The manner in which morphine is taken (e.g., swallowed, smoked, snorted, or injected) influences how quickly the drug takes effect. Smoking, snorting, or injecting it will send the drug rapidly into the bloodstream, more so than taking it orally, for example. The National Highway Traffic Safety Association (NHTSA) reports that morphine generally starts working within 15 minutes to an hour, and its effects last 4-6 hours.
When someone becomes dependent on morphine, it is because the brain’s circuitry has been altered by the drug’s interactions and disruption of the natural chemistry. When morphine enters the bloodstream, it fills up opioid receptors in the brain and throughout the central nervous system. Dopamine, a neurotransmitter that influences pleasure, then floods the brain, causing heart rate, respiration levels, blood pressure, and body temperature to lower. Someone taking morphine likely feels mellow and relaxed as well as pain-free. Over time, the brain gets used to feeling this way, and some of the pathways in the brain are physically altered. This means that the brain may rely on morphine to feel happy, making a person want to take more of the drug, bypassing the natural reward pathway and creating a new shortcut pathway to feeling good. It may be harder then for the brain to keep producing dopamine and other neurotransmitters at its normal rate without the influence of morphine.
Dependence is created. Drug cravings and withdrawal symptoms are common when morphine is not present or active in the system, as the brain struggles to regain balance without the drug.
Detox is the removal of morphine from the body. When a dependence has formed, morphine withdrawal is often best managed through medical detox provided in a specialized facility with the aid of medical, mental health, and substance abuse treatment providers. The main goal of detox is to help individuals become physically stable and then follow up with treatment that focuses on the emotional aspects of drug abuse, dependence, and addiction.
Withdrawal symptoms can start as soon as morphine stops being effective in the bloodstream. Since it is considered a fast-onset drug, this means that morphine withdrawal may begin within 6-12 hours of the last dose, NHTSA publishes. Symptoms usually progress through two stages, with early withdrawal including side effects like tearing up, yawning, sweating, and a runny nose. The more serious symptoms peak during later withdrawal, within 48-72 hours, and include chills, goosebumps, heightened blood pressure and heart rate, insomnia, irritability, inability to feel pleasure, restlessness, anxiety, muscle pain, stomach pain, nausea, vomiting, diarrhea, sneezing, tremors, loss of appetite, depression, and drug cravings. The physical side effects of morphine withdrawal are often compared to a really bad case of the flu.
Emotional withdrawal symptoms can also be significant. Medical detox in a specialized facility under the watchful eye of trained professionals can help to ensure the safety and security of all involved.
The majority of withdrawal symptoms likely subside in a week or so.
Detox in general lasts 5-7 days. Withdrawal severity and duration can be influenced by many contributing factors, such as:
Prescription opioid drug abuse is considered an epidemic in the United States. The Centers for Disease Control and Prevention (CDC) reported that overdose fatalities related to these drugs are five times higher in 2016 than they were in 1999, and more than 200,000 Americans have died from a prescription opioid overdose. The National Institute on Drug Abuse (NIDA) publishes that more than 2 million Americans battle a prescription opioid substance use disorder.
The sheer volume and magnitude of people affected by opioid abuse, dependence, and addiction means that researchers are constantly working toward finding ways to treat the disease. Currently, the U.S. Food and Drug Administration (FDA), as published by the Office of National Drug Control Policy (ONDCP), approves of three drugs for the treatment of opioid dependence (buprenorphine, methadone, and naltrexone). Many other medications are being studied for their usefulness as well.
Some of these medications are helpful during detox to ease withdrawal symptoms. Stopping an opioid drug like morphine “cold turkey” can induce powerful withdrawal symptoms and is generally not recommended. Instead, medical professionals may wish to slowly decline the amount of morphine a person takes over a period of time, called weaning or tapering off the drug.
Since morphine is a fast-acting opiate, a longer-acting one, like methadone, may be used as a substitute during a tapering schedule in detox. Methadone has a longer half-life and therefore stays in the bloodstream longer, activating the opioid receptors in the brain and requiring lower doses less often while keeping withdrawal symptoms and drug cravings to a minimum. Methadone is considered a full opioid agonist and still has the possibility of being abused and the individual becoming dependent on this opioid instead, so it may be a secondary choice to other medications during detox.Buprenorphine is a partial opioid agonist often used to replace a drug like morphine in the body during detox. This drug only partially activates the opioid receptors, meaning that it can help reduce withdrawal symptoms without the “high” that full opioid agonists can produce. It may also have a limit to its effects, and if a person tries to take more than the prescribed dose, after a certain level, it stops being effective, hitting a kind of ceiling.
Naloxone, an opioid antagonist, is commonly combined with buprenorphine. Naloxone is meant to remain dormant unless someone attempts to abuse the medication by injecting it, which then activates the antagonist and precipitates withdrawal symptoms.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the FDA approves the following buprenorphine products: transmucosal buprenorphine products and Suboxone, Bunavail, and Zubsolv, which are all combination buprenorphine/naloxone products. These medications may be used toward the end of detox or at least after the morphine is completely removed from the bloodstream.
Other medications that are not specifically approved to treat opioid dependence may be useful during detox to manage withdrawal symptoms. Clonidine, for example, is a high blood pressure medication that is often beneficial during opioid detox to control withdrawal symptoms that are related to the heightened activity of the central nervous system. By lowering the stress response, withdrawal can be eased.
Similarly, anti-anxiety medications may also be helpful. Benzodiazepine drugs, however, should be used with caution with individuals who have a history of substance abuse since they too are common prescription drugs of abuse. Sleep aids, antidepressants, anti-nausea medications, nutritional supplements, and antidiarrheal medications can all home in on particular withdrawal symptoms.
It is important that treatment providers prescribing medications and supplements are aware of any and all drugs in a person’s system upon entering detox so they can properly manage potential interactions between medications. It is also vital that detox is followed with a comprehensive substance abuse treatment program for the best chances of sustained recovery.