morphine is used to treat moderate to severe pain, and short-acting formulations are taken as needed for pain. The extended-release form of morphine is for around-the-clock treatment of pain and for use on an as-needed basis for pain management. Morphine is a naturally occurring opiate that affects the way the central nervous system responds to pain. Typically, morphine is administered by injection, and it is also prescribed in pill form. Morphine is the most abundant opiate found in opium, and there are semi-synthetic and synthetic versions of morphine.

Morphine use can lead to addiction and extreme physical and psychological dependence. The drug has the potential to be highly addictive as tolerance to the drug develops rapidly. Morphine also runs a high potential for abuse because of its pleasurable effects and relative accessibility. Morphine addiction is similar to heroin addiction because the action mechanism in the brain is similar. Morphine is usually available in liquid and tablet form, and it can be abused in many ways. Legally, morphine comes in many ways, like extended-release tablets, injectable solutions, immediate-release tablets, and extended-release injectables.

The chemical structure of morphine allows it to attach to the delta, mu, and kappa opioid receptors. These receptors flood the brain with dopamine and serotonin. Morphine is abused because of the intense euphoric effects it creates. Morphine comes in the form of white, crystalline alkaloids, and the chemical is odourless and also bitter. Morphine is an opiate and an opioid, and the drug is classified as a narcotic. There are significant risks involved with abusing morphine-like overdose caused by respiratory depression.

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How does Morphine Affect the Mind and Body?

Morphine is one of the oldest pain medications in history. However, the addictive nature of morphine, and other drugs like it, presents a massive problem. Morphine is typically injected into the bloodstream and is then absorbed and carried to other organs in the body. Like other opiates, it affects certain receptors in the brain. Depending on the dose and one's sensitivity to the effects of the drug of morphine can last 1.5 to 7 hours. The most noticeable effect of morphine is euphoria and decreasing levels of pain, and this becomes addictive.

Morphine causes a series of biological effects that comprise the body's immune response. According to the National Institute on Drug Abuse, morphine and other opioids suppress the immune system. The drug affects the body's immune cells in many ways, directly and indirectly. Morphine also suppresses the activity of three types of white blood cells. Moreover, high doses of morphine can completely shut down the brainstem and lead to coma and or death. Morphine has also been found to prevent specific processes that allow the strength of the synapsis in the brain to remain strong. The weaker the connections are within the brain, the harder it is for the brain to function.

Morphine affects the body in many different ways, like causing constipation. The drug reduces gut mobility that results in constipation and inhibits nitric oxide generation. The drug also reduces gut secretion and increases intestinal fluid absorption that leads to constipation. Morphine also causes liver inflammation and could lead to hepatitis c because of intravenous drug use. Morphine complicates hepatitis c by suppressing immunity and also enhances the hepatitis c virus replication. The use of morphine leads to the progression of the disease.

Morphine affects other systems within the body like slowing down metabolism, moderate blood sugar levels, lower blood pressure, and acute and chronic effects on the endocrine system, blood, heart, and lungs. Morphine is also a central nervous system depressant, and the early effects include slowed reaction time, sleepiness, depressed consciousness, poor performance, and divide attention. The long-term effects of morphine can result in brain damage because of the neurotoxic effects of the drug.

Some of the common street names for morphine are Dreamer, Emsel, First Line, God's Drug, Hows, M.S., Mister Blue, Morf, Morpho, and Unkie, M, and Red Rockets. Some of the common trade names in Canada are Doloral, Statex, and M.O.S. Traditionally morphine was almost exclusively used by injection, but addicts can buy morphine pills and liquid morphine. Most morphine addicts prefer injection drug use because the drug enters the bloodstream faster. Drugs that are similar to morphine are opium, codeine, heroin, methadone, hydrocodone, fentanyl, and oxycodone.

Prescription opioids like morphine are classified as Schedule I drugs under the Controlled Drugs and Substances Act. The use of these drugs is legal when they are prescribed by a licensed practitioner and use by the person it was prescribed for. Illegal possession of morphine is common because of double doctoring, and this involves obtaining a prescription from more than one practitioner. Double doctoring can result in lengthy prison time. Trafficking, importing, exporting, or producing morphine can result in life imprisonment.

The History of Morphine in Canada

Morphine was first isolated from opium in 1803 by German Scientist Friedrich Serturner. In its purest form, morphine is ten times stronger than opium. The drug was widely used as a pain medication during the 1800s. However, by the second half of the nineteenth century, scientists began to look for a less addictive form of morphine. In 1874, an English chemist refined heroin from a morphine base, and the drug was intended to be a safer replacement for morphine. Morphine today is still the precursor to all other opioids like prescription pain medication. Morphine is a precursor in codeine, fentanyl, methadone, hydrocodone, hydromorphone, meperidine, and oxycodone.

Morphine is a commonly used and prescribed pain medication in Canada. The common brand names are Doloral, Statex, and M.O.S. The history of morphine in Canada is directly connected to heroin, and over the past 20 years, the heroin situation in Canada has increased. Heroin and morphine are closely related as heroin becomes morphine once it enters the bloodstream. Along with heroin use in Canada, the country has a history of overprescribing pain medication like morphine. However, the number of opioid prescriptions given to Canadians has been on the decline.

According to a 2019 report looking at opioid prescribing, one in five people took an opioid in 2017, down slightly from 2013. Approximately 65% of claimants were using opioids acutely, and a large portion of opioid prescriptions was for chronic use. The number of people using opioids chronically was more than double for claimants covered by public plans. The highest median morphine equivalent dose was among individuals aged 25 to 44 years. The average median morphine equivalent dose increases the longer the patient stays on therapy. Much of the history of morphine in Canada is linked to pain medication. Cities like Vancouver, Toronto, Ottawa, and Montreal have experienced continuing issues with intravenous drug use involving heroin.

What are the Long-Term and Short-Term Effects of Abusing Morphine?

Morphine addiction becomes a serious problem causing significant long-term and short-term damage. Someone prone to morphine addiction usually has a history of substance abuse and abuses other opiates. Because of the potency and the drugs reinforcing actions with the brain's reward pathways, morphine has a high potential for addiction. The abuse of morphine is especially dangerous because of the potential breathing problems and respiratory depression. Morphine gives the user a feeling of euphoria, intense relaxation, and decreased perception of pain.

Many of the side effects caused by morphine range from mild to fatal. Common short-term effects include nausea, vomiting, itchy skin, appetite loss, constricted pupils, urinary retention, constipation, and slowed breathing. Other short-term effects are altered or irregular heart rate and rhythm, chest pain, dizziness, confusion, agitation, and seizures. The main risk associated with the long-term use of morphine is the development of addiction. The body adapts to the presence of the drug, and withdrawal symptoms occur when the person reduces or stops using the drug.

Long-term use can lead to the development of physical dependence leading to tolerance to the drug. The potential for addiction increased with repeated use of higher doses. The long-term damage to the body can lead to chronic constipation, heartburn, gastrointestinal bleeding, hyperalgesia, memory damage or loss, impulse control issues, structural changes in the brain, oxygen deprivation, cardiovascular damage, and muscle tone loss. Overall, the long-term use of morphine causes adverse effects. According to the Journal of Pain and Symptoms Management, opioids are thought to worsen the performance of psychomotor tasks due to their sedating and mental clouding effects.

The long-term use of opioids like morphine raises concerns about the possibility of adverse cognitive effects. The study suggests there is evidence that short-term use of opioid medication in persons who have never used these drugs before experiencing adverse effects on their psychomotor performance. Common adverse effects include mental clouding, sedation, and confusion. For example, some studies have shown cognitive interference in cancer patients taking opioids, and the problems increased with higher doses. However, this is not always the case and most issues with morphine stem from abuse and misuse.

Morphine Overdose, does it Happen, and How Does it Occur?

Morphine and other synthetic opioids are powerful drugs and have life-threatening effects on someone who abuses them. Unfortunately, opioid overdose and abuse are common with drugs like morphine. Although morphine is typically administered in a controlled setting, like any other pain medication, there is black market availability. Morphine overdose is not no uncommon, especially among intravenous drug users. The signs of a morphine overdose are cold and clammy skin, blue coloration to the fingertips and lips, constricted pupils, blurry vision, nausea, vomiting, severe constipation, irregular breathing, slow heartbeat, limp muscles, and loss of consciousness.

There are significant risk factors that increase the likelihood of a morphine overdose—mixing morphine with other central nervous system depressants like alcohol and benzodiazepines. Moreover, someone who takes larger doses or more frequently than prescribed. Older adults are at an increased risk, especially those with a history of substance abuse—men are more likely to overdose than women. If an overdose occurs, it is essential to receive immediate medical attention. Drugs like naloxone can reverse the effects of an overdose if given early enough. Basic life support is often needed for more severe overdose. Other morphine overdose treatment efforts may include blood and urine tests, activated charcoal, intravenous fluids, and heart monitoring.

According to an article in the European Respiratory Journal, a morphine overdose can cause respiratory depression. The case examined a patient that took 12-times there four-hourly doses of immediate-release oral morphine solution. The report points out the lack of monitoring by doctors with patients using prescription morphine and the increased risk of overdose. The amount of morphine needed to overdose varies and depends on the individual and their tolerance. The risk of overdose is highest when someone is first introduced to the drug.

Opiate overdoses involving drugs like morphine are a common occurrence in Canada. According to Health Canada, between January 2016 and June 2020, there were 17,602 apparent opioid toxicity deaths. Between April and June 2020, there were 1,628 opioid-related deaths, and this represented the highest quarterly count since national surveillance began. During that time, the number of deaths also represented a 58% increase compared to January-March 2020 and a 54% increase compared to the same time frame in 2019. Opioid overdose deaths are most common among men and individuals aged 20 to 49 years old. Men accounted for the majority of accidental apparent opioid toxicity deaths from January to June 2020.

Morphine Addiction and Recreational Drug use in Canada

Morphine addiction does occur easily, but there are different circumstances that lead to addiction. Initially, someone with a history of substance abuse, like with opiates, is at an increased risk of addiction. Most opiate addicts misuse various opiates over the course of their addiction. Heroin and morphine are similar, and heroin converts into morphine once it enters the bloodstream and reaches the brain. Morphine is just as addictive as other opiates and causes the same euphoric effects. Someone can also become addicted to morphine with prescription pain medication because of misuse and or abuse of the prescription. Under this situation, dependence usually occurs first, and this happens when the brain and body become adjusted to the dosage and depend on the interaction of the drug.

As the drug use continues, the dependence on morphine results in addiction because it creates painful withdrawal symptoms and an urge to use the drug despite the consequences. Even recreational morphine use leads to addiction, and long-term use, whether with a prescription or not, increases the risk of addiction. Overall, most opiate addictions are traced back to a prescription that was taken too long or misused. According to medical data, high-dose opioid prescribing increased by 23% in Canada between 2006 and 2011. Clinical guidelines at that time recommended that most patients should avoid high-doses of these drugs. Research released by the Institute for Clinical Evaluative Sciences found that high rates of high-dose opioid dispensing across Canada increased from 781 units per 1000 people to 961 units per 1000 people.

Canada and the United States have the highest levels of prescription opioid use in the world, and on average more than 30 million high-dose opioid tablets or patches are dispensed in Canada each year. The long-term use of pain medication like morphine has the potential to cause a loss of control over drug usage. Also, it could lead to polysubstance use, like misusing alcohol and other prescription drugs. Morphine changes brain chemistry by flooding the brain with neurochemicals, and the brain begins to adapt to the presence of these chemicals. Becoming addicted to morphine occurs differently for each person.

Detecting a morphine addiction is not always easy, especially if the person has a prescription for it. Some of the common signs of morphine addiction are dilated pupils, nodding off, slurred speech, shallow breathing, neglecting responsibilities, legal issues, doctor shopping, isolation from loved ones, irritability, and mood swings. Family and friends should be aware of some of the early warning signs. Someone struggling with addiction spends most of their time and energy using the drug or trying to find the drug to use it. There are usually problems with irritation and anger, extreme drowsiness, and dramatic weight loss. Financial difficulty is a common sign with any form of addiction and even getting in trouble with the law.

According to the Canadian Centre on Substance Use and Addiction, opioid pain medication was sued by 13% of the Canadian population. Among Canadians that used pain medication, about 2% reported using them for non-medical purposes. Pain is one of the most common reasons for seeking health care in North America. In 2012, between 14% and 29% of the Canadian population experienced chronic pain. In 2017, the Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain reported that opioids are associated with a 5.5% risk of addiction. One study found that 37% of opioid-dependent patients admitted to the Center for Addiction and Mental Health in Toronto reported receiving opioids solely from physician prescriptions. Moreover, 26% reported accessing opioids through a prescription and the street, and 21% accessed opioids illegally.

Morphine Addiction Treatment and Detox in Canada

Treatment for morphine addiction begins with drug detoxification, as a medical detox and withdrawal management. Someone dependent on morphine can expect to experience a painful withdrawal period that could be described as an intense flu. Some of the withdrawal symptoms include insomnia, anxiety, agitation, yawning, goosebumps, sweating, runny nose, racing pulse, increased blood pressure, muscle aches, nausea, vomiting, and abdominal cramps. Typically, withdrawal symptoms occur within 12 to 24 hours after the last use of morphine. Symptoms are not usually life-threatening, but every individual is different, and proper medical supervision is recommended.

Medication-Assisted Treatment is an option that some opiate addicts choose, and this is often part of a residential or outpatient drug rehabilitation program. According to the National Institute on Drug Abuse, not a single treatment is right for everyone, and people need to have quick access to drug rehab. Effective drug rehabilitation addresses all the patient's needs, not just their drug use. In addition, staying in drug rehab long enough is critical, and counselling and other behavioural therapies are the most commonly used forms of drug rehabilitation. Evidence-based approaches like behavioural therapies are often incorporated with holistic treatment and or non-traditional approaches to drug rehab. Effective drug rehabilitation for opiate addiction includes contingency management interventions and or motivation incentives. Other approaches like the community reinforcement approach plus vouchers and 12-step facilitation therapy have proven effective.

According to the Canadian Centre on Substance Use and Addiction, between 2017 and 2018, 1 in 206 Canadians were in treatment for substance use. More men accessed drug rehab than women, with patients being 62% male and 38% female. Overall, alcohol continues to be the single most frequently reported problem substance among individuals accessing drug rehab. This is followed by drugs like cocaine, cannabis, and opioids. Drug rehabilitation for morphine addiction should be well-rounded and also include aftercare support. An aftercare program would involve 12-step meetings, sober living homes, or another form of peer support.

According to the Canadian Center on Substance Use and Addiction, among the general population, the rate of past-year use of opioid pain medication was 13.1% compared to 14.9% in 2013. In 2015, the rate of past-year use of opioid pain medication among youth aged 15-24 was lower than that of adults aged 35 and over. Among youth aged 15-19, the rate of past-year opioid pain medication use was 7.4%, and the rate of opioid pain medication use among Canadian adults was 13.6%. Unfortunately, countless addictions begin with prescription morphine that is taken too long or misused.

According to the Pan-Canadian Trends in the Prescribing of Opioid and Benzodiazepines, 2012 to 2017—the overall quantity of opioids dispensed in Canada declined 10.1% between 2016 and 2017. The decline during that time was more than twice that between 2015 and 2016, and it exceeded the overall decline between 2012 and 2016. Approximately 21.3 million prescriptions for opioids were dispensed in 2017, compared to 21.7 million in 2016. The top six prescription opioids that accounted for 96% of all opioid prescriptions were codeine, tramadol, hydromorphone, morphine, oxycodone, and fentanyl. Between 2012 and 2017, the number of morphine prescriptions given to Canadians continues to decline.

According to a report outlining Opioid Prescribing in Canada, fewer people are prescribed opioids. The proportion of people prescribed opioids decreased from 14.3% to 12.3%. Fewer people have started opioids, and the number of people starting opioid therapy decreased from 9.5% to 8.1% among all age groups. However, the dosage and duration of therapy among people starting opioids remained relatively stable. The number of people being prescribed less than 50 morphine milligram equivalents daily increased, and the number of people prescribed new opioid therapy for one week or less increased.

Additionally, the report also indicated that fewer people are prescribed opioids on a long-term basis, and these individuals are being prescribed smaller doses. Overall, more people are stopping long-term opioid therapy. The proportion of people on long-term opioids who stopped therapy for at least six months increased from 18.3% to 20.4% in 2017. According to the Canadian Centre on Substance Abuse and the Misuse of Opioids in Canadian Communities—historically, heroin has been the best-known misused opioid and has been associated with the greatest harms.

In cities like Vancouver, drugs like heroin, morphine, and hydromorphone are the most commonly abused opiates. In Saskatoon, hydromorphone and morphine are frequently misused; in Ottawa, hydromorphone, fentanyl, and morphine are frequently misused. The misuse of opioids like morphine is different in every large city across Canada. Among the general population, approximately 2.2% of adults who use opioid pain medication reported using them for non-medical purposes.

Common Terminology Surrounding Morphine

Terms Definition
Morphine This is a pain medication of the opiate family and is found naturally in a dark brown, resinous form from the poppy plant. There are two alkaloids found in opium: Morphine and Codine.
Opiate An alkaloid drug like morphine that contains or is derived from opium.
Opioid This is a natural, semi-synthetic, or synthetic substance that typically binds to the same cell receptors as opium and produces similar narcotic effects.
Morphine Milligram Equivalent MME is a unit of measure used to compare opioids of varying potencies. It is the amount of morphine in milligrams equivalent to the strength of the opioid dose prescribed.

CONTRIBUTORS TO THIS ARTICLE

Marcel Gemme, DATS

Marcel Gemme, DATS

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on February 22, 2021

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