Is morphine addictive compared to an opioid drug like fentanyl or heroin?
What exactly is morphine sulfate? What do you think of when you think of morphine use?
Many people associate morphine with medical treatment for pain relief. Morphine has been used for decades in hospitals to treat severe pain due to cancer, trauma, or other serious medical conditions.
Hospice programs provide morphine therapy to patients for end-of-life care. The drug provides pain relief to keep hospice patients comfortable during their final days.
Yet, we do not associate morphine with opioid addiction in the same way that we might think of oxycodone, dilaudid, heroin, or fentanyl. Heroin addiction is well known, yet we rarely hear about an opioid user who identifies as a morphine addict.
Is morphine addiction a problem? If morphine is addictive, why do we not hear more drug abuse stories about morphine addiction and abuse?
Morphine is an opiate derived from the opium poppy.
Opiates are natural opioid drugs that have been used for centuries, by cultures around the world. These drugs can be manually extracted from the flowering plant, known as the opium poppy, or Papaver somniferum.
Morphine is one of the main opiate components of the plant. When consumed, morphine acts on the mu opioid receptors to produce the effects of analgesia (pain relief), and euphoria (pleasure).
Fentanyl works on the same receptors as morphine, yet it is fully synthetic. There is no natural form of fentanyl.
Heroin, on the other hand, is semi-synthetic, because it is made from naturally occurring morphine. Special chemical processing of morphine results in the illicit drug, heroin.
Each of these opioid drugs has a different level of potency. Morphine has been designated as the standard to which we compare other opioids.
For example, fentanyl is up to 100 times more potent than morphine. Heroin is four times more potent than morphine. You will be surprised to know that heroin can cause brain damage .
What is the difference between heroin and morphine?
Heroin is a drug associated with opioid abuse. It is illegal, and only obtained as a street drug. Morphine is a drug used to treat chronic pain and acute pain.
Yet, as we have seen, morphine and heroin are related. Heroin is made from morphine.
In fact, they are even more closely related than that. Heroin converts to morphine in the drug user’s system, after they have consumed it.
Heroin itself has little activity at the mu opioid receptor. It quickly metabolizes into morphine, which has a high affinity for that receptor.
Heroin works as a pro-drug for morphine. Heroin is easily transported across the blood-brain-barrier, into the human central nervous system, where it breaks down into morphine, the active opioid drug.
So, morphine, the prescription opioid drug, is essentially the same as heroin. Shooting up morphine is likely a very similar experience to shooting up heroin.
Why, then, do we not hear about morphine dependence and addiction very often? Why is morphine not associated with substance abuse and drug addiction in the same way that heroin is?
How does someone go from a pill addiction to a heroin addiction?
Opioid users typically have an opioid of choice. They tend to stick with their drug of choice, whenever possible.
For example, there are people who prefer prescription drug abuse with an opioid, such as oxycodone. They like that their drug is from a regulated, legal factory, and they may prefer the unique effects of that particular opioid.
If oxycodone suddenly becomes available, the oxycodone addict will reluctantly accept an alternative. Dilaudid, morphine, Norco, or one of many other opioid pain pills may be substituted.
However, going from a prescription opioid to an illicit opioid is a big jump. The pain pill addict will not want to use heroin if they can avoid it.
The problem is that many opioid dependent people end up in a situation eventually where they are suffering from severe opioid withdrawal symptoms, and their preferred drug is not available. Opioid withdrawal can be tortuous and difficult to tolerate.
Imagine a sick and suffering oxycodone addict talking to their drug dealer, and they are offered heroin. The dealer explains that it is essentially the same thing, and people snort it, so injecting with a needle is not necessary.
Heroin is cheaper than oxycodone pills, and it is readily available. So, the pill addict becomes a heroin addict.
Is a morphine high as good as a heroin high?
The morphine high should be similar, if not identical to a heroin high. Heroin metabolizes into morphine, so the active drug is the same.
While heroin is four times the potency of morphine, an opioid user could simply take a higher dose of morphine to get the same effect. The drugs should, in theory, provide the same high when abused.
Yet, morphine has not been a preferred drug of choice by opioid abusers in recent decades. The opioids that people typically abuse are heroin, fentanyl, oxycodone, hydrocodone, hydromorphone, and oxymorphone.
This is not to say that morphine abuse does not occur. There are people who prefer morphine as their drug of choice, and there are even morphine addiction treatment centers.
Healthcare workers may be at higher risk of abusing morphine, only because of the easier access to pharmaceutical morphine. Nurses and paramedics, for example, work with morphine on a regular basis.
Otherwise, morphine almost seems like broccoli in the world of opioid abuse. It is not the first choice on the streets.
So, while morphine and heroin are very close cousins, we may assume that the high from snorting or shooting up morphine is preferred over the high from heroin by many people. If given a choice, many opioid users would choose heroin over morphine.
What happens to someone who is addicted to morphine?
Morphine addiction does occur, and there are treatment options. While drug users may fear going through morphine withdrawal, there is addiction therapy that can help to minimize the withdrawal symptoms.
Methadone maintenance therapy is one possible option. A person who is taking morphine throughout the day, suffering from active morphine addiction, can go to a methadone clinic.
At the clinic, they will be given one methadone dose each day to prevent cravings and withdrawal. Methadone is a powerful and long-acting opioid.
Another addiction resource is to go to a detox clinic and then attend outpatient treatment. The detox will use medications to wean the client off of morphine, and then send them for individual and group therapy at a PHP or IOP, which are two common types of addiction treatment programs.
Another substance abuse treatment program that is now considered the gold standard for treating opioid addiction is Suboxone therapy. Suboxone contains buprenorphine and naloxone, and it is delivered in a film or tablet that dissolves under the tongue.
Suboxone treatment can be obtained at a private doctor’s office on a monthly basis. It provides much more freedom compared to methadone maintenance, which requires daily clinic visits.
If morphine is a legal drug, would it be possible to use morphine to treat opioid addiction?
This is an excellent question. Many people would not be in favor of the idea of morphine being used for used for opiate addiction therapy.
Even though morphine is a legal opiate drug, it is known to have a high abuse potential. The Drug Enforcement Administration would be greatly concerned that morphine used for addiction treatment might be diverted and sold on the streets.
Yet, methadone is an opioid drug with a high abuse potential that is currently in use as an addiction treatment medication. What is the difference?
Methadone is a potent mu receptor agonist, hence, users do get high when they take it. They also develop tolerance and may require more over time to get the same effect.
One major difference is that methadone is very long-acting, so a single daily dose will last an addiction patient a full twenty-four hours, until it is time to visit the methadone clinic again. Morphine, on the other hand, is short acting, so if it were used in place of methadone, the user would have to visit the clinic multiple times daily to get the same coverage.
Another difference is that methadone may have additional beneficial properties, such as blocking opioid cravings. Morphine does not block cravings, so the opioid user may still obsess over opioid use throughout the day if they are treated with morphine instead.
Interestingly, there were morphine clinics around the turn of the 20th century, where doctors administered morphine injections to people addicted to opiates. At that time, methadone and buprenorphine were many years away from being synthesized for the first time.
As expected, clients of these clinics did have to return throughout the day for additional injections. While not ideal, these clinics did possibly provide a relatively safe, supervised environment for addictive opioid consumption.
Within a short time, the US government outlawed medical addiction treatment with opiate drugs, and all morphine clinics were shut down. It would be many decades before medication assisted treatment would be tried again for opioid addiction.
Is there any possible use for morphine today in treating opioid addiction?
In recent history, the opioid epidemic has worsened, year by year, because of highly potent, long-lasting fentanyl analogs. These fully synthetic opioids are imported from clandestine labs around the world to the US.
While the federal government allows two opioids, methadone and buprenorphine, to be used for treatment, the new fentanyl analogs present a unique problem. Methadone is an unpopular choice of treatment, because of the required daily clinic visits and the difficulty in transitioning off of methadone.
Buprenorphine has become the gold standard of treatment, but the issue is that the new fentanyl on the streets reacts with buprenorphine to cause precipitated withdrawal. Patients are unable to start Suboxone, a buprenorphine drug, for fear of going into precipitated opioid withdrawal.
Morphine, or another short acting opioid, could act as a bridge for helping patients to get safely onto buprenorphine treatment with Suboxone. A detox facility could administer pharmaceutical morphine for a period of time to allow the toxic fentanyl to leave their system.
Then, they would be prepared for a relatively uneventful transition to Suboxone. Unfortunately, morphine cannot be used legally as a bridge to medication-assisted treatment with buprenorphine.
Hopefully, in the future, the US federal government will help to make it possible to use bridge opioids in detox facilities to help patients quit illegal street fentanyl. For now, the transition is difficult and dangerous, because opioid users put off starting treatment, exposing themselves to ongoing overdose risk.
Which is more addictive: MS Contin vs. OxyContin?
During the height of the pill mill crisis OxyContin was a favorite of opioid pill abusers. Oxys were bought and sold on the streets, so drug users could crush them to snort or shoot up.
When a doctor would suggest switching a patient from OxyContin (time release oxycodone) to MS Contin (time release morphine), the patient often complained. Chronic pain patients would demand OxyContin, and it became one of the most prescribed opioids ever.
That is not to say that chronic pain patients were drug dealers or drug abusers, but there was a perception that OxyContin was stronger and better. And, there have likely always been a small percentage of pain management patients who were really trying to get opioids prescribed for the purpose of abusing them or selling them.
There was a forgotten time, maybe in the 1970s or 1980s, when MS Contin was a popular drug of abuse. Opioid users would crush the tablets into powder, just like they would, years later, with OxyContin.
Why, when OxyContin came along, did opioid abusers decide that MS Contin was an undesirable product? Why did they prefer oxycodone over morphine?
Oxycodone is known to be a bit stronger than morphine, about 1.5 times stronger, but this does not seem to explain the difference in street demand. More likely, the reason why people greatly preferred oxycodone was due to the heavy marketing efforts of Purdue, the maker of OxyContin.
Purdue is now being disciplined for their role in promoting OxyContin as being safe and non-addictive. The company engaged in a powerful marketing campaign for over two decades that infiltrated medical training at all levels.
The pharmaceutical company worked very hard to groom a generation of doctors and other healthcare providers and administrators to ensure that OxyContin would be the opioid of choice in all cases. It is likely that they also indirectly promoted generic oxycodone with the thinking that all oxycodone eventually leads to OxyContin.
I once spoke to a scientist who studied OxyContin and was convinced that the drug used a modified version of oxycodone that was more addicting than the generic brands of the drug. While there is no literature to confirm this claim, it would not be the first time that a company altered a product to increase its addictive potential.
Find out five worst side effects of OxyContin abuse here .
Does opioid addiction treatment help with morphine addiction?
Fortunately, drug addiction treatment programs designed to help with opioid addiction should work fine for morphine addiction. Being addicted to morphine is not very different from heroin addiction.
Fentanyl addiction treatment works just as well for oxycodone addiction, or morphine addiction. For patients who attend an inpatient treatment program, they may be started on Suboxone, Sublocade (a long-acting buprenorphine injection), or Vivitrol (a long-acting naltrexone injection).
For best results, medication assisted treatment should be continued for at least a year. This gives enough time for the brain’s addiction to heal, and time for the opioid user to lose contact with drug dealers and other sources of the drug.
If someone has found themselves addicted to morphine, they should not be concerned about being in a different, unique situation. Medication-assisted treatment works very well, and it works especially well for morphine addiction.
In fact, it is much easier to start MAT with buprenorphine when the drug being abused is morphine, as opposed to fentanyl. The transition from morphine to Suboxone is straightforward.
If you, or a loved one, is interested in learning more about treatment options for morphine addiction, please contact us for general consultation .
