Author: Ruben Bermea, LPC

Morphine is a non-synthetic opioid drug derived from opium, prescribed to treat pain. Classified as a Schedule II controlled substance, morphine has a high potential for misuse, diversion, and addiction.^1,2 Morphine misuse increases the chance and potential severity of side effects and risks.

What Is Morphine and How Is It Used?

Solid, odorless, and bitter, morphine comes in several forms as a medication for pain management.^1,3 Researchers first derived morphine from the opium poppy plant.^1,4 A small amount of morphine derived from this plant is used for morphine-containing pharmaceuticals; the rest is used to make codeine and other opioid derivatives.²

Previously, morphine was primarily used intravenously in hospital settings, but today there are many different formulations, including liquid solutions, tablets, suppositories, and capsules.^1,2,4

Generic and brand names for morphine include:²

• MS-Contin
• MSIR
• Roxanne
• Kadian
• RMS
• Oramorph SR

Dilaudid vs. Morphine

Morphine has effects that are similar to other medications, such as Dilaudid. Dilaudid contains hydromorphone, another opioid drug.^5,6 Though both Dilaudid and morphine come from the opioid drug class, they have important similarities and differences.

Dilaudid, which is a fast-acting opioid, is about two to eight times more potent than morphine.⁶ The risks of side effects, overdose, dependency, and addiction resemble that of morphine and other opioid medications.^6,7

How to Take Morphine

Each form of morphine has its own dosage instructions, which you should follow when you take this medication. You can take liquid solutions with a cup or syringe to help ensure accurate dosages.⁴

When taking morphine tablets, swallow each one at a time without soaking, licking, wetting, or chewing the medication. The capsules may have little beads that can be eaten with applesauce, though you should take care to ensure you swallow them as soon as possible. Water can help you swallow the tablets or capsules.⁴

When starting this medication, your doctor may prescribe a lower dose and increase the amount of morphine over time. Your doctor will want to know how the medication is managing your pain. You should tell your doctor how morphine affects you before deciding to change the amount you take.⁴ If you have any concerns, or feel this medication does not work, share this information with your prescriber. They can guide you through a safe medication adjustment process.

Morphine Misuse

Morphine misuse occurs when someone takes this opioid in a way other than prescribed, including:

• Taking morphine without a prescription
• Taking higher doses of morphine than prescribed
• Taking more frequent doses than prescribed
• Mixing morphine with other substances like alcohol or benzodiazepines
• Using morphine in a way other than directed (e.g. snorting or injecting)

Misusing this medication can have short– and long-term effects on your health. Like all other opioid substances, misuse can lead to addiction.⁷
Street names for morphine include:²

• Morf
• Morpho
• First Line
• Dreamer
• Emsel
• God’s Drug
• Hows
• M.S.
• Mister Blue
• Unkie

Injecting morphine can lead to infection or blockages in your blood vessels.¹ Other risks of injection include the possibility of contracting HIV or hepatitis when sharing needles with others.⁸

Though many people inject morphine when they misuse it, other routes of misuse can also cause health problems and addiction.² Snorting this medication chronically can damage the nasal passages and even lead to a perforated septum.

Morphine Side Effects

Like most medications, morphine can cause side effects, ranging from uncomfortable to severe. Misusing morphine greatly increases the risk of experiencing dangerous side effects.

Some potential side effects of morphine use include:⁴

• Sleepiness
• Headache
• Mood changes
• Small pupils
• Anxiety
• Dry mouth
• Stomach pain

Consult with your doctor if these symptoms persist or worsen while you take this medication.⁴
Morphine use can potentially lead to severe and potentially life-threatening side effects. These may include:⁴

• Rash
• Hives
• Swelling in your face, mouth, lips, throat, or eyes
• Skin turning blue or purple
• Breathing or swallowing problems
• Chest pain
• Fainting
• Seizures
• Loss of energy or strength
• Extreme sleepiness
• Sweating
• Shivering

If you experience any of the above side effects, call 911 immediately—it could indicate a medical emergency.

Morphine can also cause agitation or psychosis. Psychosis is characterized by the presence of hallucinations and delusions. Hallucinations occur when you begin to see, hear, taste, touch, or smell things that do not actually exist. Delusions consist of beliefs that do not match reality.⁷ While psychosis in and of itself is not potentially fatal, it can have dangerous consequences, such as accidents, injuries, or violent behaviors.

Risks of Morphine Use

Whether you take morphine as directed or recreationally, you can still develop serious short– and long-term side effects. Using this medication alongside alcohol, certain medications, or other depressant substances can cause profound respiratory depression and increase the risk of overdose.^1,3,4

When using morphine with migraine medication or antidepressants, you face an increased risk of developing serotonin syndrome, a potentially life-threatening condition leading to toxic buildup of serotonin in the brain and body.³
This medication can also affect your adrenal glands.Though rare, this effect can reduce your body’s ability to produce cortisol, a hormone that helps the body cope with stress.³

Some long-term effects of morphine use may include:⁹

• Severe constipation, leading to bowel obstruction
• Sleep-disordered breathing
• Heart attack
• Heart failure
• Increased risk of falls and fractures, especially in older patients
• Suppressed immune system

One of the most serious risks of morphine use is that of potential overdose, which can be fatal without emergency treatment.

Overdose Risk and Signs

Morphine overdose can occur when you take too much of this opioid for your body to handle. An overdose can cause severe problems for several systems in your body. While these complications can also result in death, multiple nonfatal overdose experiences may have the potential to cause chronic brain damage.¹⁰

Signs of morphine overdose include:⁴

• Difficulty breathing
• Concerning changes to the speed, depth, or rate of breathing
• Extreme sleepiness
• Inability to wake up
• Unresponsive
• Muscle weakness
• Clammy skin
• Cold to the tough
• Extremely small pupils
• Extremely slow heartbeat
• Vision blurring
• Fainting
• Nausea

Treat every morphine overdose as an emergency and seek medical attention immediately. Stay with the person until the first responders arrive. If you have naloxone on you, administer it to rapidly reverse the effects of the morphine overdose.

After you administer naloxone, continue to monitor for symptoms of overdose while you wait for medical help to arrive. Symptoms of overdose can return, and you may need another dose of naloxone within minutes of the previous dose.⁴

Morphine Withdrawal, Dependence, and Addiction

Chronic morphine misuse can lead to addiction, or an opioid use disorder. A morphine addiction is characterized by uncontrollable, compulsive morphine use despite negative consequences, such as problems at home, school, or work.⁷

Signs of an opioid use disorder include:⁷

• Using more of this medication than you intended
• Using this medication longer than you intended
• Spending large amounts of time seeking this medication
• Using morphine at the cost of your responsibilities
• Continuing morphine use despite consequences in your relationships
• Using morphine despite effects on your mental and physical health
• Needing more morphine to get the same effects that you achieved at lower doses (tolerance)
• Developing withdrawal symptoms when you attempt to quit or reduce morphine use (dependence)

If you are addicted to morphine, you almost certainly have a dependence as well, although the reverse is not necessarily true. For instance, if you take morphine as prescribed you may develop a physiological dependence on it. This isn’t indicative of an addiction—it simply means your body adjusted to taking morphine. If you suddenly stop taking it, you’ll experience morphine withdrawal symptoms, which can be uncomfortable.

Signs of morphine withdrawal include:⁴

• Runny nose
• Yawning
• Teary eyes
• Restlessness
• Irritability
• Sweating
• Sleep problems
• Anxiety
• Physical pain
• Nausea
• Vomiting
• Low appetite
• Diarrhea
• Stomach pain
• Increased breathing
• Increased heart rate

Talk to your doctor before suddenly stopping morphine use. They can create a tapering schedule for you in which your morphine dose is gradually reduced over a predetermined schedule. Weaning you off of morphine slowly will help prevent withdrawal symptoms from emerging.

If you’re addicted to morphine call 800-934-1582(Who Answers?) .

Resources

1. Bennett, A. C. P. (2019). Morphine. Salem Press Encyclopedia of Health.
2. United States Department of Justice Drug Enforcement Administration. (2020, April). Drug fact sheet: Morphine. 
3. National Center for Biotechnology Information (2021). PubChem compound summary for CID 5288826, morphine. 
4. U.S. National Library of Medicine. (2021, April 16). Morphine. MedlinePlus.
5. Parker, J. N., & Parker, P. M. (2004). Morphine: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. Icon Group International, Inc.
6. United States Department of Justice Drug Enforcement Administration. (2020, April). Drug fact sheet: Hydromorphone.
7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
8. Ciulla-Bohling, R. (2020). Heroin. Salem Press Encyclopedia of Health.
9. Baldini, A., Von Korff, M., & Lin, E. H. (2012). A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide. The primary care companion for CNS disorders, 14(3), PCC.11m01326.
10. RTI International. (2019, September). Non-fatal opioid overdose and associated health outcomes: Final summary report. The Office of the Assistant Secretary for Planning and Evaluation.