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What is morphine withdrawal?


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

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
  • Euphoria
  • Respiratory depression
  • Sedation

….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.

Symptoms

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:

  • Agitation.
  • Anxiety.
  • Muscle aches.
  • Increased tearing.
  • Insomnia.
  • Runny nose.
  • Sweating.
  • Yawning.

Late symptoms of withdrawal include:

  • Abdominal cramping.
  • Diarrhea.
  • Dilated pupils.
  • Goose bumps.
  • Nausea.
  • Vomiting.

Protracted Symptoms

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:

  • Anxiety.
  • Cravings.
  • Disturbed sleep.
  • Irritability.
  • 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.

Timeline

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.
  • Yawning.

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.

Main Treatments

A multi-faceted approach to morphine withdrawal can include:

1. Supervised medical detox.
2. Medications.
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.

Medications

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.

Tapering

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!

Home remedies 

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

Benzodiazepines

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.

Buprenorphine

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

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

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

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

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!

Other medications

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

Outpatient Detox

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.
  • Diabetes.
  • 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.

Your Questions

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)
SAMHSA: Opioids

Photo credit: redwolf518stock

Leave a Reply

22 Responses to “What is morphine withdrawal?
garry schrier
7:44 pm June 21st, 2014

I have been on 100 m pills twice aday fot 15 years or so. What can I do to get off of this drug.

8:47 am June 24th, 2014

Hello Garry. Speak with your prescribing doctor to set up a tapering schedule. Because of the length of use, you may want to ask for an extended taper, of 4-6 weeks, or longer. the idea is that you slowly lower morphine doses to minimize the severity of symptoms, and then stop taking it completely. You can possibly replace morphine with another opioid medication such as buprenorphine or methadone or even tramadol to minimize withdrawal symptoms, but you meed medical supervision and advise during the entire process. Best of luck to you!

Observer in the Field
8:37 am January 5th, 2015

Get sober as follows:
-Acceptance of Past (instead of resentment over past)
-Faith in the Future (instead of fear of future)
-Live in present (instead of dwelling on past or worrying about future) Meditation
-Be grateful for what you have
-Try to alleviate suffering of people worse off than you
-Live simple
-Exercise/Eat decent
-Work on being less self centered. Know Thyself. Judge others and be humbled.
-Ask God/The Force/The Eternal to help you. Or if the idea of “God” does not appeal to you remember this iron logic: Drugs always cause you to be worse off. Therefore, don’t use and you eliminate an action that is guaranteed to make you worse off. You make this Logic into your “higher power.” It’s Iron.
This is a great day to start something new. Winners start anew today. Take your last drugs today (5 Jan 2015) and see your life better off in one year. It’s guaranteed.
1-5-15 will be the end/beginning of a new order for you. a DAy of hoPe

Al
9:43 pm August 13th, 2015

Hard,
I was taking 160 mg of morphine daily for the past 1 1/2….I stopped, cold turkey, on June 28. After a few days,My symptoms became intolerable.
After the 10th day, I went to the Dr. He prescribed as one Benzodiazepine.

Throughout the entire month of July, I had experienced symptoms, especially fatigue and muscle aches.

Today is August 13th, I finally beginning to feel confident. I can work, somewhat, without fatigue. I’m not 100 percent, I still have issues with the psychological cravings, especially in the morning.

Worst 45 days of my life. A very humbling experience. I was very judgmental towards addicts, not realizing I was a prescription drug addict myself.

Still afraid to totally let go of the crutch, morphine. It was a 5 year companion. Insecurity is scary.

Cherokee
5:37 pm August 20th, 2015

My mom has been on morpine for at least 10 years her meds were stolen and she went without for a month and then got them refilled the following month…she passed away the second of July and death certificate said heart attack. Could this caused her heart attack?

4:50 pm August 24th, 2015

Cherokee, I’m very sorry for your loss. Whatever I say would be only speculations and I believe it’s best to ask medical professionals to get a solid answer to your questions.

Bill
8:00 pm August 24th, 2015

Quit cold turkey 20 days ago. how long does it take for the brain to get rewired(?)

1:36 pm August 25th, 2015

Hi Bill. It’s different for everyone and depends greatly on many important factors such as how long you were taking morphine, how often, what doses, what’s your general health state, etc. It will probably take months before you can feel like you used to, because the self-healing process of the brain is not a rapid one.

bobbi
2:34 am October 1st, 2015

I have been on 800mg morphine a day for 26 years. How long to get out of system and back to normal life? I already have short term memory loss and was wondering will I regain my memory? It is prescription morphine due to being hit by truck would like different ideas for pain.

4:19 pm October 9th, 2015

Hi Bobbi. If you still need morphine for managing pain and it works, and if you only use it as prescribed, I don’t believe there is a problem. Other medications will also raise your tolerance and dependence on them, and every medication has possible side effects. Even if you quit all medications completely, it will take months and years for your brain to completely heal and recover from 26 years of morphine use. By now, your mind and body have gotten accustomed to the presence of morphine and it will take a lot of time for your brain’s chemistry to return to homeostasis.

Andy
3:06 am January 31st, 2016

Hi. I was taking liquid morphine for only 3 weeks about 100/110ml a day, i’ve had problems with pain meds, and recently (3 months ago) did a detox for subutex, i was sniffing 2mg a day for a couple of years. It was only a week or so ago i was taking the morphine, since then i have felt like i did comming off the bupe’s. Only more depressed, emotional and mentally unballanced. Surely 3 weeks of use can’t be the reason i feel so bad, can it? I was also taking benzo’s for around 2 months. I stopped taking those the same time as the morphine, i then had to return to work for 4 weeks and i have taken some benzos with me although i can sleep on them all other symptoms remain. Could i really be withdrawing from the morph??? Plz help. Also how long should i feel like this after such a short time taking it? Thanx

Lydia @ Addiction Blog
9:48 pm February 8th, 2016

Hi, Andy. This could be signs of morphine withdrawal. I suggest you consult a pharmacist to recommend home remedies, and teas as well as over-the-counter medications to ease these symptoms.

Corey
6:03 pm March 4th, 2016

hello, i quit morphine almost 2 years ago and im still living with side effects

i have very low sex drive and motivation, i also get no euphoria/buzz from alcoholic drinks. it seems my receptors are damaged?

all blood tests are normal. any help?

Lydia @ Addiction Blog
2:16 pm March 7th, 2016

Hi Corey. You may consult your doctor to run some tests on your level of testosterone. According to some experts sometimes the body shuts down the production of testosterone due to the extended opiod use.

Maggie
4:41 pm April 5th, 2016

I did a stupid thing and smoked marijuana…it was time for my labs at pain management. So it showed positive. Im scared The dr will no longer see me. And terrified of withdrawals. Ive been taking 30 er twice a day and 2 15 mg for break through pain. Im 64 and scared to death

Jane
12:02 am February 24th, 2017

I took 60mg of morphine for 3 weeks. I stopped. 48 hours later, the diarrhea was awful, so i took 30 mg at 48 hours after last dose. Is this like starting all over again, too get off of them. Diarrhea was my only withdrawal symptom

Lydia @ Addiction Blog
5:56 pm March 1st, 2017

Hi Jane. I suggest that you speak with your doctor to help you create an individualized tapering schedule. Also, consult with a pharmacist to recommend some over-the-counter aid to ease withdrawal symptoms.

Timmy
9:24 pm March 13th, 2017

I was on 60mg sr for only 10 days. Stopped on a Friday morning and by Saturday I was hit with flu like symptoms and extreme muscle pain in my back,ect. Just generally felt like crap. Feeling much better today (Monday). I can’t imagine trying to come off that stuff after a year or more of usage. By the way, it did nothing for the pain, I just didn’t care!

Hearher
8:02 pm March 31st, 2017

I quit 2 weeks ago and I still have a little anxiety and diarrhea. I tried to taper off, but it just prolonged the detox. So, 2 weeks ago I went cold turkey. I had developed a very high tolerance. While I was tapering off and detoxing I had chills, rapid heart beat (at least it felt like it), diarrhea and some insomnia. I am sleeping now, but I have been taking nyquil at night. I don’t get the chills anymore, but I do still have a bit of anxiety and loose bowels. About a week in I felt significantly better. I also started to feel better when I got myself some I’m opium ad, nyquil, drinking juice and eating healthy. I lost my appetite, but I just ate little portions. I usually do not write things online, but I read what someone else wrote while I was detoxing and it really helped me. This was an awful experience, but it does not last too long.

ANDY
1:14 pm September 7th, 2017

THREE WEEKS AFTER STOPPING MORPHINE MST 10 X 4 PER DAY MG FOR 5 YEARS, I STILL HAD ALL THE ABOVE SYMPTOMS IE TERRIBLE FLU LIKE SYMPTOMS ,THE WORST WAS SEVERE ABDO & TERRIBLE DIAHORRE, AFTER WEEK 3 I WAS AS BAD AS I WAS @ DAY2 , HELP.

ANDY

Mike
5:38 pm March 29th, 2018

I want to stop taking 140 mg of morphine sulfate per day.

Lydia @ Addiction Blog
10:59 am March 30th, 2018

Hi Mike. I suggest that you consult with your doctor to help you plan an individualized tapering schedule.

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