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November 20, 2018

Morphine Detox Guide

morphine detox guide

The drug behind the first opiate-addiction crisis in mainstream America, morphine is still prescribed today. And it’s still a frequent cause of addiction disorders.  

 In 1805, German scientist Friedrich Sertürner became the first to extract morphine from opium, and unwittingly set in motion a chain of events leading to the first opiate-painkiller-addiction epidemic in the United States. Morphine, with ten times the intoxicating power of opium, was widely used by military doctors during the Civil War, and also by civilian doctors as a painkiller and antidepressant. By 1895, it was the primary offender in an addiction crisis affecting as many as one in 200 Americans.

While only about half as strong as heroin, morphine is still causing addictions today. It is also still prescribed legally as a painkiller, usually to patients who have developed tolerance to other opiate medications. (Currently, morphine is classified as a Schedule II drug in the U.S., which means the government officially recognizes its medical value but also its dangerously high addiction potential.)

MORPHINE WITHDRAWAL SYMPTOMS

 Morphine withdrawal, like all opiate withdrawal, produces severe flulike symptoms:

  • Nausea and stomach cramps
  • Diarrhea
  • Vomiting
  • Fever and chills
  • Muscle spasms
  • Pounding heart, rising blood pressure
  • Mood swings

While withdrawal is rarely life-threatening in itself, it does occasionally happen that someone turns suicidal, becomes seriously dehydrated from diarrhea and vomiting, or even experiences a seizure or heart attack.

MORPHINE WITHDRAWAL TIMELINE

Physical withdrawal as a whole typically lasts about a week and begins within six hours of the last morphine dose. Initially, physical symptoms will be mild: runny nose, teary eyes, minor aches and pains, longings for a fresh dose of morphine.

By the end of the first 24 hours, physical pains and cravings become intense. Diarrhea and vomiting begin in earnest. Blood pressure rises. Other symptoms reach their peak. This stage lasts two or three days (which to many patients feels like forever).

Around the fourth day, a patient begins to feel better. By the end of the first week, most symptoms have disappeared, though morphine cravings may return periodically for weeks.

This is, of course, merely a typical withdrawal timeline: the detox procedure may take several days more or fewer for various individuals. Factors that affect intensity and duration of withdrawal include:

  • The patient’s overall physical condition
  • The patient’s mental and emotional health
  • How long morphine has been taken, and how frequently
  • Whether the patient uses other drugs or has a genetic proneness to addiction

INPATIENT TREATMENT FOR MORPHINE

Detox from morphine is best managed under medical supervision, which is readily available: in recent years, the rise in general opiate addiction has prompted a corresponding rise in professional treatment options. By the end of 2016, the Substance Abuse and Mental Health Services Administration recognized nearly 1,500 opiate treatment programs in the United States.

Since a newly detoxed patient is still inclined to reach for more morphine under stress, up to three months of follow-up care and therapy (including coaching for drug-free pain management) is recommended to prepare the patient for a morphine-free future. Inpatient care, which involves residential hospitalization, is frequently recommended because:

  • The patient remains in a low-stress environment away from old temptations.
  • Professional help is always close at hand.
  • Therapy sessions are easy to get to and not crowded out by other to-do items.
  • The patient is in 24/7 close proximity to peer support (other people recovering from addiction).

Anyone without a solid support network on the outside almost certainly needs inpatient care. So does anyone with a dual diagnosis (a mental illness apart from the addiction).

OUTPATIENT TREATMENT FOR MORPHINE

For all its advantages, inpatient care isn’t for everyone. The pros of going home right after detox may outweigh the cons if someone:

  • Is more comfortable in familiar surroundings, among familiar people, and can rely on those people to support him or her in recovery.
  • Has legitimate relational or vocational responsibilities on the outside (though it’s important to get input from a counselor before deciding one is ready to handle these again).
  • Enjoys his or her outside responsibilities, and finds them an effective distraction from stress and relapse temptations.

Even then, the patient needs professional therapy and accountability for the first few months after physical detox. The solution is outpatient treatment, which involves reporting to aftercare facilities several times a week. Most outpatient programs use one of the following models:

  • Intensive Outpatient: The patient is on site three hours a day, three days a week.
  • Partial hospitalization: The patient is on site six hours a day, five days a week.
  • Transition: The patient remains under inpatient treatment for the first month after detox, then moves to outside housing operated by the treatment center.

Most people in outpatient situations, especially if living beyond walking distance of the detox center, are more vulnerable to relapse than those in structured and supervised environments. It’s important to have a detailed relapse-prevention plan, family support and strong accountability.

CAN MORPHINE DETOX BE DONE AT HOME?

 Looking at everything involved in both inpatient and outpatient treatment, many people think, “Wouldn’t it be easier to quit cold at home? It’ll hurt, but it won’t kill me, right?”

Well, aside from the rare but real physical risks (noted under Morphine Withdrawal Symptoms, above), and the increased risk of overdose if someone gives up the fight and puts a “normal” dose of morphine into a partially detoxed body, there’s much more to addiction recovery than just getting through physical withdrawal. Without counseling to pinpoint the reasons behind the addiction, and a support plan for dealing with a recurrence of cravings, a person has limited motivation or accountability to avoid going back to morphine as soon as life gets stressful again.

TAPERED VS. COLD TURKEY

 Even in a clinical setting, there are varying opinions on the safest forms of detox. Many clinics opt for the cold turkey approach of cutting off all drugs and simply keeping the patient comfortable, rather than risk possible complications from substitute opiates. Other programs use “tapered” or medication-assisted treatment (MAT), administering replacement opiates such as Suboxone to satisfy cravings without the risks of taking actual morphine.

While MAT makes withdrawal less agonizing, there are cases of patients staying on the substitute drug indefinitely and becoming as desperately dependent on it as on the original morphine. Therefore, every MAT program should include a plan to taper off the new medication through gradually reduced doses, until a patient is weaned from all cravings and completely opioid-free.

CONSIDERATIONS/HOW TO DECIDE WHAT IS RIGHT FOR YOU

 Once a morphine detox client is clear on the preferred medical approach, other factors to consider in choosing a treatment center include:

  • Geographic location
  • Philosophical and therapeutic approaches
  • Facilities for recovering patients
  • The center’s overall reputation and its time at one location

Cost may also be a factor. Most addiction rehab is at least partly covered by health insurance, but if “too expensive” concerns still make it tempting to give up the idea, consider what an untreated addiction will cost in the long term, not only in money spent on the drug itself but in damage to health, relationships, property, and productivity.

RECOVERY SUCCESS AND AFTERCARE SERVICES FOR MORPHINE

 Unfortunately, addiction dangers don’t all disappear with detox. As with other chronic illnesses, around half of patients will have at least one subsequent relapse. Some people develop post-acute withdrawal syndrome (PAWS), which can cause periodic depression, insomnia and morphine cravings for months. But with or without these setbacks, the true recovery success stories are those who remain not only sober but personally fulfilled.

 To help avoid relapse and recover from any relapses that do occur, long-term recovery from morphine addiction should include regular human support:

  • Long-term therapy for both patient and family
  • A primary care physician who understands the issues involved
  • Peer support groups comprising other recovering addicts and their families
  • Membership in mental- and behavioral-illness organizations

WHO NEEDS MORPHINE DETOX?

Anyone with a morphine addiction disorder, whether or not it began with a legitimate prescription, will likely display some or all of the following symptoms:

  • Chronic drowsiness
  • Frequent constipation
  • Pupils of the eyes dilating
  • Secretive behavior
  • Unexplained disappearance of money or possessions, or repeated requests for money without clearly defined reasons
  • Taking larger doses of morphine without medical approval, or crushing pills to get a stronger dose faster

If addiction is suspected, the person taking morphine should seek medical advice, the sooner the better. A morphine addiction may soon lead to a ruined life, or to a dangerous overdose. Overdose is typically indicated by:

  • Weak pulse
  • Pinpoint pupils
  • Shallow breathing
  • Blue lips, fingernails or tongue
  • Severe drowsiness, or unconsciousness

Call for medical help immediately if such symptoms are observed. Without professional treatment, a morphine overdose can easily cause death through stopped breathing or heart failure. Morphine is among the “natural and semi-synthetic opioids” that caused nearly 15,000 overdose deaths in the United States in 2017.

Fortunately, addiction detox and aftercare have prevented thousands of more such tragedies.

SOURCES

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Brook, Karolina, Jessica Bennett, and Sukumar P. Desai (2017, April). “The Chemical History of Morphine: An 8,000-Year Journey, from Resin to De-Novo Synthesis.” Journal of Anesthesia History, Vol. 3, No. 2, pp. 50–55. Retrieved from https://www.anesthesiahistoryjournal.org/article/S2352-4529(16)30129-3/abstract

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Jasinski, Donald R., Rolley E. Johnson, and Theresa R. Kocher (1985, November). “Clonidine in Morphine Withdrawal: Differential Effects on Signs and Symptoms.” Archives of General Psychiatry, Vol. 42, No. 11, pp. 1063–1066. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/article-abstract/493689

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For related information on opiate detox, see the following articles:

Addiction to Oxycodone, Hydrocodone and Other Opiates: Warning Signs, Effects and Stats

Heroin Detox—Withdrawal Symptoms and Timeline

Hydrocodone Detox Guide—Withdrawal Symptoms and Timeline

Prescription Opiate Detox: What to Expect from Withdrawal and Recovery

 

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