Morphine: Therapeutic use, Treatment. Morphine rehab.

Last modified: Saturday, 20. June 2009 - 1:04 pm

Official names: Morphine sulfate or morphine hydrochloride (solutions for injection), Duramorph (for spinal use), MS Contin and Oramorph SR (long-acting, controlled release oral form), Kadian (oral, sustained release), MSIR (instant release), Roxanol (liquid concentrate)
Street names: M, morph, Miss Emma, monkey, white stuff
Drug classifications: Schedule II, opiate

 

Key terms

ALKALOID: Any organic agent isolated from plants that contains nitrogen and reacts with an acid to form a salt.
DEPENDENCE: A psychological compulsion to use a drug that is not linked to physical addiction.
EUPHORIA: An exaggerated feeling of well being.
NARCOTIC: A natural or synthetic drug that has properties similar to opium or opium derivatives.
N EU ROPATHIC: Relating to a disease of the nerves.
OPIATE: A drug originating in the opium poppy, such as codeine and morphine.
OPIOID: A drug, hormone, or other chemical substance having sedative or narcotic effects similar to those containing opium or its derivatives; a natural brain opiate.
SYNAPSE: The gap between communicating nerve cells.
THALAMUS: The central area of the brain below the cerebral lobes that relays messages from the spine to the forebrain.
TOLERANCE: A condition in which higher and higher doses of a drug are needed to produce the original effect or high experienced.

 

Overview

Morphine is the most active part of opium, a pure chemical isolated from the dried sap of the unripe poppy pod. Even today, morphine is still made from poppies. It is the prototype opiate, the parent from which all the others sprang. But efforts over the past two centuries to separate the beneficial aspects of opiates from their social drawbacks have failed. Even totally synthetic drugs that mimic morphine and the other opiates remain utterly linked to addiction.
At the turn of the nineteenth century, opium was an important part of medical practice. By the time that Frederick Serturner, a young clerk in a small German pharmacy, extracted morphine from opium, the world was already experienced in both medicinal and recreational opium use. Serturner’s extraction was the first alkaloid ever isolated, and he named it after the Greek god of dreams, Morpheus.
Morphine’s discovery became well-known after Serturner published his findings in 1817. In 1837, an Endinburgh chemist and physician, William Gregory, found a cheaper way to isolate and purify it. But not until the 1850s, with the introduction of the hypodermic needle, would morphine gain wider use.
The Civil War was a ready stage for the entry of morphine into common medical practice. Medics from the North and the South used morphine for the massive practice of amputation. With no delicate, germ-free surgical technique available, any serious wound to a limb called for its swift and horrendously painful removal.
The Union army obtained 29,828 oz (846 kg) of morphine sulfate. And when Confederates realized that a blockade of their ports could part them from sources of opium, they tried getting Southern women to cultivate and produce opium from garden-grown poppies. On both sides, discharged soldiers went home as addicts after the hostilities ceased.
In the years after the war, however, women abused morphine even more than man. The spread of patent medicines and the unregulated sale of hypodermics brought opiate use into the parlors of the upper classes. Fashionable women could buy and wear syringes pinned to their clothing, as they did watches or brooches. Surveys by public health officials in Michigan and Iowa recorded that by the 1880s about 75% of all drug addicts were women seeking to ease neuralgia (sharp, severe nerve pain), cramps, and morning sickness. Meanwhile, babies and toddlers were soothed with various nostrums, or “quack medicines,” containing opiates, with alcohol as another major constituent. “Mrs. Lambert’s Ladies Elixir” is an example: 23% alcohol with 40 mg of morphine in every bottle. Also, “Mrs. Winslow’s Soothing Syrup,” with 0.05 g of morphine per bottle. Even patent medicines to cure morphine dependence were sold; inevitably they contained alcohol or opium. Thomas Edison patented and marketed his own nostrum, “Poly-Form.” It contained morphine, chloroform, ether, chloral hydrate, alcohol, and spices.
By the late 1800s, one in 25 Americans used large amounts of opiates. No laws limited their use. People simply went to the local druggist for morphine, no prescription required. Abuse was considered a vice or a weakness, not a crime. But doctors did begin to recognize and criticize their own profession’s ability to create a lifelong servitude to the drug. Newspapers recorded morphine as an agent for suicides and deaths by accidental overdose.
At the turn of the century, the German chemical company Bayer was capitalizing on a previously unnoticed chemical improvement on morphine. In 1898, Bayer began aggressively marketing heroin as a cough cure for the rampant disease of the time, tuberculosis. Heroin, a derivative of morphine, crosses directly into the brain, where it is converted immediately back to morphine. Unbelievably, it was said to be non-addictive. Heroin was even proposed as a way to cure morphine addicts. This turns out to be a recurring theme in the story of narcotics: to hopeful physicians, a new version brought to market appeared to be free of abuse potential, until enough people used it to prove otherwise.
In medical practice today, morphine is regarded as the standard for pain relief by which all other drugs are measured. Still, doctors may be hesitant to use morphine. They must register with the federal Drug Enforcement Administration (DEA) to dispense the drug, and paper trails lead easily to doctors who prescribe it too freely. A current debate in medicine seeks to expand the medical use of the drug, and to change state laws to recognize the legitimate place for morphine in a physician’s practice.

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