- Classification: Narcotic
- CSA Schedule: Schedule II
- Trade or Other Names: Duramorph, MS-Contin, Roxanol, Oramorph SR
- Medical Uses: Analgesic
- Physical Dependence: High for nonmedical use, low for medical patients in pain
- Psychological Dependence: High
- Tolerance: Yes
- Duration (hours): 3–6
- Usual Method: Oral, smoked, injected
- Possible Effects: Euphoria, drowsiness, respiratory depression, constricted pupils, nausea
- Effects of Overdose: Slow and shallow breathing, clammy skin, convulsions, coma, possible death
- Withdrawal Syndrome: Watery eyes, runny nose, yawning, loss of appetite, irritability, tremors, panic, cramps, nausea, chills and sweating
Morphine is an opiate-type of medication which is naturally found in some plants and animals. It acts directly on the central nervous system (CNS) to decrease the feeling of pain. It can be used for both acute and chronic pain, such as the one in a myocardial infarction or labor. Morphine can be administered orally, rectally, intravenously, by injection into a muscle, under the skin or into the space around the spinal cord. Its effect peaks at around 20 minutes after the intravenous approach and 60 minutes after the oral administration and it lasts for about three to seven hours. There are also long-acting formulations available on the market.
Potentially serious side effects include a decreased respiratory effort, low blood pressure and a high potential for addiction and abuse. Therefore, if the dose is reduced after long-term use, there may be signs of withdrawal. The more common side effects include drowsiness, vomiting and constipation.
Origins of Morphine Use
At the end of the 18th century or early in the 19th, a German pharmacist poured liquid ammonia over opium and obtained an alkaloid, a white powder that he found to be much more potent than opium. Friedrich W. Serturner named the substance “Morphium” after Morpheus, the Greek god of sleep and dreams. Within thirty years of Serturner’s discovery, it was possible to buy medicines with morphine from any store that sold remedies. Both morphine and opium cost less than alcohol, and the substances were abused by famous and everyday people alike.
It was not until 1817 that articles published in scientific journals popularized the new drug, resulting in its widespread use by doctors. Quite incorrectly, as it turned out, the medical profession viewed morphine as an opiate without adverse side effects. By the 1850s, morphine tablets and a variety of morphine products were readily available without a prescription. In 1856, the hypodermic method of injecting morphine directly into the bloodstream was introduced to U.S. medicine. The popularity of morphine rose during the Civil War when the intravenous use of the drug to treat battlefield casualties was rather indiscriminate. Following the war, morphine use among ex-soldiers was so common as to give rise to the term of “army disease”. Even then, medical journals were replete with glowing descriptions of the effectiveness of the drug during wartime and its distinct advantages for peacetime medical practice. As a result, hypodermic kits now became widely available, and the use of unsterile needles led to abscesses or various forms of diseases.
In the 1870s, morphine became exceedingly cheap (even cheaper than alcohol), and pharmacies or general stores carried preparations that appealed to a broad segment of the population. Anyone who visited nearly any physician for any complaint, from a toothache to constipation, would be prescribed morphine, with the substance being widely abused by doctors themselves. Morphine abuse in the latter part of the 19th century was apparently widespread in rural America. Starting in the 1870s, doctors injected women with morphine to numb the pain of “female troubles” or to turn the “willful hysteric” into a manageable invalid. By the 1890s, when the first drug epidemic peaked, women who were prescribed morphine by their doctor reportedly made up almost half of all users in the United States. In the 20th century, the drug scene shifted to the underworld elements of urban America, the disreputable “sporting class”: prostitutes, pimps, thieves, gamblers, gangsters, entertainers and youths who admired the sporting men and women.
In 1874, a British chemist experimenting with morphine synthesized diacetylmorphine and so the strongest of opiates thus far came into being: “Commercial promotion of the new drug had to wait until 1898 when the highly respected German pharmaceutical company Bayer, in perfectly good faith but perhaps without sufficient prior care, launched upon an unsuspecting world public this new substance, for which they coined the trade name “heroin” and which they marketed as a “sedative for coughs” “ (Bresler 1980: 11). Jack Nelson and his colleagues (1982) state that heroin was isolated in 1898 in Germany by Heinrich Dreser, who was searching for a non-habit-forming pain reliever to take the place of morphine. Dreser named it after the German word “heroisch”, meaning “large and powerful”.
Opiates, including morphine and heroin, were readily available in the United States until 1914. In 1900, 628,177 pounds of opiates were imported into the United States (Bonnie and Whitebread 1970). The President’s Commission on Organized Crime (1986) notes that between the Civil War and 1914 there was a substantial increase in the number of people using opiates.
This was the consequence of a number of factors:
- The spread of opium smoking from Chinese immigrants into the wider community
- An increase in morphine addiction as a result of its indiscriminate use to treat battlefield casualties during the Civil War
- The widespread administration of morphine by hypodermic syringe
- The widespread use of opium derivatives by the U.S. patent medicine industry
- Beginning in 1898, the marketing of heroin as a safe, powerful, and nonaddictive substitute for the opium derivatives morphine and codeine
How Morphine is Consumed
None of the chemical derivatives were known to opium farmers in the era before modern medicine. In the Middle Ages (c. 500–c. 1500), opium was mixed with wine or other alcohol and called ‘‘laudanum.’’ Crude opium was also smoked, particularly after the introduction of pipes from the Americas after Columbus (1451–1506) reached the New World in 1492. When opium smoking became widespread in Asia, and particularly in China, the destructive and habit-forming effects of the drug began to be revealed.
Morphine that can be dissolved in water became wildly popular in 1848 when an inventor perfected the hypodermic needle. This allowed the substance to be injected right into a vein, producing pain relief and euphoria in minutes. Surgeons welcomed this new substance since it enabled them to perform pain-free operations. Although eventually, the medical community would learn that morphine was habit-forming.
Today prescription morphine comes in many forms. As morphine sulfate and morphine hydrochloride, it is a liquid injected into veins. As Duramorph, it is a liquid injected into the fluid surrounding the spine. This type of injection is called an epidural. Duramorph is used during childbirth and some forms of surgery that can be performed while a patient is awake.
Morphine pills of various strengths are also available and are prescribed for cancer pain, back pain, recovery from surgical procedures, and occasionally migraine headaches. The drug can also be found in rectal suppositories. The suppository form of morphine is given to people suffering from severe nausea. A liquid form of morphine is available for oral use among patients who have difficulty swallowing pills.
Some patients use morphine pumps. These come in two forms. Either the patient is hooked up to a needle (IV) and can press a button to increase the flow of morphine through the needle, or a morphine dispenser is implanted under the skin, releasing a set dose of the medicine at hourly intervals. The pumps are usually programmed so that a patient cannot receive too much morphine and overdose. Too much morphine can lead to death by stopping a patient’s breathing.
Morphine is usually sold illegally on the street in its pill forms. Users crush the pills and snort, smoke, or inject them.
Effects of Morphine Use
Short Term Use Effects:
- Diminished sexual impulses
- Breathing problems
- Impaired judgement
- Relief of pain
- Constricted pupils
- Warm flushing of the skin
Long term Use Effects:
- Infectious diseases like HIV/AIDS, hepatitis
- Bacterial infections
- Venous sclerosis
- Cardiovascular disease
- Cold sweats
- Loss of appetite
- Dentition problems
- Respiratory (breathing) illnesses
- Muscular weakness that may evolve to partial paralysis
- Reduced sexual potency and long-term impotence in men
- Menstrual disturbance in women
- Inability to achieve orgasm
- Impaired immune system
- Loss of memory
- Lowered intellectual performance