Morphine: Treatment and rehabilitation

Last modified: Saturday, 20. June 2009 - 1:09 pm

Overdoses of morphine resulting in unconsciousness can be rapidly reversed with the opiate antagonist naloxone (Narcan). Given by intravenous injection, naloxone works in a minute or two by occupying the opiate receptors in the brain, without any action of its own other than to block morphine or other opioids. A dose of 0.4-0.8 mg (to a maximum of 10 mg) is given every three to five minutes to revive an overdosed person.
Abruptly stopping the abuse of morphine will result in withdrawal. While not life threatening, as are withdrawal from alcohol or other depressants, going “cold turkey” is immensely unpleasant. The recovering addict may become suicidal from the suffering experienced.
Medical means of getting an addict off morphine allows withdrawal with less drastic symptoms. Methadone, legally administered through drug rehabilitation programs, can be substituted for morphine just as it is for heroin. A totally synthetic opioid, methadone lasts longer within the body than either morphine or heroin. Methadone closely mimics the basic opiate structure.
Methadone is given orally (different from the usual means of abuse), and thereby also substitutes for the paraphernalia that accompany illicit drug use. Methadone helps relieve the craving for more drug and delays the appearance of withdrawal symptoms as long as it is in the body. Doses are gradually decreased. If the dose of morphine that was abused is known, then 1 mg of methadone can substitute for 4 mg of morphine. Otherwise, a dose of 10-50 mg a day is generally used, and can be reduced by 20% per day.
Clonidine (Catapres) is another drug used to treat opiate addiction. It can relieve the anxiety, runny nose, salivation, sweating, abdominal cramps, and muscle aches of opiate withdrawal. Side effects are dry mouth, dizziness, and drowsiness. Clonidine is initially taken at 0.8-1.2 mg a day, maintained for a few days, and then gradually decreased. Combined with the opiate blocker naltrexone, clonidine can allow a more rapid detoxification (the removal of morphine from the body). Detox in a single day can be accomplished by heavy sedation or anesthesia while giving naltrexone to an unconscious addict. This controversial method has not been studied in controlled trials.
Recovering addicts who fear a moment of weakness can strenghten themselves with the long-acting opioid antagonist naltrexone. Using naltrexone makes it impossible to get high from taking other opioids. But naltrexone must be taken before any other opioids are used, or withdrawal will occur. The usual dose of naltrexone is 25-50 mg orally, in the morning. Depression has been reported with its use, and it also raises toxin levels in the liver. Headache and nausea are encountered with naltrexone use.
LAAM, the abbreviation of levo alpha acetyl methadol, is another opiate blocker that has been used to wean addicts. It persists up to 72 hours.
Getting past withdrawal is only the first step in confronting morphine abuse. The psychological need for the drug must be addressed as well. Narcotics Anonymous and other programs are devoted to this challenge. A peer group that replaces the one that encouraged the addiction is a key feature of successful rehabilitation.
For those who are taking morphine to control pain, the same principle of tapering off the dose applies, with gradual lowering of the dosage over a period of a few weeks. However, short-term use of morphine for acute pain in a medical setting rarely requires weaning.

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