Morphine Withdrawal and Treatment

Normally, taking a medication prescribed by a doctor does not seem like a problematic situation, but not all medications are safe, especially when abused or used long-term.

Opioids, a group of medications including morphine, are associated with a number of side effects like dizziness and confusion and can lead to the development of tolerance and dependence, both of which can raise the potential for abuse and addiction.¹

As dependence sets in, the prospect of quitting may become much more daunting, due to the likelihood of a very uncomfortable withdrawal syndrome. The good news is that there are programs to help manage narcotic withdrawal and keep the worst symptoms at bay.

What Is Morphine?

Morphine is an opioid painkiller used to manage either acute or chronic pain that is severe enough to merit the use of an opioid.¹

As an opioid, morphine’s effects are similar to those of other prescription painkillers like oxycodone, as well as illicit opioids such as heroin.² The euphoric and pain-relieving effects of morphine contribute to a high potential for abuse and addiction.³

Who Will Experience Morphine Withdrawal?

Any person who uses morphine—whether by prescription or recreationally—may become dependent within a matter of weeks and come to rely on the drug to feel well enough to get through the day. ^1,4

When a person frequently uses a substance like morphine, their brain gradually adjusts to the presence of the drug. As these changes take place, a person will eventually require continued drug use to maintain stability. Without morphine, the user will experience a range of symptoms collectively referred to as the withdrawal syndrome.⁴

Those who abuse morphine in large quantities may become dependent more quickly than those who use the drug as prescribed. Someone abusing morphine may:^1,2

• Use the drug even if it is not for them.
• Use the drug to get high.
• Mix the drug with alcohol or other drugs to modify or enhance the effects.
• Use the drug more often, in higher doses, or in ways other than prescribed.
• Try to manipulate medical professionals to obtain more of the drug.

Anyone who is physically dependent on morphine will experience some degree of withdrawal upon quitting. Whereas dependence reflects the physiological impact of the drug on the body, morphine addiction encompasses much more than the brain’s adaptation to the drug.¹

Opioid addiction, sometimes called an opioid use disorder, is a collection of symptoms that illustrate how much a person’s life is affected by the morphine. Someone with an opioid use disorder may:⁵

• Use opioids like morphine in larger amounts over a longer period of time than planned.
• Make unsuccessful attempts to use less morphine or stop altogether.
• Spend tremendous amounts of time trying to get, use, and recover from morphine.
• Experience strong cravings for the medication.
• Struggle to maintain and fulfill obligations at work, home, or school.
• Encounter issues with their work, education, or social network due to drug use.
• Shift their interests and hobbies away from healthy behaviors.
• Keep using morphine despite the risks of negative physical, mental, financial, or legal outcomes.
• Develop tolerance to the opioid.
• Experience withdrawal symptoms when not using morphine.

Physical dependence and addiction frequently develop simultaneously, but not always. Someone using the medication as prescribed may develop some degree of physical dependence without showing any other signs of problematic use.

Morphine Withdrawal Symptoms

Morphine withdrawal will trigger a number of very uncomfortable symptoms that stand in contrast to the relaxed euphoria of an opioid high, including:^5,6

• Muscle twitches.
• Muscle aches.
• Bone pain.
• Heavy sweating.
• Runny nose and watery eyes.
• Dilated pupils.
• Gastrointestinal discomfort.
• Nausea and vomiting.
• High blood pressure.
• Fast pulse rate.
• Fast breathing rate.
• Diarrhea.
• Fever.
• Low mood.
• Restlessness.
• Anxiety.
• Depression.

The above symptoms are called acute withdrawal symptoms because they occur in the hours and days following last use of the drug. There is another set of withdrawal symptoms that can last much longer than the acute variation. These persisting symptoms, referred to as the post-acute withdrawal syndrome (PAWS), can include:⁷

• Irritability.
• Anxiety.
• Depression.
• Sleep problems.
• Low energy and fatigue.
• Feeling emotionally numb.

Is Opioid Withdrawal Dangerous?

Although opioid withdrawal won’t usually endanger the life of the person who quits, there are situations that emerge during withdrawal that may be cause for concern.

• Vomiting and diarrhea linked to withdrawal can be perilous if the individual becomes severely dehydrated or suffers a significant electrolyte imbalance.⁶
• People with preexisting cardiac issues could notice a dangerous worsening of symptoms set in motion by pulse and blood pressure changes during withdrawal.⁶
• Symptoms of preexisting anxiety disorders may also intensify during withdrawal.⁶

Not every person will experience every withdrawal symptom, and the intensity of symptoms will vary among detoxing individuals.

Morphine Withdrawal Timeline

Most people dependent on an opioid painkiller like morphine will experience symptoms within 6-12 hours of their last dose. Over the course of 1 week, most acute symptoms will resolve. For a longer-acting form of morphine, such as extended-release capsules (e.g., Kadian), symptoms may take longer to emerge.^5,8 In some cases, the symptoms will remain several months past the resolution of the acute symptoms.⁵

Morphine Detox

Attempting to detox at home without medical help can result in unnecessary pain and suffering. Many people looking to quit morphine for good will choose to undergo professional detoxification as a safe and effective means of withdrawal management. Detox is a group of strategies and techniques professionals use to make withdrawal more comfortable, mitigate dangers, and lessen relapse risk.⁶

Detox can take place in a number of inpatient and outpatient settings depending on the individual’s needs and the likely risks of withdrawal. Several factors may influence the severity and discomfort of withdrawal, including:⁶

• The rate, amount, and method of use.
• How long the drug was being used/abused.
• If any other substances have been abused in combination with morphine.
• Previous unpleasant experiences with withdrawal.
• Current medical or mental health issues.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends inpatient detox for alcohol, sedatives such as benzodiazepines, and opioids.⁶ Inpatient detox provides the best chances of a comfortable detox. Attempting to detox at home without medical help can result in unnecessary pain and suffering.⁶

Patients who wish to detox from morphine in an inpatient environment often undergo a medical detox. Medical detox programs are most commonly conducted in an acute care hospital or specialized detox center, which allows a team of addiction professionals to provide patient monitoring and intensive withdrawal management in a safe environment.⁶

Medications for Morphine Withdrawal

Buprenorphine and methadone are opioid medications that can be used for morphine withdrawal management.⁶ Not only do they minimize the symptoms of opioid withdrawal, they can curb cravings and may be instrumental in maintaining recovery for months or years.⁹

Clonidine, a nonopioid medication for high blood pressure, is a commonly used detoxification drug.⁶ It helps relieve anxiety, muscle aches, cramping, and other symptoms. It may be combined with other medications, which address vomiting and diarrhea, if necessary.

A newly approved medication, Lucemyra, is another nonopioid medication specifically intended to ease the opioid withdrawal process.¹⁰ Like clonidine, this is an alpha-2-adrenergic agonist medication that works by diminishing the release of norepinephrine in the brain, as the actions of this neurotransmitter are believed to be associated with many of the symptoms of withdrawal.

A “social detox” approach might be right for some people who are strictly opposed to the use of medications in their recovery. Rather than using medications to manage opioid dependence and withdrawal, social detox models use support from staff in a safe, calm environment.⁶

Rehab for Morphine Addiction

Once physical dependence is addressed with detox, many people benefit from longer-term addiction rehabilitation. This will involve tackling the cognitive, emotional, and behavioral influences of drug abuse.⁹

Treatment after detox can take place in inpatient/residential or outpatient treatment centers.⁹ Inpatient settings are great fits for people with more severe addictions and those who face many temptations at home.

Outpatient treatment programs are, in general, somewhat less intensive than inpatient ones but may be suitable for people with more support from friends and family.⁹ Since outpatient rehab allows the person to live at home, it may be a more realistic treatment option for people who can’t take significant time away from their jobs or who need to care for small children.

The length of these programs varies based on the goals of the individual with some residential options lasting for as long as 1 year.⁹ Outpatient therapy may continue indefinitely.

Both types of facilities will offer a mixture of group therapy and support, as well as individual therapy, to help people recover. In medication-assisted treatment (MAT), medications like methadone, naltrexone, or buprenorphine are combined with therapy to help people achieve lasting sobriety.⁹

Some therapy options for opioid addiction are:^9,11

• Contingency management (CM) – a behavioral treatment that offers physical rewards like food, gift cards, and other prizes for drug-free behaviors including going to meetings and providing clean urine samples.
• Community Reinforcement Approach (CRA) – an intensive 24-week program that aims to help people improve relationships and build new coping skills to achieve lasting abstinence.
• Cognitive behavioral therapy (CBT) – a treatment style that focuses on learning the connections between thoughts, feelings, and behaviors in order to recognize triggers, manage stress without drugs, and avoid relapse.

To keep momentum, recovering individuals may attend meetings at a support group such as Narcotics Anonymous. Although support groups do not offer professional therapy, they help to complement the benefits of professional treatments and offer a supportive sober community.⁹

Addiction treatment is an ongoing process—one which may be challenging at times but is always worth the energy.

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Morphine Information at a Glance1,12
Medication Name, Costs	Class of Medicine
Generic Name: Morphine Sulfate Generic Name Variations: Morphine Brand Name: Kadian, MS Contin, Embeda, Astramorph, Duramorph Cost/Price: Varies with supplier and prescription	Used to Treat Addiction? No Function or Use: Treatment of moderate to severe chronic or acute pain System: Opioid analgesic
Form, Intake and Dosage	Interactions and Complications
Drug Forms: Tablet, capsule, oral solution, injectable solution Administration Routes: Oral, Injection Dosage: Varies according to administration route and patient’s pain level	Alcohol Interaction: Additive depressant effects Prescription Medications: Severe respiratory depression when used with other CNS depressants Contraindications: Respiratory depression, acute bronchial asthma, hypercarbia, intestinal obstruction
Effects and Adverse Reactions	Substance Abuse
Short-Term: Respiratory depression, convulsions, urinary retention, constipation, headache Long-Term: Dependence, addiction, fatal overdose may occur	Risk of Substance Abuse: High Signs of Abuse: Increased sedation, respiratory problems, taking more of the drug than prescribed
Dependence and Addiction Issues	Withdrawal
Tolerance: Users may develop tolerance Physical Dependence: High risk Psychological Dependence: High risk	Withdrawal Symptoms: depression, anxiety, flu-like symptoms, hypertension
Legal Schedules and Ratings
Controlled Substances Act Rating: Schedule II