Morphine: Usage trends

Last modified: Saturday, 20. June 2009 - 1:07 pm

Morphine is infrequently found “on the street,” yet it can get there by its widening use in legitimate medicine. Abuse also can appear in health professionals. Street use in combination with cocaine or methamphet-amine has also been documented.
A study published in 2000 reviewed data obtained from 1990 to 1996 on the number of morphine prescriptions written, and the emergency room admissions related to its abuse. Doctors prescribed 59% more morphine in that time period. Yet the number of people seeking emergency aid for morphine abuse rose by just 3%. The study concluded that legitimate use by medical professionals attempting to help patients does not necessarily lead to increased use on the street.
In medical school, doctors learn to treat morphine with suspicion. Even when the use of the drug is clinically called for, they may be hesitant to prescribe it. Many experts on pain say that prescribing morphine for surgical recovery, or even for chronic pain, will not turn most people into drug addicts. While the medical use of morphine does indirectly increase the potential supply to the street addict, restricting its medical use harms people in pain.
A survey published in 2001 shows that primary care physicians would much rather prescribe Schedule El pain relievers — such as acetaminophen with codeine — for chronic pain not due to cancers. Thirty-five percent of the 161 doctors responding to the mailed survey stated they would never prescribe Schedule II opioids to be used around-the-clock by patients in persistent pain. Those who would be willing to give the Schedule II drugs were those who also indicated a lower degree of concern about physical dependence, tolerance, and addiction. The survey researchers noted that few carefully designed studies have been carried out to test morphine and similar opioids in relieving chronic pain other than that from malignancies (cancerous tumors that grow uncontrollably). In addition, doctors are often scrutinized by state medical boards for prescribing Schedule II drugs.
A joint statement issued by 21 health organizations and the Drug Enforcement Administration acknowledges the balancing act that medical use of morphine engenders. “Preventing drug abuse is an important societal goal,” the statement says, but “it should not hinder patients’ ability to receive the health care they need and deserve.”
Scope and severity
In 1999, four million people in the United States were using prescription drugs outside medical use. Of these, 2.6 million were misusing pain relievers, according to the National Institute on Drug Abuse (NIDA).
Doctors must be able to recognize the occasional patient who is seeking morphine to feed an addiction. Physicians must be wary of being manipulated. Allegations of overprescription of scheduled drugs is the leading reason physicians are investigated, as well as the leading reason for the suspenstion of a doctor’s license.
Age, ethnic, and gender trends
Older people receive prescriptions at three times the rate of the rest of the population. But the National Household Survey on Drug Abuse recorded the sharpest increase in nonmedical use of prescription drugs in young adults and teens.
The sexes are known to react differently to opiates. In humans, women are more likely to misuse opiates. Research in animals shows that females require higher doses to relieve pain (the sex steroid hormones change the brain’s organization early in life to create this difference). Female rats also appear to enjoy morphine more than males. The females continued to choose to receive the drug even at doses so high that their breathing was halted, doses that the males chose to avoid.

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