ARTICLE OVERVIEW: Daily users of morphine can develop a physical dependence on morphine after just a couple of weeks of regular dosing. Physical dependence causes withdrawal symptoms to manifest when you significantly lower doses or stop taking morphine completely. Treatments include medications and symptomatic support.
TABLE OF CONTENTS:
- Morphine Basics
- What Is Withdrawal
- Why Withdrawal Occurs
- What It Feels Like
- Protracted Symptoms
- Main Treatments
- Medications That Help
- Types of Detox Clinics
- Home Detox
- Signs Of A Drug Problem
- Who Uses Morphine?
- Your Questions
Morphine is an opiate alkaloid isolated from the plant Papaver somniferum that is produced in a lab. Morphine binds to and activates specific opiate receptors, each of which are involved in controlling different brain functions. Effects include:
- Analgesia, or pain relief
- Anxiety relief
- Respiratory depression
….and gastrointestinal system smooth muscle contraction.
Morphine is mainly prescribed for acute chronic pain. However, the medicine can be highly addictive, and physical and psychological dependence are expected outcomes of regular dosing. Users also develop a tolerance for the drug, which means that the longer they use morphine, the more of it they need to produce the same initial effects.
What Is Morphine Withdrawal Syndrome?
The American Society of Addiction Medicine defines withdrawal as:
“the onset of a predictable constellation of signs and symptoms following the abrupt discontinuation of, or rapid decrease in, dosage of a psychoactive substance.”
Symptoms of withdrawal are generally the opposite of the intoxication effects. For example, pupils constrict during morphine intoxication and dilate during withdrawal. Symptoms of morphine withdrawal begin within hours after last and gradually resolve over the course of several days.
Why Withdrawal Occurs
Morphine withdrawal occurs because the brain adapts to the presence of the drug and becomes used to it. This is called “drug dependence”. When your body processes morphine regularly, specific changes occur in the brain. Mainly, the brain counterbalances the depressant chemistry of morphine by “over stimulating” some functions and processes. In a way, the brain adapts to morphine by “speeding up”. It does this to survive.
But when you stop using the drug, the brain doesn’t automatically reverse the “stimulating” chemicals it’s been creating. Instead, the body takes time to restore balance.
So, another way to understand withdrawal is view these symptoms as the brain’s way of coping without morphine.
What Does It Feel Like?
Typical morphine withdrawal feels like a very bad flu. Symptom begins about 6 to 14 hours after the last dose. You may feel a craving for the drug, anxiety, irritability and may be sweating. Some hours later, you may feel sleepy and could have intensification of the initial symptoms.
The physical withdrawal symptoms of morphine could last for several days. However the psychological symptoms (evidence of addiction) may be longer lasting and more complex. Craving, compulsion, and obsession to use morphine can persist for weeks or months after cessation of use. Severe insomnia, depression, mood swings, memory problems, confusion, paranoia, low self-esteem and psychological disorders can also stem from morphine withdrawal.
As mentioned above, morphine withdrawal is like having an awful flu. Stopping use of morphine causes classic withdrawal symptoms, also referred to as prototypical opioid withdrawal syndrome. These symptoms are very uncomfortable, but are not life-threatening. These include:
Early symptoms of withdrawal include:
- Muscle aches.
- Increased tearing.
- Runny nose.
Late symptoms of withdrawal include:
- Abdominal cramping.
- Dilated pupils.
- Goose bumps.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), protracted withdrawal is the persistence of symptoms beyond the generally expected timeline. The most commonly reported protracted symptoms include:
- Disturbed sleep.
- Mood swings.
- Tiredness, variable energy, low enthusiasm.
- Variable concentration.
These symptoms can last for weeks or even months following detox.
Why do PAWS happen?
Doctors think that PAWS may be due to reduced endogenous production of endorphins. Prescription opioids like morphine can lead to post-acute withdrawal syndrome if they are not tapered off properly. Furthermore, people who experience the full intensity of acute withdrawal are more likely to develop PAWS.
Morphine withdrawal symptoms typically arise within six hours of the last dose. According to the Drug Enforcement Administration, early opioid withdrawal symptoms are:
- Fairly mild and include sweating.
- Runny nose.
- Watery eyes.
As more time passes, the symptoms worsen and peak until they eventually subside, which is usually within five days.
6 Hours After The Last Dose
Cravings may start; at this stage, depression, anxiety, and mood swings may also occur.
12 Hours After The Last Dose
Depression may persist 12-14 hours after the last dose, and individuals may also experience excessive sweating and congestion.
16 Hours After The Last Dose
The physical symptoms become more uncomfortable. Muscle cramping and twitches may occur, and many individuals lose their appetite.
24 Hours After The Last Dose
After going one day without morphine, diarrhea is common, as are trouble sleeping, high blood pressure, cramping, and rapid breathing.
36-48 Hours After The Last Dose
The most uncomfortable symptoms at this stage are involuntarily limb movement, vomiting, diarrhea, muscle cramps, pain, and insomnia.
72 Hours After The Last Dose
The worst of the physical symptoms have usually passed. Individuals are left to face the psychological symptoms of withdrawal, like depression, anxiety, and cravings.
A multi-faceted approach to morphine withdrawal can include:
1. Supervised medical detox.
3. Social support and psychotherapy.
4. Tapering protocols.
5. The use of home remedies.
Supervised Medical Detox. Voluntary supervised medical withdrawal is recommended during withdrawal. So you can get help from a a residential (inpatient) facility or can undergo detox as an outpatient at an addiction center. Drugs and counseling may be a part of this phase of treatment.
Morphine withdrawal can be treated with many kinds of medications for opioid withdrawal . Clonidine can help control feelings of anxiety, cramping and flu like symptoms. Buprenorphine (Subutex or Subozone) is effective for easing and shortening the duration of detox. Methadone maintenance treatment may also be used to block the euphoric effects of the opioid.
Social Support and Psychotherapy
Drug cravings are strong during morphine withdrawal. This is natural and a part of the recovery process. Joining a support group (in your locality or even online) can help you feel less isolated and helpless. Sharing your problems with a psychologist, psychiatrist, or sober friend or joining self-help groups like Narcotics Anonymous or SMART Recovery can put you on the track to lasting recovery.
Structured tapering can help during withdrawal from morphine. Gradual tapering of the drug is recommended as against abrupt cessation because the latter can result in acute withdrawal and may trigger reuse rather than support lasting recovery. Safe and effective tapering could mean that the user doesn’t need methadone or buprenorphine maintenance treatment.
In most cases a 2 to 3 week tapering regimen can be quite effective. General guidelines include:
- Reduce the each daily dose by 10%.
- Reduce the dose by 20% every 3-5 days.
- Reduce the dose by 25% per week.
- Avoid reducing the daily dose by more than 50% at any given interval.
The tapering should be closely monitored by your prescribing doctor via observation and urine testing for drugs. It is important to remember that after some weeks of abstinence the body loses its tolerance to the drug so that previously tolerated doses can result in overdose!
Self-help and home remedies to get through the withdrawal phase will help manage symptoms and may prevent relapse. For example, over the counter medications for flu, ibuprofen and Tylenol and steam inhalation can help bring relief. Heating pads and warm baths can also help reduce physical discomfort. Nausea, vomiting and runny stools can be controlled with the help of medications such as Loperamide (Imodium). It is important to take in plenty of fluids to prevent dehydration because sweating is usually a part of morphine withdrawal, which can result in significant water loss.
Medications That Help
Insomnia is both common and debilitating. Clonazepam, trazodone, and Zolpidem have all been used for withdrawal-related insomnia, but the decision to use a benzodiazepine needs to be made carefully, especially for outpatient detoxification.
The Food and Drug administration (FDA) approved sublingual buprenorphine in 2002 for office-based treatment for detoxification. Buprenorphine is long-acting, safe, and effective by the sublingual route, but may precipitate withdrawal symptoms if given too soon after an opioid agonist. Buprenorphine may be combined with Naloxone (Bunavail, Suboxone, Zubsolv), which helps prevent dependence and misuse.
Clonidine is an antihypertensive. Clonidine is used to help reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping. It does not help reduce cravings. Since clonidine has mild analgesic effects, added analgesia may not be needed during the withdrawal period for medical opioid addicts.
Lofexidine, an analogue of clonidine, has been approved in the UK and may be as effective as clonidine for opioid withdrawal with less hypotension and sedation. Combining lofexidine with low-dose naloxone appears to improve retention symptoms and time to relapse.
Methadone relieves withdrawal symptoms and helps during detox. It is also used as a long-term maintenance medicine. After a period of maintenance, the dose may be decreased slowly over a long time. This helps reduce the intensity of withdrawal symptoms. Some people stay on methadone for years.
Naltrexone blocks the euphoric and sedative effects of drugs such as heroin, morphine, and codeine. It works differently in the body than buprenorphine and methadone, which activate opioid receptors in the body that suppress cravings. Naltrexone binds and blocks opioid receptors. Naltrexone decreases reactivity to drug-conditioned cues and decreases craving. You have to be cautious! People treated with extended-release injectable naltrexone have reduced tolerance to opioids and can overdose!
Treatments for ancillary withdrawal symptoms include nonsteroidal anti-inflammatory drugs for muscle cramps or pain; bismuth subsalicylate for diarrhea; prochlorperazine or ondansetron for nausea and vomiting; and a2-adrenergic agents (such as clonidine) for flu-like symptoms. Vitamin and mineral supplements are often given.
Types of Detox Clinics
In outpatient detox, you live at home but come into the clinic for detox treatment during the day or evening. The intensity of treatment may range from a single intake session and a series of brief daily follow-up sessions to intensive outpatient treatment or day hospitalization, which can provide many hours of treatment each day. Outpatient detox treatment usually ranges from three to 14 days, according to an article in Alcohol Health & Research World.
Inpatient Medical Detox
In this highest level of treatment, you receive 24-hour-a-day services from trained medical staff. If you’re diagnosed with the most severe medical needs, you can detoxify in an inpatient hospital setting, while people with less severe symptoms usually detoxify in residential, non-hospital housing. In addition to detoxification services, you’ll also receive intensive individual and group therapies to help you get to the root causes of any addictions. Alcohol Health & Research World reports that inpatient detox usually lasts from five to 14 days.
Detox At Home?
Withdrawal from certain types of drugs can be highly disruptive, unpleasant, or even life-threatening. Endangering yourself by trying to withdraw from morphine on your own just isn’t worth it. In fact, medical detox under physician supervision is the safest way to get off morphine.
Detoxing at home has some apparent advantages:
- Ability to continue day-to-day activities, like holding down a job or caring for children.
- Comfortable and familiar surroundings.
- Greater freedom in activities.
- No inherent cost.
- Social support from family and friends.
- Usual self-soothing mechanisms to distract from the unpleasantness of withdrawal, such as access to music collections or videogames.
However, it also carries a number of serious drawbacks:
- Drug-using friends may encourage drug use.
- Easy access to drugs to tempt relapse.
- Familiar surroundings may include cues associated with drug use.
- No access to medications that may ease withdrawal symptoms.
- No additional treatment for co-existing psychological problems that may be driving drug use.
- No medical supervision in case of withdrawal-related medical emergency.
- Severe withdrawal symptoms can disrupt work, costing wages and endangering employment.
- Stressful family, work, or home situations can hinder rather than help recovery.
Safety During Withdrawal
Before starting the withdrawal treatment make sure to clearly state to medical staff if you suffer any of the following, because of the elevated risk of exacerbate them or generate any drug interaction:
- Acute alcohol dependence.
- Head injury.
- Respiratory deficiency.
- Severe hepatic impairment.
- Treatment with monoamine oxidase inhibitors (antidepressant).
- Ulcerating colitis or Crohn’s disease (inflammatory bowel diseases).
- Urethral obstruction.
During acute withdrawal, there could be heart beat acceleration, which could contribute to the possibility of heart attack or stroke. There is also greater susceptibility to infection during the withdrawal period.
During the treatment and after it has ended …know that you are at increased risk of overdose due to reduced opioid tolerance. If you should use opioids for any medical reason, physicians must use a smaller amount than usual to reduce the risk of overdose.
Never go through this alone, family and friends are always good choice for support in this hard process.
Seek for help if you need it, you are not alone.
Signs of a Drug Problem
The DSM-V proposed a list of some situations that can lead to the diagnosis of a substance use disorder. Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
- Continuing to use, even when it causes problems in relationships.
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
- Cravings and urges to use the substance.
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
- Giving up important social, occupational, or recreational activities because of substance use.
- Needing more of the substance to get the effect you want (tolerance).
- Not managing to do what you should at work, home, or school because of substance use.
- Spending a lot of time getting, using, or recovering from use of the substance.
- Taking the substance in larger amounts or for longer than you’re meant to.
- Using substances again and again, even when it puts you in danger.
- Wanting to cut down or stop using the substance but not managing to.
If you exhibit fewer than two of these situations, you aren’t usually diagnosed a substance use disorder. Three or more are considered a mild disorder, four or five are indications of a moderate disorder and six or more symptoms are considered a severe substance use disorder.
If you or someone you love manifests these signs, seek for help before it’s too late.
Who Uses Morphine?
A number of opioids are prescribed by doctors to relieve pain. While many people benefit from using this medication to manage pain, prescription drugs are frequently diverted for improper use. In fact, the 2013 and 2014 National Survey on Drug Use and Health (NSDUH) reported that 50.5% of people who misused prescription painkillers got them from a friend or relative for free, and 22.1% got them from a doctor.
According to the National Survey on Drug Use and Health (NSDUH):
- 4.3 million Americans engaged in non-medical use of prescription painkillers in the last month.
- Approximately 1.9 million Americans met criteria for prescription painkillers use disorder based on their use of prescription painkillers in the past year.
- 1.4 million people used prescription painkillers non-medically for the first time in the past year.
- The average age for prescription painkiller first-time use was 21.2 in the past year.
As people use opioids repeatedly, their tolerance increases and they may not be able to maintain the source for the drugs. This can cause them to turn to the black market for these drugs and even switch from prescription drugs to cheaper and more risky substitutes like heroin.
We hope to have covered most of what you can expect if you’re trying to quit morphine. But we realize that you still may have a burning question on your mind.
Do you still have questions about morphine withdrawal? If you or anyone close to you has become addicted to morphine, we encourage you to reach out. Feel free to ask questions and share any of your experiences in the comments section below. We will get back to you personally and promptly.
Reference sources: CDC: Pocket guide: Tapering opioids for chronic pain
MAYO CLINIC: Tapering off opioids: When and how
MEDLINE PLUS: Opioid and opioid withdrawal
NCBI: Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions
NCBI: DSM-V Criteria for substance use disorder: Recommendations and Rationale
NCBI: Pharmacological treatment for opioid dependence: Detoxification and maintenance options
NIDA: FDA approves first medication to reduce opioid withdrawal symptoms
NIDA: Patients Addicted to Opioid Painkillers Achieve Good Results With Outpatient Detoxification
SA HEALTH: Opioid withdrawal management
SAMHSA: Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health
SAMHSA: Medication-Assisted Treatment (MAT)
All of the information on this page has been reviewed and verified by a licensed medical professional.