Morphine belongs to the category of drugs known as narcotics. It is an opiate, and as such derives from the poppy plant in the same way as opium. Morphine is synthesised from raw opium and is most commonly used in a medical context to treat pain, particularly after surgical operations or during palliative care of the terminally ill.
Morphine is commercially available as a pill or a syrup. It can also be injected into the bloodstream or given as a suppository. Illicit users of morphine may inject, swallow or smoke morphine. It is often used by heroin addicts as an alternative to that drug due to the potency and similarity of its effects. Morphine sulphate looks like a white powder. It is soluble in water and partially soluble in alcohol.
Like other opioids, morphine acts by attaching itself to the opioid receptors in the brain, gastrointestinal tract and spinal column, altering the way the body processes pain.
Morphine was isolated from raw opium in 1804 by German chemist Friedrich Sertürner, who named the new drug after Morpheus, the Greek god of dreams. Invention of the hypodermic needle in 1853 made use of morphine widespread as this meant it could be administered in precisely calibrated doses. Morphine rapidly became the preferred drug for the relief of pain, replacing opium, and was used extensively on injured troops during the American Civil War. After the end of the war it was reported that in excess of 40,000 soldiers had become addicted to morphine. In Europe, the Franco-Prussian War was similarly said to have produced hundreds of thousands of morphine addicts. In America in 1914 use of morphine was outlawed except when prescribed by a doctor.
Morphine is the most potent of all the opioids and is highly addictive. Although physical dependence can take many months to develop, psychological dependence can occur after only a small number of doses, such is the strength and effectiveness of the drug in relieving pain and producing a state of euphoria in the user.
On the streets morphine is most often used as a substitute for heroin. Morphine can come in the form of white pills that are swallowed and might go by the name ‘white lady’. These tablets may also be ground down to a fine white powder which might either be snorted or else dissolved in water or alcohol and drunk, or injected as a solution. This powder is sometimes referred to as ‘salt’ or ‘sugar’.
As a play on the ‘em’ sound that morphine begins with, the drug has been given the name ‘Emma’ (also ‘Aunt Emma’, ‘Miss Emma’, ‘Emsell’ and variations of these names, including ‘Missy’, ‘Auntie’ and ‘Em’).
The drug also goes under the name ‘Mister Blue’, ‘China White’, ‘Morph’, White Stuff’, ‘Morpho’, ‘Dreamer’, ‘Unkie’, ‘God’s drug’ and ‘Pectoral Syrup’.
Morphine, like other opioids, such as raw opium and heroin, acts on the opiate receptors of the central nervous system. Taking morphine will first induce feelings of euphoria. It will suppress any pain being experienced by the user, relieve anxiety, suppress hunger and also make them feel drowsy. When someone takes morphine their breathing becomes shallower, so if the dose is too high it can result in severe depression of the respiratory system, leading to coma and death.
Morphine has the effect of suppressing the cough reflex. Morphine may also have the effect of making someone constipated and may lower their sex drive. It can also affect the menstrual cycle of women
Using morphine over a long period of time can lead to the body developing a tolerance for the drug, meaning users have to take higher and higher doses in order to achieve the same effect. Morphine is also psychologically and physically addictive.
One of the reasons morphine can be so addictive is the withdrawal effects that occur when someone stops taking the drug. Withdrawing from morphine can make someone highly nauseous, make them vomit, cry uncontrollably, involuntarily yawn and experience severe chills and cold sweats. The most acute withdrawal symptoms can continue for up to three days.
A pregnant woman who takes morphine will transfer the drug to their unborn baby via the placenta and their babies will also experience withdrawal symptoms once they are born.
Long-term use of morphine may impair the body’s immune system, making a morphine user more susceptible to infections.
In 2010 the country that produced the most morphine in the world was the UK, which was responsible for the production of 97.4 tons of the drug. This amount accounted for 23% of the world’s total morphine production. The USA produced the second largest amount of morphine with 78.4 tons, the equivalent of 19% of global production. Third largest producer was France with 67.9 tons or 16% of the world’s production and fourth was Australia with 41.2 tons or 10% of global production. The fifth largest producer of morphine was Iran who produced 23.4 tons, making up 6% of total world manufacture of the drug.
Taken as a whole these five nations were responsible for producing 74% of the world’s production of morphine, showing that the vast majority of morphine is produced in the affluent, industrialised areas of North America, Europe and Australasia.
Figures from 2010 continue to show that there were four other countries that contributed more than 10 tons each to the global production of morphine. These were China, who produced 18.5 tons, Japan (12.5 tons), Slovakia, at 11.5 tons and lastly Hungary, who produced a total of 10.5 tons.
The 20 years from 1990 to 2010 saw both production and consumption of morphine rise across the globe.
The USA consumed approximately 55% of the world’s morphine, Europe consumed around 27%, Canada consumed just over 4% and Australia and New Zealand just under 3%.
Countries producing morphine export the drug to all parts of the world. The total amount of exported morphine was close to 25 tons in 2010, with the leading exporter being the UK, accounting for 33% of all exported morphine. In the same year Slovakia exported an amount of morphine that represented 17% of all exports.
In terms of imports, seven countries imported over one ton of the drug, which were the UK, Brazil, Germany, France, Austria, Canada and Hungary. Of these France was the largest importer of morphine with 4.4 tons, closely followed by Germany who took in 4.3 tons.
Although in terms of commercial sale, morphine is a relatively cheap drug, many people in the developing nations have restricted access to it. In 2005 just six countries - USA, Canada, Australia, UK, Germany and France - were responsible for 79% of the world’s total consumption of morphine. At the same time, poorer countries, which accounted for 80% of the population of the world, consumed just 6% of the world’s morphine.
Morphine is classified in varying ways in its production countries. In the UK, morphine is categorised under the Misuse of Drugs Act as a Class A drug. It also appears as a Schedule 2 Controlled Drug for use medically. The USA also categorises morphine as a schedule II drug, whereas in Canada it is a Schedule I drug. Australia groups morphine amongst other drugs that have a therapeutic benefit but are open to abuse, such as cocaine and ketamine.
The most obvious signs of morphine addiction are those which manifest themselves as withdrawal symptoms. These include sweating, shaking and vomiting. Someone experiencing morphine’s withdrawal symptoms might also seem very anxious and in pain.
Signs of morphine addiction also include physical and behavioural changes to the user. Someone who is under the effects of morphine may display uncoordinated movement, extreme drowsiness, shallow breathing, stiff muscles and may fall unconscious. Their pupils will be abnormally small, their face flushed and they may display abnormality and lack of logic in their thought processes. They may also exhibit a reduced sensitivity to pain, slur their words, involuntarily move their eyes around and have difficulty urinating.
Morphine causes fluid retention in the user so someone addicted to morphine may also display signs of swelling and bloating.
If someone is injecting morphine then needle marks might be observed on their body with the arms, ankles or behind the knee, common sites for injection.
Morphine addiction can have a powerful emotional effect on the addict and they might display signs of anxiety, depression, irritability, an over-inflated sense of well being or severe irrational fear. Morphine addicts are also prone to fantasy and hallucination.
Some people are allergic to morphine and in these cases the morphine user might experience skin rashes, repeated sneezing and difficulty breathing.
Signs that someone has overdosed on morphine are floppy limbs, flaccid muscles, skin that is cold or clammy to the touch, slow heart rhythm and unconsciousness.
The highly addictive nature of morphine almost always necessitates professional rehabilitation in the form of a treatment programme, which might be delivered via the addiction counselling or treatment section at a live-in rehab centre, depending on the seriousness of the addiction and other factors.
The withdrawal symptoms of morphine are also so severe that coming off morphine without professional help can have serious consequences for the health of the morphine addict.
Treatment first involves the user stopping taking morphine. Morphine withdrawal, like that of other opioids, goes through distinct stages. The first stage, which occurs between six and 14 hours after a user’s last dose of morphine involves a strong craving for the drug, irritability, anxiousness, sweating and mild depression.
The second stage, occurring between 14 and 18 hours after the last dose sees the addict yawning, sweating heavily and crying. This is when more severe depression happens. Over the next 72 hours the addict may experience a runny nose, goose bumps, cold and hot flushes, aching limbs, intestinal cramps, insomnia, a racing pulse, vomiting, diarrhoea, involuntary ejaculation, rapid weight loss and increased sensitivity to pain. The biggest withdrawal symptoms occur between 48 and 96 hours after the last dose. Withdrawal symptoms then subside over the next 8 to 12 days.
Treating someone with morphine addiction requires that both the physical and the psychological dependence be addressed. Therapy sessions designed to uncover the root cause of the addiction and group therapy where addicts share their experiences are both common in dealing with morphine addiction.
Changes to the physical environment as well as the behavioural motivators of the morphine addict need to occur in order to prevent relapse, which in morphine addicts is common. Abusers of opiates like morphine and heroin have one of the highest rates of relapse compared to that of other drug addicts. Some medical professionals have estimated the relapse rate as being 98% higher than the addicts of other drugs.
It has been shown that out-patient detox programmes for morphine addicts are far less effective than live-in programmes, mainly due to the long tail off associated with the withdrawal symptoms. A common scenario is the morphine addict using another form of the drug, often on prescription, to help them overcome the symptoms of withdrawal. Anti-depressants are often used by addicts attempting to detoxify themselves of morphine, leading to an additional addiction to these drugs. This phenomenon is known as ‘mixed addiction’. It has been shown that the best way for morphine addicts to free themselves of addiction is to undertake a life completely free of all drugs.
Morphine addiction can be insidious in that it can ‘creep up’ on someone who may have begun using morphine for necessary pain relief. As such, a morphine addict may be in denial about their addiction. One option for the friends or family members of someone who is suspected of being addicted to morphine, is for them to stage an ‘intervention’. This is where friends and family can share their experiences of how the morphine dependency of the addict has affected them and, in this way, help the addict realise that they have a problem.