Morphine Abuse and Withdrawal Timelines
Opiate drugs, also known as narcotic drugs, include heroin, opium, morphine, Vicodin, OxyContin, and many others. Opioid drugs come from the poppy plant or are synthesized from substances found in the poppy plant.
All of these drugs have ready-made receptors in the human brain for them because the central nervous system produces natural opioid type neurotransmitters known as endorphins. Endorphins play a key role in the regulation of respiration, controlling the sensation of pain, hormone regulation, and other functions, such as regulating nausea and vomiting. Because the structure of the endorphins and opioid drugs are similar, opioid drugs readily attach to the neurons in the brain that are specialized for endorphins. This makes these drugs useful in the control of acute or chronic pain from surgery and a number of different injuries or diseases as well as useful for suppressing cough.
These drugs also produce a very powerful sense of euphoria and wellbeing, and have a high potential for the development of abuse and physical dependence.
Morphine is a particularly powerful opioid drug with a high potential for abuse and addiction. Readers interested in learning more about opioids like morphine can refer to books like Alcohol and Opioids: Neurochemical and Behavioral Properties or Addiction and Opiates.
Specific figures on the abuse of morphine are difficult to find. National organizations such as the Substance Abuse and Mental Health Services Administration (SAMHSA) or The American Society of Addiction Medicine (ASAM) publish figures on overall prescription medication abuse and narcotic/opioid medication abuse in general. However, figures from these organizations and others indicate that:
- The number one cause of accidental death in the United States is overdose of prescription medications such as opioid medications.
- In 2014, nearly 2 million individuals had a substance use disorder involving prescription pain medications such as morphine and other opioid drugs.
- Of this group, about 168,000 adolescents between the age of 12 and 17 years old had substance use disorders involving prescription pain medications.
- The rate of individuals with prescription pain medication use disorders has remained relatively steady between 2003 and 2014.
It is not as difficult to obtain morphine as one might think. Individuals may be able to get it from friends or family members who have a prescription for it. Even the Internet has become an increasingly popular means of illegally purchasing prescription pain medications such as morphine.
Addiction and Physical Dependence
Physical dependence refers to the development of both tolerance and withdrawal to a drug that has been used regularly for a specific time. ASAM has specifically defined the differences between the notions of tolerance, physical dependence, and addiction (a substance use disorder) as follows:
- The development of tolerance, a process where an individual needs to take higher doses, or more of a drug, to achieve the effects that were felt when the individual took it earlier at a lower dose is a common phenomenon that occurs with many drugs.
- Withdrawal symptoms – the development of negative physical and emotional symptoms that occur when levels of a specific drug in the system drop dramatically – represent a situation where the person’s body has learned to function efficiently only when the drug is in the system.
- When a person has developed both tolerance and withdrawal symptoms, a physical dependence is present.
- For individuals who take opioid drugs for chronic pain for months and even years, the development of physical dependence on these drugs is inevitable. However, if they take the drugs as prescribed and under the supervision of a physician, it is generally not considered a sign of abuse or addiction.
- Addiction or a substance use disorder represents a dysfunctional process where an individual engages in the nonmedical use of drugs that results in a number of negative or dysfunctional outcomes.
- Many individuals develop substance use disorders to other drugs without developing significant physical dependence.
- Thus, while physical dependence can be a symptom of addiction, it is neither necessary nor sufficient to have physical dependence on a drug in order to have a substance use disorder related to the drug.
Morphine Withdrawal Timeline
Despite whether or not one has a morphine use disorder, anyone using morphine for any length of time longer than a few weeks will develop physical dependence on the drug. If the person wishes to discontinue the drug, they will inevitably develop withdrawal symptoms unless they use opioid replacement therapy or a tapering process to avoid severe withdrawal symptoms.
While there is a general timeline associated with withdrawal from morphine, specific cases will vary slightly in the length of the symptoms and their severity. Withdrawal from morphine can be affected by the length of time someone used the drug, the amount of the drug someone was using, the method of administration (most individuals either inject or snort morphine which results in more severe withdrawal symptoms than individuals who abuse an opioid drug in pill form), and individual differences in physiology and psychological makeup. In addition, anyone using morphine in conjunction with other drugs of abuse, such as alcohol or other prescription medications, will experience a much more complicated withdrawal process.
A good resource to learn and read about the complications of morphine use disorder and substance abuse disorders involving other opioid drugs is the two-volume set Opioids. A general timeline of withdrawal from morphine follows:
- The symptoms of withdrawal will begin to appear within 12-24 hours following discontinuation; however, individuals with severe morphine use disorders may start to experience symptoms as soon as 6 hours after discontinuing use. The initial symptoms are usually fatigue, irritability, and minor agitation. As the withdrawal process continues, individuals will begin to experience muscle aches, muscle spasms, nausea, vomiting, diarrhea, watery eyes, and running nose. Individuals will also often begin to feel anxious, depressed, and begin craving morphine. Anxiety may increase to the point of near panic attacks.
- The symptoms peak within the first 24-48 hours for most individuals, and the potential for relapse during this period is extremely high. While the symptoms are not considered life-threatening, there is a potential for individuals who are severely anxious or depressed to become suicidal, and of course, individuals who are severely ill may be accident-prone.
- Symptoms will begin to decrease in severity around days 3-5 in most cases; however, individuals with severe morphine use disorders may continue to have more acute symptoms for longer periods of time. There will still be periods of nausea, abdominal pain, potential vomiting, shivering and chills, low-grade fever, and mild anxiety and discomfort. Cravings will continue.
- For most individuals, the acute phase will be over after the first week, but they may still experience mild nausea and anxiety. There may also be periods of apathy, a loss of motivation, energy loss, fatigue, and even some depression.
- Because chronic drug use leads to changes in the central nervous system, individuals may continue to experience issues with motivation, mood swings, depression, and overall apathy for some time. Some researchers have identified a syndrome known as post-acute withdrawal syndrome that consists of these psychological and emotional issues. In some cases, this syndrome may continue for months or even years, and may be a potential trigger for relapse. Thus, individuals recovering from a morphine use disorder should include a long-term aftercare program that includes therapy, social support, and other resources following the withdrawal process.
One has the option of attempting to go “cold turkey” and withdraw from morphine alone. In this case, individuals will experience withdrawal syndrome and be at much higher risk for relapse during the withdrawal process. There are a number of self-help sites on the Internet that suggests various different natural methods to withdraw from opioids; however, these have very little empirical evidence to support them.
Instead, individuals should consider discontinuing morphine under the supervision of an addiction medicine physician or psychiatrist trained in addiction medicine. This will allow the individual to detox using medically assisted treatment options, such as opioid replacement medicines (e.g., methadone or Suboxone) in conjunction with a tapering process that will minimize the symptoms of withdrawal. In addition, individuals have the option of using inpatient or outpatient treatment for the medical detox process. In many cases, individuals trying to stop using highly addictive drugs like morphine will need to isolate themselves from potentially damaging environmental conditions in order to focus on the detox and recovery process. Individuals can also receive support and initial therapy during this time that can better prepare them for the long road ahead.
Whatever the option one chooses, the withdrawal process is only the first step in recovery from a morphine use disorder. Individuals will need to engage themselves in a number of treatments, including therapy, social support, family support, and long-term aftercare treatment focused on relapse prevention. For many individuals, recovery from morphine represents a long-term and even lifelong process.
This process involves changing one’s attitudes, outlook, coping strategies, peer relations, and overall approach to life to make them more advantageous to sobriety and overall wellness.