With “sheer originality, slow-burning intensity, excellence of songcraft, and pure fun,” ventured Billboard’s Chris Morris, “Morphine is at the head of the pack among alternative rock bands. “The moody, evocative sound of the Boston group has inspired rock critics to try to outdo one another in describing it: words like “noir” suggest its vibe, while “smoky” is usually the adjective of choice for bassist-singer Mark Sandman’s voice. Inevitable references to the narcotic properties of the trio’s music usually follow.
Morphine’s striking aesthetic—so unlike the assaultive directness of most rock—derives from its unique instrumentation. Sandman’s bass has usually sported only two strings, and he often plays with a slide; saxophonist Dana Colley generally plays a baritone, and drummer Billy Conway leaves lots of space for the music to breathe. With no guitar, apart from subtle touches in the studio, Morphine creates a spacious and surprisingly heavy musical environment. Their 1995 album yes saw them turning the cult success of the group’s previous effort, Cure for Pain, into a prolonged stay on the charts.
Members include Dana Colley, baritone saxophone Billy Conway (joined group 1993), drums; Jerome Deupree (left group 1993), drums; and Mark Sandman, bass, vocals.
Formed in Boston, MA, c. 1992; released debut album, Good, Accurate/Distortion, 1992; signed with Rykodisc and released Cure for Pain, 1993; appeared on soundtrack of film Spanking the Monkey, 1993.
Selected Awards: Good named Independent Album of the Year at Boston Music Awards, 1992.
Addresses: Record company —Rykodisc, 27 Congress St., Salem, MA 01970.
Sandman, a native of Newton, Massachusetts, grew up “a normal kid” listening to “adolescent cock rock,” as he told Option. Yet he also revealed that his adult experience was somewhat more offbeat, including tuna fishing in the Aleutian islands, construction work in the Rocky Mountains, driving a Boston taxi, and gadding around Rio de Janeiro, Brazil. He and Conway formed part of the sultry blues-rock band Treat Her Right; Yale University alumnus Colley played with the group Three Colors.
Treat Her Right disbanded in 1990. Sandman then embarked on a period of musical experimentation, inviting various musicians to jam with him and looking for new sonic opportunities outside the overworked repertoire of guitar rock. Influenced by the ambitious soundscapes of jazz bassist and composer Charles Mingus, the single-string expressiveness of Middle Eastern music, the gritty intensity of Mississippi Delta blues, the bleak themes of classic country music, and the atmospheric pop of groups like the Police, he began to hone in on the Morphine concept. “I listen to a lot of tapes I pick up at ethnic grocery stores,” he informed Steve Morse of the Boston Globe. “I like things that aren’t necessarily coming from Western sources, that have phrasings that don’t begin and end where you expect them to.”
But it wasn’t until Sandman played a one-stringed bass with a slide—inspired in part by seeing a bassist in a club do the same—against Colley’s saxophone that the concept began to gel. “It wasn’t like’Eureka!’ or anything like that,” he insisted to Billboard’s Morris. “It was, ’This is different—let’s try a gig and see if it flies.’” And, he remarked to Morse, “If the band didn’t work, it would have been no great matter. We would have just tried something else another day.”
Jazz-rock drummer Jerome Deupree originally rounded out the trio. Their maiden gig was well received, encouraging them to carry on. In 1992 Morphine recorded their debut album, Good, on the independent Accurate/Distortion label. It quickly became clear that the group’s sound, which allows the confluence of saxophone and slide bass to work within the space normally filled by guitar, had found an audience. “It just seems like the guitars are there,” Sandman mused in Pulse! “They’re just sort of imaginary.” Of the saxophone—usually relegated to brief solos in pop music—Colley noted in an interview with Randee Dawn Cohen of Alternative Press that he “always felt it had a lot more potential than that and could succeed in becoming part of the music, part of the rhythm and bass. “Pulse! called Good a ” surprisingly accessible” effort that “transcends petty genre distinctions in favor of timeless emotional truths.” It was named “Independent Album of the Year” at the 1992 Boston Music Awards.
Sandman’s lyrics and vocals evoked for many listeners the dark, jaded narratives of noir or “pulp” fiction and film—stories of crime, obsession, and betrayal. Reading off a list of his thematic preoccupations to Option’s Bob Gulla, he cited “perseverance, disadvantage, lust, despair, international love, self-delusion.” At the same time, of course, these often seedy tales are dangerously sexy, lending credence to Sandman’s description of Morphine—solicited by Patrick Bryant of Detroit’s Metro Times —as “f—rock.”
Nonetheless, Sandman has argued that the noir element in his songwriting has been exaggerated. “I mean, I read a lot of those books,” he admitted in SF Weekly, referring to such standards of the genre as the novels of Raymond Chandler, “but I don’t read them over and over.” Indeed, as he remarked to Alternative Press contributor Cohen, his compositions “are probably autobiographical, but it’s hard to tell.” In fact, he lamented not having “disguised” these elements as well as he’d intended.
The promise displayed by Good prompted the Rykodisc label, another independent, to sign Morphine and re-release the album. In the meanwhile, the trio set to work on a follow-up; during this period Deupree left the group and Conway took his place. Cure for Pain came out in 1993 and was a hit with both critics and underground music fans. “Morphine evoke the zonked swing of lounge jazz and the grind of dirty blues while maintaining rock & roll convictions,’ asserted Rolling Stone reviewer Arion Berger, who felt that Sandman displayed “no imagination” as a singer but conceded, “If his vocals can be faulted,” his “songwriting can’t.” Songs like “Thursday,” a tense story of lust and peril, the rocking “Mary Won’t You Call My Name,” and the plaintive, grooving title track—on which Sandman deadpans, “Someday there’ll be a cure for pain/That’s the day I’ll throw my drugs away” —took the record’s sales far beyond expectations. Five tracks from the album appeared on the soundtrack for the acclaimed independent film Spanking the Monkey.
Morphine toured relentlessly in support of Cure for Pain; Colley’s tour diary—excerpts from which appeared in Raygun— preserved some of the immediacy of their international travels. After experiencing the massive earthquake in Los Angeles in January of 1994, the group broke the citywide curfew and played a show there the next night. Colley also wrote of the “surprise and terror” of a packed gig in Brest, a town in the French countryside: “By the time’Mary won’t you call my name’ begins, all hell breaks loose. People are flying back and forth in one group of twisted limbs and bobbing heads. The monitors are the first to go, followed by mike stands, speaker stacks and light rigs. “The hapless soundman was pinned against a wall, unable to improve the mix—which was being broadcast on the radio.”
Morphine’s next release was 1995’s yes. Rykodisc confidently issued the leadoff track, “Honey White,” as a single, and the trio promptly hit the road again. The record earned more rave reviews— Billboard deemed it “one of the year’s best releases, “while USA Today gave the album 31/2 stars out of four and called it the group’s “best album to date” —as did the band’s now well-honed live act. “Morphine has developed from a surprisingly strong unit into a unique force in modern rock music,” marveled Phil Gallo of Daily Variety. “There’s no compromise within Morphine’s daringly original songs that challenge notions of rhythm, melody and even the use of instrumentation as the band bounces off tuneful skeletons from the closets of rockabilly, improvisational jazz, punk and blues.”
yes also demonstrated significant, if not truly mainstream, commercial viability, debuting at the top of the Billboard Heatseekers chart and, despite losing some ground, remaining on the chart for months. As a Los Angeles record retailer told Billboard,” It’s a rock thing, but it’s not a rock thing—it’s a moody rock thing, and there always seems to be a market for that stuff.” Sandman expressed an eagerness to do “residencies” in the band’s favorite cities—several gigs at the same small venue, rather than one in a larger space—as a way of offsetting the wear of nonstop touring. “It’s a way to not have to travel every single day, and a way to get to see some of the cities we’re interested in.”
The members of Morphine have also had a hand in other projects—Sandman has played with the Pale Brothers, Hypnosonics, Supergroup, and Candybar, for example—and this freedom has allowed them, as Colley told Alternative Press, “to keep our chops up” and try different things. Resisting formula is a top priority for the band, as Sandman pointed out in SF Weekly: ” We’re trying to keep the definition of’what’s a Morphine song’ pretty flexible. Pretty soon it’s going to be just about anything. We’ve been holding back a lot of the stranger things. We’re feeling braver now. It’s a big cosmos out there.”
Good, Accurate/Distortion, reissued by Rykodisc, 1992.
Cure for Pain (includes “Thursday,” “Mary Won’t You Call My Name, “and “Cure for Pain”), Rykodisc, 1993.
yes (includes “Honey White”), Rykodisc, 1995.
Alternative Press, May 1995.
Billboard, February 12, 1994; February 11, 1995; March 25, 1995; April 15, 1995.
Boston Globe, May 20, 1994.
Boston Phoenix, March 17, 1995.
College Music Journal, April 1995.
Daily Variety, April 3, 1995.
Entertainment Weekly, March 17, 1995.
Metro Times (Detroit, Ml), March 2, 1994.
New Yorker, April 10, 1995.
Option, March 1995.
Pulse!, November 1992; December 1993.
Raygun, April 1995.
Request, April 1995.
Rolling Stone, March 24, 1994; July 14, 1994; March 23, 1995.
SF Weekly (San Francisco, CA), March 29, 1995.
USA Today, April 3, 1995.
Additional information for this profile was obtained from Rykodisc publicity materials, 1995.
How low can you go? That’s the musical question posed by Morphine, purveyors of “low rock,” a bottom-heavy, cacophonous rumble you can feel in your bones. It’s produced by a decidedly unusual grouping of instruments: a baritone sax, drums, and a unique two-string bass that’s played like a slide guitar. Unlike most rock bands, Morphine doesn’t use a guitar or piano to carry the melody or fill sonic space. Instead, those notes are implied, like in certain jazz tunes, but the overall impact of Morphine’s music can’t be denied. Like the band’s name implies, low rock’s effect is disorienting, feels somewhat illicit, and it totally addictive.
The concept of the low-rock sound was created by Mark Sandman, who died of a heart attack while performing in Italy on July 3, 1999. In some ways, he was the ultimate scenester among the Boston/Cambridge music community, maintaining numerous side projects before and during his tenure in Morphine. Creatively restless, he began experimenting with low sounds when he played in the Boston blues-rock quartet Treat Her Right. There, Sandman played a conventional six-string guitar, but did so through an octave-shifting effects pedal that made the instrument sound more like a bass.
He then switched to a conventional bass, but one with just a single string, reasoning (somewhat Zen-like) that all the notes he’d need to play were on that one string. By the time Morphine took off, he’d added a second string. Later, he would add a third, albeit one from a guitar, and call the invention the Tritar. Obviously, experimentation and innovation came naturally to Sandman, who was just 46 when he died.
Songwriting came naturally, too, and to hear a tune by Morphine is to hear something that’s quite removed from mainstream pop and rock. Besides “low rock,” Morphine’s sound is sometimes called “beat noir,” in reference to its jazzy feel—in a perfect world, the sound you’d hear emanating from a smoky bar at unreasonable hours of the morning—but also its lyrical content, which is often dark, hard-boiled, and full of intrigue.
Sandman played with his Treat Her Right bandmates David Champagne, a guitarist and the leader of that group, harmonica player Jim Fitting, and drummer Billy Conway who would later join Morphine on the albums Treat Her Right, released in 1986, Tied to the Tracks, released in 1988, and What’s Good For You released in 1991. The first was released independently, but the second was recorded for RCA, who didn’t know how to market the band’s quirky sound and sensibility. For the third, they were back to indie status, working with Boston-based Rounder Records.
As Treat Her Right was in its final throes, Sandman was gigging all over the place, most frequently at
Members include Dana Colley, baritone saxophone; Billy Conway (joined 1993), drums; Jerome Deupree (left band 1993), drums; Mark Sandman (died July 3, 1999), bass, vocals.
Group formed in Boston/Cambridge, Massachusetts area in 1992; released debut album Good on independent Accurate/Distortion label. It was later picked up by larger indie Rykodisc. Ryko also released albums Cure for Pain, 1993, and Yes, 1995, plus an album of rarities B-sides and Otherwise, 1997’. The group was represented on numerous movie soundtracks, and built up a solid cult following through insurgent touring campaigns. Signed with DreamWorks label in 1996, resulting in Like Swimming, 1997, and their swan song, The Night,2000.
Addresses: Record company —DreamWorks Records, 100 Universal Plaza, Bungalow 477, Universal City, CA 91608.
Cambridge nightspots the Plough & Stars and the Middle East. His various bands included Supergroup, a collaboration with Seattle-based Chris Ballew, who would eventually rise to fame with the Presidents of the United States of America. There was also Treat Her Orange (later the Pale Brothers), which found Sandman playing with mandolinist Jimmy Ryan of the Blood Oranges, and the Hyposonics, whose membership included future Morphine saxman Dana Colley and Either/Orchestra leader Russ Gershon.
Morphine, too, started out as just one among many of his projects, but Sandman was quick to recognize its potential. He formed the trio with Colley and drummer Jerome Deupree. As Boston Phoenix columnist Matt Ashare wrote of Morphine, “[It] best captured the essence of Sandman’s singular style: his deadpan delivery, his wry pulp-noir vignettes, his less is best’ aesthetic, and his love of loose R&B grooves rooted equally in the deep meaty blues of Howlin’ Wolf and Muddy Waters and the savvy pop funk of an artist like Prince, who was one of his all-time favorites.”
The band’s debut album was released through Russ Gershon’s Accurate/Distortion label in 1992. The next year, it was picked up by the independent but nationally distributed Rykodisc label, based in Salem, Massachusetts. There was nothing special about the songs themselves—“We write pretty standard three-minute rock songs with verses, choruses, and hooks,” Sandman told the Boston Phoenix— but the vibe of those songs was as indelible an individual stamp as a rock band can hope to muster these days.
Just as their music stood outside the mainstream, so did Morphine’s approach to the business of music. They didn’t open shows for larger acts very often; instead, they did their own modest headlining tours, setting up short residencies in various towns and allowing their audience to develop organically. Sandman knew how to exploit what he had to work with, and let the press run with the band’s oddities—he invented the term “low rock” for that very purpose—but kept the particulars of his private life out of the papers.
While they were recording their second album, Cure for Pain, Deupree was replaced with Treat Her Right skinsman Billy Conway. The album, released in 1993, was less than a commercial sensation, but gained much wider exposure when some of the songs were used prominently in the film Spanking the Monkey. That, and almost universal critical praise, raised the group to a level of popularity that it was able to maintain until its untimely end.
“Listening to early Morphine creates a sensation similar to slowly burning yourself with a cigarette,” wrote Addicted to Noise contributor Seth Mnookin around the time of the release Morphine’s third album, Yes in 1995. “It’s a little scary, very intense, and impossible to stop because you’re so determined to feel what’s going to happen next.” That sort of response was typical of a Morphine fan, and the group sated its public’s desire for material with numerous singles sprinkled with bonus tracks and songs on various soundtracks. A collection of such odds and ends, B-Sides and Otherwise, surfaced in 1997.
Just before that, Morphine became the second act signed to DreamWorks records, the music arm of the entertainment conglomerate owned by Steven Spielberg, David Geffen, and Jeffrey Katzenberg. The album Like Swimming found the band varying the low-rock sound to a degree, incorporating instruments such as guitar, tritar, mellotron, and female background vocals into the mix. Ultimately, though, low rock was Morphine’s hook, not an end in itself, and there were no hard and fast rules about what could and couldn’t be done within the context of the band.
That became even more the case on The Night, the album Morphine had finished just before Sandman collapsed on a stage outside Rome and was pronounced dead-on-arrival at a local hospital. The Night seems a fitting epitaph, however, because its music finds Morphine’s sound taken to its logical conclusion as a unique brand of chamber-rock—adding more, and somehow ending up with less. Only Morphine could do that. Keyboards, violin, cello, and double bass, acoustic and electric guitars, oud, and various hand drums are played on the album. Drummer Deupree is back, too, playing in tandem with Conway on nearly every track. In some ways, the album is the lowest of the low, which is meant as both a compliment and a tribute to Sandman, who brought something unique to music— something not very many musicians can claim.
The Night may have been Sandman’s final work, but it was not the last word on his legacy. In late 1999, Morphine’s surviving members—Conway, Colley, and Deupree as well—formed Orchestra Morphine, a big band that toured the country, playing Sandman’s music in a new, and wholly fleshed out fashion. Sidemembers included Either/Orchestra leader and Accurate Records executive Russ Gershon, trumpeter Tom Halter, keyboardist Evan Harriman, bassist Mike Rivard, and singers Laurie Sargent and Christian McNeill.
Whether Orchestra Morphine can go on to create new music without Sandman seems unlikely, though not entirely impossible. “He was a visionary,” DreamWorks chief Lenny Waronker said of the fallen musician. “He invented a sound that was unique. He was one of a kind; he was uncompromising. It might be a cliché to call someone the real thing, because too many say that these days, but in his case it’s the truth. He was truly the real deal.”
Good, Accurate/Distortion, 1992; Rykodisc, 1993.
Cure for Pain, Rykodisc, 1993.
Yes, Rykodisc, 1995.
Like Swimming, Rykodisc, 1997.
B-Sides and Otherwise, Rykodisc, 1997.
The Night, DreamWorks, 2000.
“You Look Like Rain,” The Best of Mountain Stage, Vol 7, Blue Plate, 1994.
“Yes,” National Lampoon’s Senior Trip Original Soundtrack, Capricorn, 1995.
“I Had My Chance,” “Bo’s Veranda,” Get Shorty, Antilles, 1995.
“Radar,” Safe and Sound, Mercury, 1996.
“Gone for Good,” 2 Days in the Valley Original Soundtrack, 1996.
“Kerouac,” Kerouac: Kicks Joy Darkness, Rykodisc, 1997.
“This Is Not a Dream (with Apollo 440),” Spawn: The Album, Epic, 1997.
“11 O’Clock,” Phoenix Original Soundtrack, Will Records, 1998.
“Honey White,” MTV 120 Minutes Live, Atlantic, 1998.
“Hanging on a Curtain,” La Femme Nikita Original TV Soundtrack, TVT, 1998.
“I Had My Chance,” “Murder for the Money,” Wild Things Original Soundtrack, Varese Sarabande, 1998.
“You’re an Artist,” The Mod Squad Original Soundtrack, Elektra, 1999.
“Sheila,” IFC—ln Your Ear Volume 1: Original Soundtracks, Hybrid, 1999.
“Radar,” Condo Painting: Life From a Different Angle Original Soundtrack, Gallery Six, 2000.
Billboard, July 17, 1999.
Boston Phoenix, July 9-15, 1999.
Seattle Post Intelligencer, May 12, 2000.
Addicted to Noise, http://www.addict.eom/issues/1.05/Features/Morphine/(June 23, 2000)
Boston Rock Storybook, http://www.rockinboston.com/morphine.htm (June 26, 2000)
What Kind of Drug Is It?
Morphine is a natural product of the opium poppy plant. Of the many mind-altering compounds in the opium poppy, morphine is the strongest. The drug has many important medical uses, all having to do with pain control. It is never used to treat emotional or psychological problems.
For many people recovering from painful surgery—and for even more people facing the daily agony of end-stage cancer—morphine can dramatically improve their quality of life. The drug, called an opiate, has been used for pain relief for many years, in many different cultures worldwide.
When prescribed for a patient by a physician, morphine can help speed recovery from operations, ease the pain and trauma of childbirth, and give dying people relief from incurable pain. When used illegally as a recreational drug solely to get high, morphine is highly addictive with many unpleasant side effects. When purchased on the street, it is usually found in the form of heroin, a substance that turns to morphine in the brain. (An entry on heroin is available in this encyclopedia.)
Whether used legally or illegally, morphine is a very dangerous drug. Overdoses can cause fatal breathing problems. Even those who use it for pain relief can develop a dependence or physical need for the drug. Doctors tend to be very conservative when they prescribe it for pain because they are aware of its risks and drawbacks. Since the beginning of the twenty-first century, patients' rights groups have urged the medical community to use morphine more freely to control pain. They believe that patients in severe pain would be more likely to contemplate or commit suicide if they were unable to use the drug.
Official Drug Name: Morphine sulfate,morphine hydrochloride (for injection); Duramorph (spinal injection); MS Contin, Oramorph, Kadian, MSIR (pill and tablet forms); Roxanol (liquid for oral use)
Also Known As: M, Miss Emma, monkey, morph, white stuff
Drug Classifications: Schedule II, opiate
Morphine is derived from a flowering poppy called Papaver somniferum. This plant can grow in many environments, but it thrives in a soil that contains some sand and loam, in higher elevations with cooler temperatures. Opium poppies were first grown by people
6,000 years ago in the area that is now Iran and Iraq. A manuscript from the ancient Egyptian city of Thebes, dating to 1552 bce, mentions opium as a cure for more than 700 illnesses.
From Plant to Drug
Although the leaves and stems of the opium poppy plant also contain opiates, it is the sticky sap in the bulbs that has the most strength. The bulbs begin to ripen after the flower petals fall. As the bulbs ripen, skilled farmers cut them, and the sap flows out. Once collected, the sap is dissolved in boiling water. The twigs and other plant material float to the surface, and the boiled opium is strained. It is then cooked a second time, this time to remove the water. Once the water has evaporated as steam, what remains is a putty-like substance called "smoking opium." After this simple process, users sometimes smoke or eat the opium to get high.
More commonly, though, the cooked opium goes through another chemical process. Again it is boiled, this time with lime. The lime converts the opium from a non-water soluble morphine alkaloid into the water-soluble calcium morphenate. Ammonium chloride is added to the solution, and this causes the morphine to settle to the bottom of the cooking pot. The solution is poured through a straining cloth, and what remains is chunks of morphine that are dried in the sun. Legally, these morphine "bricks" are processed into prescription painkillers. Illegally, they are smuggled into laboratories and turned into heroin.
None of this chemistry was known to opium farmers in the era prior to modern medicine. In the Middle Ages (c. 500–c. 1500), opium was mixed with wine or other alcohol and called "laudanum." Crude opium was also smoked, particularly after the introduction of pipes from the Americas after Columbus (1451–1506) reached the New World in 1492. When opium smoking became widespread in Asia—and particularly in China—the destructive and habit-forming effects of the drug began to be revealed.
In 1803 German chemist Friedrich Sertürner (1783–1841) experimented with opium and isolated morphine for the first time. He named his discovery after the Greek god Morpheus, who is often depicted in ancient statues sleeping among opium poppies. Within thirty years of Sertürner's discovery, it was possible to buy medicines with morphine from any store that sold remedies. Both morphine and opium cost less than alcohol, and the substances were abused by famous and common people alike. The users of morphine and opium-laced medicines were aware of the dangers. As early as 1821 author Thomas de Quincy wrote Confessions of an English Opium Eater, describing his personal experiences of addiction and drug-induced mental breakdown.
Morphine, a painkiller that can be dissolved in water, came to the forefront in 1848, when an inventor perfected the hypodermic needle. This allowed the substance to be injected right into a vein, producing pain relief (and euphoria) in minutes. Surgeons welcomed this new tool, since it enabled them to perform pain-free operations. But the medical community quickly learned that morphine was habit-forming. In his book Illegal Drugs: A Complete Guide to Their History, Chemistry,
Use and Abuse, Paul M. Gahlinger estimates that 400,000 soldiers became addicted to morphine during the American Civil War (1861–1865). Morphine addiction was so common among returning veterans that it was called "the soldiers' disease."
Discovery of Heroin
Doctors and chemists continued to experiment with morphine, hoping to create a product that would be less habitforming but would still control pain. Codeine was isolated in 1832. It was not as strong as morphine but was used in cough formulas and diarrhea medications. Soon it was found to be addictive as well. Another experiment on the morphine compound occurred in 1874, when British chemist Alder Wright created diacetylmorphine (DIE-uh-SEE-tuhl-MOR-feen), marketed as heroin.
With the introduction of heroin, morphine users and opium smokers hoped they had found a cure for their addictions. Many tried heroin to wean themselves off the other substances. In doing so, they traded a bad addiction for an even worse one. By that time, over-the-counter medicines containing codeine, morphine, heroin, and cannabis (marijuana) could be bought for problems as varied as toothaches, headaches, and fussy babies. (Entries for codeine and marijuana are available in this encyclopedia.) At that time, people did not realize the dangers of using such products.
Dealing with the Growing Abuse
China had long struggled with large numbers of opium addicts. As Chinese immigrants came to the United States to work, some brought the habit with them. By the late 1800s, almost every major city in the United States had at least 1 opium "den"; New York had more than 300. Opium dens were darkly lit establishments where people went to smoke opium. Many dens had beds, boards, or sofas upon which people could recline while experiencing the effects of the drug.
On February 1, 1909, China and the United States led a meeting called the International Opium Commission. Eleven other countries participated. Three years later, a convention in the Netherlands produced the first international agreement on the regulation of narcotics—especially opium and heroin. Gahlinger wrote: "This began a process whereby the United States took a global leadership in controlling the international narcotics trade, even while its own domestic use of addictive drugs was rampant. One hundred years later, this situation has not changed."
The Harrison Narcotics Act of 1914 made it illegal to sell medicines containing heroin, morphine, or opium without labels warning of the presence of the drug in the product. In 1926 heroin was made completely illegal. Morphine remained legal but only when prescribed by a doctor.
The twentieth century was marked by enormous progress in surgery, medications, and treatments of all sorts of diseases. Scientists
developed synthetic painkillers based on the properties of morphine, such as oxycodone and fentanyl. However, they made no progress in removing the habit-forming effects of the substances. (Entries on oxycodone and fentanyl are available in this encyclopedia.) Morphine is still widely used in hospital settings and is prescribed as pills and liquids. It is also available in a pump implanted in the body, for use in the most stubborn, ongoing, and incurable pain. Except in the case of surgery, doctors use morphine as a drug of "last resort," after all other painkillers have failed. It is most often used when a patient is dying. At the last stage of life, the fact that morphine is addictive is no longer significant.
What Is It Made Of?
Morphine is an alkaloid, the chemical class to which many drugs belong. It is also an organic product, meaning that it is derived from a plant. The process of extracting morphine from opium is so simple that farmers can do it alongside their fields, with few other tools than cooking pots, lime (an ingredient in fertilizers), and ammonium chloride (also found in fertilizers). In its basic form, the morphine alkaloid is not soluble in water. Once it has been treated with lime and ammonium chloride, however, it becomes the water-soluble compound calcium morphenate. Further treatments produce morphine sulfate, morphine hydrochloride, and morphine. All of these are used in medicines.
After having gone through chemical processing, morphine salts appear as a bitter white powder. Some people take this powder by mouth, while others snort it or dissolve it in water and inject it. Morphine products are not as fat soluble as heroin. A highly fatsoluble drug like heroin enters the bloodstream quicker and moves to the brain faster, no matter how it is taken. As such, morphine products do not work as quickly to produce the intense high that is experienced with heroin use. Injected morphine does work quickly, in about five to ten minutes, whereas heroin works almost immediately.
The vast majority of legal morphine is converted to codeine, a milder painkiller and cough suppressant used in great quantities worldwide. The remainder of legal morphine is processed as a painkiller. More than 1,000 tons of morphine are produced legally every year, from poppies grown on government-regulated farms in India, Turkey, and the Australian province of Tasmania. Illegal opium production is widespread in the highlands of Burma, Laos, Vietnam, Thailand, Pakistan, Afghanistan, Colombia, Mexico, and Lebanon.
How Is It Taken?
Prescription morphine comes in many forms. As morphine sulfate and morphine hydrochloride, it is a liquid injected into veins. As Duramorph, it is a liquid injected into the fluid surrounding the spine. This type of injection is called an epidural. Duramorph is used in childbirth and some forms of surgery that can be performed while a patient is awake. Morphine pills of various strengths are also available and are prescribed for cancer pain, back pain, recovery from surgical procedures, and occasionally migraine headaches. The drug can also be found in rectal suppositories. The latter form of morphine is usually given to people suffering from nausea. A liquid form of morphine is available for oral use among patients who have difficulty swallowing pills.
Some patients use morphine pumps. These come in two forms. Either the patient is hooked up to a needle (IV) and can press a button to increase the flow of morphine through the needle, or a morphine dispenser is implanted under the skin, releasing a set dose of the medicine at hourly intervals. The pumps are usually programmed so that a patient cannot receive too much morphine and overdose. Too much morphine can lead to death by stopping a patient's breathing.
Morphine is usually sold illegally on the street in its pill forms. Users crush the pills and snort, smoke, or inject them.
Are There Any Medical Reasons for Taking This Substance?
Morphine is used most often to ease the pain of dying from cancer. Cancer causes tumors (abnormal growths) in just about any organ in the body, from the brain to the limbs. These tumors can cause intense pain that never goes away. Morphine does not shrink tumors. Rather, it causes the brain not to respond to the pain that the tumor causes. Patients know they are in pain, but they feel more comfortable. Their anxieties are also eased by the relaxing components of the morphine.
Newspapers and magazines report cases of end-stage cancer patients who, with high doses of morphine, are able to take care of themselves around the home, do tasks such as gardening and attending family functions, and even work on projects they want to finish before death. hospice workers who try to make dying patients as comfortable as possible report a greater sense of calm and less trauma for the patient and family when morphine is used to sedate and control pain.
Recovery from surgery without morphine would be a terrible ordeal for many patients. Even though the drug is often used only for the first few days, it greatly eases the pain and trauma the patient feels after a procedure. Used in this way it does not promote addiction. As the body recovers, doctors reduce the doses of the painkiller, eventually switching to over-the-counter products such as aspirin, acetaminophen, or ibuprofen.
Morphine's Not for All Patients, Though
For chronic, or ongoing, conditions such as back pain and migraine headache, morphine is never used as the first drug for treatment. Typically the drug is only prescribed for people who have used other opiate or opioid painkillers, or other prescription drugs, with disappointing results. Morphine's side effects—tolerance, constipation, nausea, drowsiness, and dizziness—make it a drug of last resort for people in pain.
Some people suffer pain that does not respond to morphine. This kind of pain, known as nerve damage, is particularly frustrating both for patients and their doctors. If nerves are damaged, they cannot read the chemical message morphine sends them.
One of morphine's main uses is in end-of-life situations where doctors try to control pain and suffering. In March of 2005, after a long legal battle, Terri Schiavo—who was diagnosed with severe brain damage and no hope of recovery—was removed from the feeding tube that had kept her alive for fifteen years. As she perished from starvation and dehydration, doctors administered morphine to ease any suffering she might have felt. Terri Schiavo died on March 31, 2005.
Doctors who prescribe morphine must be certified to do so by the U.S. Drug Enforcement Administration (DEA). Morphine prescriptions require extra paperwork to determine how much medicine each patient receives and whether or not the doctor is
over-prescribing it. In response, doctors tend to under-prescribe morphine for two reasons. First, doctors do not want to be seen as dispensing drugs without good reason. Second, doctors do not want to take the chance that a dose they deem safe for a patient might actually lead to a fatal overdose.
Morphine enters the illegal market in two ways. Most of it is transformed into heroin in illegal laboratories in Asia, Mexico, and South America and smuggled into the United States. The rest is diverted from its legal use through theft from pharmacies or through "doctor shopping" for prescriptions. An illegal practice, doctor shopping occurs when an individual continually switches physicians so that he or she can get enough of a prescription drug to feed an addiction. This makes it difficult for physicians to track whether the patient has already been prescribed the same drug by another physician. Additionally, some morphine fatalities can be tied to people legally taking the drug, but taking it in higher doses than recommended, or combining it with other painkillers, alcohol, or cocaine.
People of all ages and income levels abuse prescription painkillers, sometimes with fatal results. Users often start taking the prescription drug for a painful condition and wind up abusing it for the mental effects. It is difficult to determine the number of deaths caused by morphine every year because heroin shows up as morphine on drug tests. Sometimes the cause of death is simply listed as "opiate overdose," and this could also include codeine or other prescription painkillers.
According to the "2003 National Survey on Drug Use and Health (NSDUH)," an estimated 119,000 teenagers between twelve and eighteen had tried heroin at least once. If given a drug test, these teenagers would test positive for morphine. Emergency room mentions of pure morphine are much lower than those for heroin, OxyContin, and Vicodin. The strength of morphine, the difficulties doctors face prescribing it, and the close watch kept on supplies in hospitals and pharmacies tend to keep illegal supplies low. Plus, the higher purity of illegal heroin makes that drug more attractive for abuse.
Effects on the Body
Morphine floods a group of receptors in the brain and spinal column that take in endorphins and enkephalins. Biologists think that endorphins and enkephalins work together naturally to dull pain or to ease anxiety when someone is hurt or close to death. Morphine replaces these natural molecules, and in a much greater quantity than the body can supply. Pain signals surging from an injury or a cancerous tumor cannot relay their messages to the brain because morphine has blocked the receptors that register the pain, while rewarding the receptors that enhance pleasure. Patients may still hurt, but the pain will not bother them as much, and they will be able to concentrate on other aspects of life.
Not Typically Abused for a High
Morphine is not as fat soluble as heroin, so even when injected it does not produce the instant rush of pleasure that makes heroin attractive as an abused drug. Nevertheless, morphine does induce a dreamy state of happiness, drowsiness, and relief from anxiety that can last from four to six hours, depending on the dose and the way it was administered. Most people taking morphine for pain learn to live with the drowsiness and confusion. Some opt to live with the pain instead so that their senses are not dulled by the drug. Usually patients will work closely with their doctors to monitor doses so that a balance can be achieved.
Scientists are finding that patients in pain can become tolerant to very high doses of morphine—doses that, if taken recreationally, would kill a person outright. Tolerance, or needing higher doses of a drug to achieve the same results, is a standard side effect of opiate use.
All opiates produce similar side effects in the body. Morphine users will typically develop constipation because the drug slows muscle movement in the bowels. Breathing may be slowed as well. The drug can affect coordination—users must adjust to the medicine before driving or operating machinery. Other side effects include nausea and vomiting, loss of appetite, loss of sexual function, and pinpoint pupils. Some people develop a mild allergic reaction in the skin that causes itching or prickling.
Even when used as directed, morphine can cause withdrawal symptoms if a dose is missed or the medication is stopped suddenly. These symptoms include sneezing, runny nose, muscle aches, insomnia and anxiety, diarrhea, muscle twitching, sweaty and clammy skin, and goose bumps.
Reactions with Other Drugs or Substances
Because morphine can slow breathing and reaction time, it is much more dangerous when taken with alcohol, tranquilizers, sedatives, anti-anxiety medications, antidepressants, or even over-the-counter allergy medicines. Doctors must also monitor patients who take the pill form of morphine for reactions with other medicines metabolized in the liver, including medicines for tuberculosis, such as Rifampin, and medicines for seizures and epilepsy, including Dilantin. Some antibiotics can increase the level of morphine retained in the bloodstream.
Cancer patients on chemotherapy may have difficulty taking morphine because the drug can upset the stomach. These patients sometimes experience relief by using rectal suppositories or by using
pumps that bypass the stomach. However, doctors must evaluate the loss of appetite that results when morphine and chemotherapy are combined.
Some drug abusers combine morphine and cocaine. This can be particularly deadly, especially in terms of addiction. The two drugs work differently in the brain, causing high levels of disorientation, and both are habit-forming. Addicts who use opiates and cocaine at the same time find it hard to free themselves completely of both drugs.
Treatment for Habitual Users
Morphine use can lead to addiction. Even after years of not using the drug, opiate users can still crave the drug because they remember how they felt when they were taking it. Withdrawal from morphine and other opiates is a difficult task that lasts three to five days, if the user quits "cold turkey." More commonly, addicts seek treatment with methadone or buprenorphine, medications that will curb the withdrawal symptoms and block the effects of morphine in the brain. (An entry on methadone is available in this encyclopedia.) A morphine overdose that has caused breathing to stop can be treated with naloxone (Narcan), a drug that quickly rids the body of opiates. However, many opiate deaths occur in private settings. The user stops breathing, and no one is present to call for emergency care.
Health professionals advise anyone wishing to end morphine dependency to work closely with doctors and a psychiatrist or other therapist. If the dependency was brought about by morphine's use as a painkiller, a doctor may taper the dose so that the patient gradually becomes free of the drug. If the dependency comes from recreational use, the addict must learn strategies to live free of the drug's influence, often including finding new friends and staying away from the people and places associated with the drug use. Doctors and nurses who take opiates recreationally often lose their jobs—jobs they had trained for over many years.
Narcotics Anonymous (NA) is a self-help group that allows recovering addicts to meet and obtain assistance from other people who have lived through drug abuse. The nonprofit organization has a telephone helpline and group meetings in most cities and towns in the United States. Opiate dependency is one of the toughest addictions to beat, and the support of a group of peers is extremely helpful during moments of craving, anxiety, or depression.
One of the most serious consequences of a heroin or morphine addiction is the long-term profile a person creates for his or her future health care. Doctors are reluctant to prescribe powerful painkillers to people who have no history of drug abuse. They are much less likely to prescribe these drugs to people who have abused opiates in the past.
4000 bce Opium poppies are cultivated in the Fertile Crescent (now Iran and Iraq) by the ancient cultures of Mesopotamia.
1552 bce An ancient Egyptian papyrus text from the city of Thebes lists 700 uses for opium.
600-900 ce Arabic traders introduce opium to China.
1524 Swiss doctor Paracelsus mixes opium with alcohol and names the product laudanum.
1803 German scientist Friedrich Sertürner isolates morphine as the most active ingredient in the opium poppy.
1848 The hypodermic needle is invented, allowing for quicker delivery of morphine to the brain.
1861–1865 An estimated 400,000 soldiers return home from the American Civil War with addictions to morphine.
1874 British chemist Alder Wright uses morphine to create diacetylmorphine (heroin), in an effort to produce a less addictive painkiller.
1914 The Harrison Narcotics Act ends over-thecounter purchases of medicines that do not have a full list of ingredients on the label.
1970 The Controlled Substances Act names morphine as a Schedule II controlled substance, recognizing its uses in pain relief and surgical settings.
1974 The first hospice facility opens in the United States.
2005 Terri Schiavo receives injections of morphine as her feeding tube is removed and she is allowed to die, after spending fifteen years in what doctors called a persistent vegetative state.
Advocates for the terminally ill point to another consequence of recreational opiate use. Some people in pain view prescription painkillers as dangerous and addictive, products that will make them crazy, or make them sleep all the time, or turn them into criminals. Such people suffer needlessly because of the negative perception attached to opiates. Doctors feel this too. They feel they are being monitored by the government and their jobs may be in jeopardy if they prescribe too much pain medication. As a consequence, they under-prescribe, even for dying patients. The bottom line: Many people suffer pain because other people abuse painkillers.
The Controlled Substances Act of 1970 placed morphine on the Schedule II list of controlled substances. This means that the U.S. government deems morphine to be a drug with medicinal uses that also carries the potential for abuse and addiction. Doctors who wish to prescribe morphine must register with the U.S. Drug Enforcement Administration (DEA). Morphine prescriptions are not like the typical slips of paper issued for most prescription drugs. They are more complicated and must be filed with the DEA, where records are kept on each doctor and how much morphine he or she prescribes. If the DEA determines that a doctor is prescribing too much morphine, that doctor can face criminal prosecution and possible jail time.
Illegal possession or sale of morphine, or any Schedule II drug, carries serious penalties, even on a first offense. Anyone caught with the drug can expect fines of as much as $10,000, mandatory drug testing, loss of driver's license, loss of federal government college financial aid, and a permanent criminal record. Judges often order opiate abusers into detoxification clinics. Second offenses almost always carry jail time and very heavy fines.
Because morphine is so habit-forming, its use can lead to other sorts of crime. People craving the drug are more likely to rob homes in search of cash or valuables. They are more likely to break into pharmacies or to commit armed robbery. They may resort to prostitution to pay for their habits, making themselves vulnerable to the human immunodeficiency virus (HIV) and other sexually transmitted diseases. An arrest for any of these offenses will result in jail time, where the addict will receive little treatment as he or she faces drug withdrawal.
For More Information
Arsenault, Kathy. In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines. Somerville, MA: Firefly Press, 2002.
Gahlinger, Paul M. Illegal Drugs: A Complete Guide to Their History, Chemistry, Use and Abuse. Las Vegas, NV: Sagebrush Press, 2001.
Hodgson, Barbara. Opium: A Portrait of the Heavenly Doom. San Francisco, CA: Chronicle Books, 1999.
"Beware of Morphine Overdoses." Drug Topics (October 20, 2003): p. 8.
Girsh, Faye. "Death with Dignity: Choices and Challenges." USA Today Magazine (March, 2000): p. 62.
Harvey, Kay. "As Her Condition Deteriorates, Gwen Frazier Faces the Loss of Her Independence." St. Paul Pioneer Press (April 28, 2000).
Hopkinson, Tom. "Morphine Produced in the Human Brain." Chemistry and Industry (October 4, 2004): p. 8.
Hurley, Mary Lou. "New Drug for Postop Pain Is Now Available." RN (October, 2004): p. 76.
McAlpin, John P. "Pakistani Paramilitary Troops Seize Morphine, Weapons Near Afghan Border." America's Intelligence Wire (August 13, 2004).
"Nine Days in June: Drugs Claim Two Sports Stars—and 147 Others." Life (January, 1987): p. 83.
O'Neill, Terry. "Morphine, Murder and Mercy: New Painkilling Guidelines Clarify Issues Surrounding Treatment of the Terminally Ill." The Report (October 21, 2002): p. 42.
Ostrom, Carol M. "Oregon Doctors Concerned with Improving Quality at the End of Life." Seattle Times (May 14, 2000).
Rauch, Sharon. "Living, Dying with Pain." Knight Ridder/Tribune News Service (February 20, 2002).
"Schiavo Denied Communion as Parents' Legal Battle Reaches Desperate Point." Detroit Free Press (March 27, 2005).
Shnayerson, Michael. "The Widow on the Hill." Vanity Fair (May, 2003): p. 122.
"2003 National Survey on Drug Use and Health (NSDUH)." Substance Abuse and Mental Health Services Administration (SAMHSA).http://www.drugabusestatistics.samhsa.gov (accessed July 30, 2005).
"Husband Seeks Autopsy on Terri Schiavo." CNN.com, March 29, 2005. http://www.cnn.com/2005/LAW/03/28/schiavo/ (accessed July 31, 2005).
"Morphine." U.S. Drug Enforcement Administration.http://www.usdoj.gov/ dea (accessed July 30, 2005).
OFFICIAL NAMES: Morphine sulfate or morphine hydrochloride (solutions for injection), Duramorph (for spinal use), MS Contin and Oramorph SR (long-acting, controlled release oral form), Kadian (oral, sustained release), MSIR (instant release), Roxanol (liquid concentrate)
STREET NAMES: M, morph, Miss Emma, monkey, white stuff
DRUG CLASSIFICATIONS: Schedule II, opiate
Morphine is the most active part of opium, a pure chemical isolated from the dried sap of the unripe poppy pod. Even today, morphine is still made from poppies. It is the prototype opiate, the parent from which all the others sprang. But efforts over the past two centuries to separate the beneficial aspects of opiates from their social drawbacks have failed. Even totally synthetic drugs that mimic morphine and the other opiates remain utterly linked to addiction.
At the turn of the nineteenth century, opium was an important part of medical practice. By the time that Frederick Serturner, a young clerk in a small German pharmacy, extracted morphine from opium, the world was already experienced in both medicinal and recreational opium use. Serturner's extraction was the first alkaloid ever isolated, and he named it after the Greek god of dreams, Morpheus.
Morphine's discovery became well-known after Serturner published his findings in 1817. In 1837, an Endinburgh chemist and physician, William Gregory, found a cheaper way to isolate and purify it. But not until the 1850s, with the introduction of the hypodermic needle, would morphine gain wider use.
The Civil War was a ready stage for the entry of morphine into common medical practice. Medics from the North and the South used morphine for the massive practice of amputation. With no delicate, germ-free surgical technique available, any serious wound to a limb called for its swift and horrendously painful removal.
The Union army obtained 29,828 oz (846 kg) of morphine sulfate. And when Confederates realized that a blockade of their ports could part them from sources of opium, they tried getting Southern women to cultivate and produce opium from garden-grown poppies. On both sides, discharged soldiers went home as addicts after the hostilities ceased.
In the years after the war, however, women abused morphine even more than man. The spread of patent medicines and the unregulated sale of hypodermics brought opiate use into the parlors of the upper classes. Fashionable women could buy and wear syringes pinned to their clothing, as they did watches or brooches. Surveys by public health officials in Michigan and Iowa recorded that by the 1880s about 75% of all drug addicts were women seeking to ease neuralgia (sharp, severe nerve pain), cramps, and morning sickness. Meanwhile, babies and toddlers were soothed with various nostrums, or "quack medicines," containing opiates, with alcohol as another major constituent. "Mrs. Lambert's Ladies Elixir" is an example: 23% alcohol with 40 mg of morphine in every bottle. Also, "Mrs. Winslow's Soothing Syrup," with 0.05 g of morphine per bottle. Even patent medicines to cure morphine dependence were sold; inevitably they contained alcohol or opium. Thomas Edison patented and marketed his own nostrum, "Poly-Form." It contained morphine, chloroform, ether, chloral hydrate, alcohol, and spices.
By the late 1800s, one in 25 Americans used large amounts of opiates. No laws limited their use. People simply went to the local druggist for morphine, no prescription required. Abuse was considered a vice or a weakness, not a crime. But doctors did begin to recognize and criticize their own profession's ability to create a lifelong servitude to the drug. Newspapers recorded morphine as an agent for suicides and deaths by accidental overdose.
At the turn of the century, the German chemical company Bayer was capitalizing on a previously unnoticed chemical improvement on morphine. In 1898, Bayer began aggressively marketing heroin as a cough cure for the rampant disease of the time, tuberculosis. Heroin, a derivative of morphine, crosses directly into the brain, where it is converted immediately back to morphine. Unbelievably, it was said to be non-addictive. Heroin was even proposed as a way to cure morphine addicts. This turns out to be a recurring theme in the story of narcotics: to hopeful physicians, a new version brought to market appeared to be free of abuse potential, until enough people used it to prove otherwise.
In medical practice today, morphine is regarded as the standard for pain relief by which all other drugs are measured. Still, doctors may be hesitant to use morphine. They must register with the federal Drug Enforcement Administration (DEA) to dispense the drug, and paper trails lead easily to doctors who prescribe it too freely. A current debate in medicine seeks to expand the medical use of the drug, and to change state laws to recognize the legitimate place for morphine in a physician's practice.
Morphine is an alkaloid, the chemical class to which many drugs belong. Pure morphine is a white powder, bitter to the taste. More than 1,000 tons of morphine are isolated from opium a year, although most of it is converted to codeine. Morphine comprises anywhere from 3% to 17%—usually about 10%—of the more than 20 alkaloids present in opium.
The many rings of the morphine molecule include a benzene ring that fits into the receptors for the brain's own opiates (the endorphins and enkephalins). The nerve cells studded with these receptors recognize the morphine molecule by the close fit of the benzene ring and the binding of a critical nitrogen atom. Many other opioids duplicate these molecular features.
In the 1970s, researchers were able to discover exactly how morphine works in the brain. When stimulated by tiny electric currents, certain nerve tracts within the core of the brain can produce a painkiller strong enough to allow abdominal surgery in lab rodents. The painkiller consists of simple amino acids that, in their naturally folded state, mimic the structure of the morphine molecule. They were named enkephalins, for "in the head," and endorphins, for "the morphine within."
Morphine is available by prescription in many forms. It can be taken orally as a liquid or as pills, and by injection under the skin, into the veins, or into the space surrounding the spinal cord. Rectal suppositories for pain control provide longer-lasting relief with less potential for nausea. As an abused drug, morphine can be smoked and sniffed as well as swallowed.
Morphine has a clear-cut place in medicine. For cancer, after surgeries, in childbirth, and even for chronic, daily headaches that resist all other treatments, morphine is effective in relieving symptoms. It is still the most widely prescribed drug for severe pain. Typical doses of morphine injected into muscle are 5–20 mg every four hours. Oral doses must be higher, between 8 and 20 mg.
Emergency use of morphine is by intravenous injection, avoiding any "first pass effect" (the "watering down" of drugs that occurs in the liver) or the time for passage through skin or muscle. This dosage is 4–10 mg, and the analgesia (pain relief) is nearly immediate.
Doctors may use morphine to ease childbirth. Women in early and middle labor can be given an opiate, including morphine, to be able to rest between contractions. However, giving an opioid too late into labor can make the baby sleepy on delivery. The baby may also not be able to breathe actively because morphine the morphine has slowed its respiration, but an opioid blocker, naloxone, can be given.
Patients recovering from surgery are able to control their pain by devices called patient-controlled analgesia (PCA). PCA works by way of a pump set up by a hospital technician. The pump is then operated by the patient, who presses a button to deliver doses on demand. Morphine is commonly given in these PCA devices. Pain after certain surgeries can be further lessened by injecting very low doses of morphine into the space around the spinal cord before surgery. This can reduce the severe pain after heart surgeries, for instance, which require the surgeon to separate the breast bone.
A survey of patients in hospices published in 1999 showed that none of the 55 patients receiving 300 or more milligrams of morphine a day for pain relief had difficulty breathing because of the drug. Survival times in hospice were not any different for those on these high morphine doses.
Morphine is infrequently found "on the street," yet it can get there by its widening use in legitimate medicine. Abuse also can appear in health professionals. Street use in combination with cocaine or methamphetamine has also been documented.
A study published in 2000 reviewed data obtained from 1990 to 1996 on the number of morphine prescriptions written, and the emergency room admissions related to its abuse. Doctors prescribed 59% more morphine in that time period. Yet the number of people seeking emergency aid for morphine abuse rose by just 3%. The study concluded that legitimate use by medical professionals attempting to help patients does not necessarily lead to increased use on the street.
In medical school, doctors learn to treat morphine with suspicion. Even when the use of the drug is clinically called for, they may be hesitant to prescribe it. Many experts on pain say that prescribing morphine for surgical recovery, or even for chronic pain, will not turn most people into drug addicts. While the medical use of morphine does indirectly increase the potential supply to the street addict, restricting its medical use harms people in pain.
A survey published in 2001 shows that primary care physicians would much rather prescribe Schedule III pain relievers—such as acetaminophen with codeine—for chronic pain not due to cancers. Thirty-five percent of the 161 doctors responding to the mailed survey stated they would never prescribe Schedule II opioids to be used around-the-clock by patients in persistent pain. Those who would be willing to give the Schedule II drugs were those who also indicated a lower degree of concern about
physical dependence, tolerance, and addiction. The survey researchers noted that few carefully designed studies have been carried out to test morphine and similar opioids in relieving chronic pain other than that from malignancies (cancerous tumors that grow uncontrollably). In addition, doctors are often scrutinized by state medical boards for prescribing Schedule II drugs.
A joint statement issued by 21 health oganizations and the Drug Enforcement Administration acknowledges the balancing act that medical use of morphine engenders. "Preventing drug abuse is an important societal goal," the statement says, but "it should not hinder patients' ability to receive the health care they need and deserve."
Scope and severity
In 1999, four million people in the United States were using prescription drugs outside medical use. Of these, 2.6 million were misusing pain relievers, according to the National Institute on Drug Abuse (NIDA). Doctors must be able to recognize the occasional patient who is seeking morphine to feed an addiction. Physicians must be wary of being manipulated. Allegations of overprescription of scheduled drugs is the leading reason physicians are investigated, as well as the leading reason for the suspenstion of a doctor's license.
Age, ethnic, and gender trends
Older people receive prescriptions at three times the rate of the rest of the population. But the National Household Survey on Drug Abuse recorded the sharpest increase in nonmedical use of prescription drugs in young adults and teens.
The sexes are known to react differently to opiates. In humans, women are more likely to misuse opiates. Research in animals shows that females require higher doses to relieve pain (the sex steroid hormones change the brain's organization early in life to create this difference). Female rats also appear to enjoy morphine more than males. The females continued to choose to receive the drug even at doses so high that their breathing was halted, doses that the males chose to avoid.
Morphine blocks the deep, aching perception of chronic pain, without interrupting the fast signals sent by an acute injury. As pain signals rise through the spinal cord to reach the brain, morphine interrupts them at a "relay station" within the core of the brain, called the thalamus. Morphine also blocks pain messages as they enter the spinal cord.
This interruption is not complete: the message of pain still reaches the brain. However, morphine blocks the emotions surrounding pain: people receiving the drug still know they are having pain, but it bothers them less.
Two views are offered to explain the action of morphine on pain. One says that the opiates work on all types of pain. The other says that opiates cannot work on a certain type of pain, called neuropathic, which is the pain created by damaged nerves themselves. When opiates do work in neuropathic pain, some experts say, it is only because the drugs improve the patient's mood. In the early 1990s, one research team found that half of pains judged as neuropathic did respond to morphine. The changes in mood reflected the relief of pain, the researchers noted, regardless of the type of pain.
Researchers say that the euphoria produced by morphine is due to its action on dopamine. Dopamine is a neurotransmitter—nerve messenger—in the brain that acts in those parts of the brain that register pleasure.
The other mental effects of morphine take place at the arousal centers of the brain, in the brainstem, to produce a sleepiness and relaxation. However, some patients experience restlessness instead of drowsiness, with increased limb movement rather than relaxation. Confusion and slurred speech almost always accompany morphine at higher doses. Meanwhile, the so-called "pinpoint pupils" of opiate overdose are created by morphine's action on the iris, resulting in blurred vision and impaired ability to see in the dark.
Acting in the brainstem, as well as in the respiratory centers of the brain, morphine slows respiration and suppresses the cough reflex.
In the gastrointestinal system, morphine slows the stomach and smooth muscle of the gut, causing constipation and loss of appetite. It slightly lowers body temperature, causing flushing and sweating. Morphine also causes sensations of itching or prickling of the skin, especially after intravenous use. Morphine can decrease libido and interfere with a woman's menstrual cycle.
Recent findings are leading researchers to try local applying opiates to joints affected by arthritis.
Harmful side effects
The slowed breathing caused by morphine is dangerous in those who already have trouble breathing. Indeed, the slowing of respiration is considered the most dangerous action of the opiate drugs. At high doses, the respiratory suppression caused by morphine and other potent opioids can lead, in extreme instances, to death.
Morphine's effects in the digestive tract can also be severe, especially for cancer patients already rendered nauseous by chemotherapy. Nausea and vomiting are commonly encountered at therapeutic doses of morphine (although there are medicines to counter this). Morphine may also cause constipation.
Long-term health effects
Morphine can be highly addictive. When an addict stops using, the signs of all opiate withdrawal include anxiety, restlessness, yawning, flu-like symptoms including muscle and bone pain, diarrhea, insomnia, vomiting, cold flashes, goose bumps, and involuntary movement of the legs. All aspects of withdrawal are physiologically opposite to the acute effects of the drug. It takes days or even weeks for the recovering addict to regain balance.
Steady or repeated use of morphine causes tolerance as well as withdrawal (also called physical dependence). More and more drug is needed to produce the same effect as the original dose. A tolerant morphine user can take massive doses that would kill a first timer. Compared to the therapeutic range of 5–20 mg, several hundred milligrams a day is not unusual in either cancer patients or street addicts. In extreme cases, four or five grams of morphine may be taken a day.
A newly discovered risk of opiate abuse relates to a role of endogenous opiates—opiates naturally produced by the body—as growth factors. External opiates like morphine will block such functioning, possibly harming a growing embryo as well as the mother's adaptation to pregnancy.
Endogenous opiates also help form new brains cells. Morphine abuse will interfere with this process, ultimately destroying the formation of new cells.
REACTIONS WITH OTHER DRUGS OR SUBSTANCES
The respiratory depression induced by morphine can add to that of alcohol, barbiturates, benzodiazepines (such as Valium), and even with antihistamines taken for allergies. Combined effects of these drugs with morphine can dangerously compromise breathing. Tricyclic antidepressants can hamper the metabolism of morphine.
TREATMENT AND REHABILITATION
Overdoses of morphine resulting in unconsciousness can be rapidly reversed with the opiate antagonist naloxone (Narcan). Given by intravenous injection, naloxone works in a minute or two by occupying the opiate receptors in the brain, without any action of its own other than to block morphine or other opioids. A dose of0.4–0.8 mg (to a maximum of 10 mg) is given every three to five minutes to revive an overdosed person.
Abruptly stopping the abuse of morphine will result in withdrawal. While not life threatening, as are withdrawal from alcohol or other depressants, going "cold turkey" is immensely unpleasant. The recovering addict may become suicidal from the suffering experienced.
Medical means of getting an addict off morphine allows withdrawal with less drastic symptoms. Methadone, legally administered through drug rehabilitation programs, can be substituted for morphine just as it is for heroin. A totally synthetic opioid, methadone lasts longer within the body than either morphine or heroin. Methadone closely mimics the basic opiate structure.
Methadone is given orally (different from the usual means of abuse), and thereby also substitutes for the paraphernalia that accompany illicit drug use. Methadone helps relieve the craving for more drug and delays the appearance of withdrawal symptoms as long as it is in the body. Doses are gradually decreased. If the dose of morphine that was abused is known, then 1 mg of methadone can substitute for 4 mg of morphine. Otherwise, a dose of 10–50 mg a day is generally used, and can be reduced by 20% per day.
Clonidine (Catapres) is another drug used to treat opiate addiction. It can relieve the anxiety, runny nose, salivation, sweating, abdominal cramps, and muscle aches of opiate withdrawal. Side effects are dry mouth, dizziness, and drowsiness. Clonidine is initially taken at0.8–1.2 mg a day, maintained for a few days, and then gradually decreased. Combined with the opiate blocker naltrexone, clonidine can allow a more rapid detoxification (the removal of morphine from the body). Detox in a single day can be accomplished by heavy sedation or anesthesia while giving naltrexone to an unconscious addict. This controversial method has not been studied in controlled trials.
Recovering addicts who fear a moment of weakness can strenghten themselves with the long-acting opioid antagonist naltrexone. Using naltrexone makes it impossible to get high from taking other opioids. But naltrexone must be taken before any other opioids are used, or withdrawal will occur. The usual dose of naltrexone is 25–50 mg orally, in the morning. Depression has been reported with its use, and it also raises toxin levels in the liver. Headache and nausea are encountered with naltrexone use.
LAAM, the abbreviation of levo alpha acetyl methadol, is another opiate blocker that has been used to wean addicts. It persists up to 72 hours.
Getting past withdrawal is only the first step in confronting morphine abuse. The psychological need for the drug must be addressed as well. Narcotics Anonymous and other programs are devoted to this challenge. A peer group that replaces the one that encouraged the addiction is a key feature of successful rehabilitation.
For those who are taking morphine to control pain, the same principle of tapering off the dose applies, with gradual lowering of the dosage over a period of a few weeks. However, short-term use of morphine for acute pain in a medical setting rarely requires weaning.
PERSONAL AND SOCIAL CONSEQUENCES
Because addicts are so intent on finding their next fix, they often neglect basic aspects of hygiene and nutrition. Infections and illness often result. Skin infections as well as more serious bloodborne infections follow use of unsterile needles. Deadly viruses are also shared through dirty needles. Babies born to addicted mothers usually go through withdrawal that their immature systems cannot handle. Finally, risk of arrest or of death by violence usually goes along with a lifestyle that includes illegal drugs. The death rate of those abusing narcotics is estimated to increase by 2% for each year spent abusing the drug, with abuse of ten years carrying a 20% risk of death by overdose or drug-related crime.
Under the Controlled Substances Act, morphine is a Schedule II drug. Doctors must be licensed by state medical authorities to prescribe it legally. They must also register with the Drug Enforcement Administration (DEA) and obtain a DEA number to use when writing the prescriptions. The DEA number helps keep track of how many prescriptions a doctor writes. Any trafficking in morphine—or any other Schedule II drug—results in federal penalties of up to 20 years. If death or serious injury results, the penalties for a first offense are 20 years to life and fines of up to $1 million. In 1988, the penalties were slightly changed: now those who are caught with only a small quantity of morphine face civil fines of up to $10,000.
Opium smoking in the United States spread with the immigration of Chinese workers in the western frontier—they built most of the train tracks, for instance—but it still was perfectly legal. In 1879, the Memphis, Tennessee public health agency targeted opium dens by making it illegal to sell, own, or borrow "opium or any deleterious drug" or the paraphernalia related to smoking them. Critics writing at the time pointed to the hypocrisy in denying the Chinese their accustomed comfort while white citizens could freely purchase morphine—indeed, could inhale, drink, or inject it. Not until 1909 did federal law outlaw smoking opium, and the agent itself.
Federal guidelines, regulations, and penalties
In 1914, the Harrison Narcotic Act outlawed heroin in the United States. The federal Controlled Substances Act of 1970 classified morphine as a Schedule II drug, which means it has potential for abuse but also accepted medical uses.
In 2000, Congress considered the Pain Relief Promotion Act, which would have amended the Controlled Substances Act to say that relieving pain or discomfort—within the context of professional medicine—is a legitimate use of controlled substances. The bill died in in the Senate. Sponsors of the bill plan to reintroduce it.
In the medical community, there is a growing awarness of the legitimate use of opiates to reduce pain. State medical boards are adopting new guidelines to reflect this, as well as to urge aggressive treatment for pain. These new guidelines allow physicians to document their reasons for using opiates.
Hodgson, Barbara. Opium: A Portrait of the Heavenly Doom. San Francisco: Chronicle Books, 1999.
Metzger, Thomas. The Birth of Heroin and the Demonization of the Dope Fiend. Port Townsend, WA: Loompanics Unlimited, 1998.
Giannini, A. James. "An Approach to Drug Abuse, Intoxication and Withdrawal." American Family Physician 61 (May 1, 2001): 2763-2774.
Gorman, Christine. "The Case for Morphine." Time online. 1997 (February 13, 2002). <www.time.com/time/magazine/1997/dom/970428/medicine.the_case_for.html>.
Kolata, Gina. "When Morphine Fails to Kill." The New York Times July 23, 1997.
Potter, Michael. "Opioids for Chronic Nonmalignant Pain." The Journal of Family Practice 50 (February 1, 2001): 145-151.
Lane, Laura. "Benefits from Opioids Outweigh Risks, Study Says." CNN.com health. April 4, 2000 (February 12, 2002). <http://www.cnn.com/2000/HEALTH/04/04/pain.killer.wmd/>.
Medina, James L. "Narcotic Abuse." eMedicine Online Consumer Journal. March 4, 2001 (February 13, 2002). <http://www.emedicine.com/aaem/topic321.htm>.
Pain & Policy Studies Group, 406 Science Drive, Suite 202, Madison, WI, USA, 53711-1068, (608) 263-7662, (608) 263-0259, [email protected], <hhttp://www.medsch.wisc.edu/painpolicy/about.htm>.
Roberta L. Friedman, Ph.D.
Morphine, C17H19NO3 • H2O, is a narcotic analgesic drug used primarily in medicine for its pain killing properties. Morphine was isolated from opium in 1805 and named for Morpheus, the Greek god of sleep, by German chemist and pharmacist Friedrich W. Sertürner (1783–1841).
In 1805, opium was widely used for its euphoric effects. Sertürner decided to investigate the components of poppy juice, from which opium is derived. He found an unknown acid, converted it into a crystalline precipitate, and named it principium somniferum. Having determined that this substance was the active ingredient in opium, in 1809, Sertürner recommended the cultivation of the poppy on a large scale as a way to further the national economy since morphine was used in the production of the popular drug and poppy seed oil. In 1815, Sertürner and three young volunteers each took three 30-milligram doses of principium somniferum over a period of 45 minutes. They did not resume their normal functions until several days later!
In 1817, Sertürner published a paper describing the drug, in which he changed its name to morphium. The same year, the name was changed to morphine by the French chemist Joseph Gay-Lussac (1778–1850). During the 1800s, French physiologist François Magendie (1783–1855) advanced the use of morphine in medicine, administering it both orally and by injection.
Morphine’s popularity on the U.S. Civil War battlefields (1861–1865) boosted its general use in the treatment of many kinds of discomfort. In fact, a leading British doctor during this era called morphine “God’s own medicine.” However, at war’s end, over 400,000 soldiers were addicted to morphine, at that time called the Army disease. Thousands of more people worldwide were also tragically addicted to morphine during this same time. Many chronicles of addiction have been written, including Eugene O’Neill’s (1888–1953) semi-autobiographical play Long Day’s Journey Into Night.
Morphine, also called morphia, is the principle and most active alkaloid obtained from the unripe seed capsules of the opium poppy, Papaver somniferum. There is evidence that morphine was ingested, in the form of opium, thousands of years BC. Morphine can be synthesized in a laboratory but because it is difficult to do so, the medical industry relies on countries that produce opium such as India and Turkey for their morphine supply. The drug occurs as a white crystalline powder or colorless crystals and is available for legal medical use. Morphine and synthetically made morphinelike drugs are most often given to people who have pain caused by physical trauma, or those who have intense pain caused by diseases such as cancer.
Morphine, a bitter tasting, pain-relieving, habit-forming alkaloid drug, has similar painkilling properties to endorphins and enkephalins, a group of amino acid compounds produced in the pituitary gland. The molecular structure of morphine is so much like that of endorphins that it is able to bind to and occupy specialized receptor sites located in various pain centers in the central nervous system. Morphine also alters the release of neurotransmitters. The perception of pain is thus changed and the emotional reaction to pain (fear of, or anticipation of pain) is also affected. Morphine also affects the bowel and causes constipation. One’s pain threshold is elevated by morphine’s ability to induce an extreme state of relaxation. Other effects of morphine include drowsiness, slowing of respiration, cough suppression, changes in the endocrine and autonomic nervous systems, nausea, and vomiting. The most serious side effect of morphine, as with other drugs derived from opium, is its addictiveness. For this reason, scientists have strived to synthesize drugs that mimic the painkilling attributes of morphine but do not have the same addictive properties. Two semi-synthetic drugs that can be made from morphine are codeine, which is used for pain relief and cough suppression, and diacetylmorphine or heroin, an extremely potent and addictive drug.
Developed by the Bayer Company of Germany in 1898, heroin is obtained by treating morphine with acetic anhydride. Heroin, which is four to eight times as potent as morphine, was originally used as a cough suppressant and narcotic analgesic. However, it proved to be even more addictive and have worse side effects than morphine and codeine. Although heroin is converted into morphine in the body, it acts on the brain faster than morphine. Heroin has greater lipid solubility and is able to cross the blood-brain barrier more easily.
In 1906, the Pure Food and Drug Act required that the use of morphine be labeled onto patent medicines and tonics. Later, other laws were enacted that restricted the importation of morphine. By 1914, the Harrison Narcotics Act prohibited the possession of morphine and other narcotics unless prescribed by a medical physician. In the United States, heroin was sold over-the-counter as a cough suppressant until 1917. Because of its exceptional pain killing properties, heroin abuse has been a problem since it was discovered; however, addiction to heroin was not prevalent until after World War II (1941–1945). Today, the use and trafficking of heroin are a major problem throughout the world. Recent medical studies show that morphine is produced naturally in very small amounts within the brain. Today, morphine is used most often for short-term, post-operative pain control, while methadone is used to treat opiate addiction and for long-term pain control.
Brunton, Laurence L., et al., eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill, 2006.
Illinois Department of Human Services. Facts You Should Know About Opiates. Springfield, IL: Illinois Department of Human Services, 2004.
Formed: 1990, Cambridge, Massachusetts; Disbanded 1999
Members: Mark Sandman, lead vocals, 2-string bass guitar, keyboards (born 24 September 1952; died 3 July 1999); Dana Colley, baritone and tenor saxophones (born 17 October 1961); Billy Conway, drums (born 18 December 1956). Former member: Jerome Dupree, drums (born 9 November 1956).
Best-selling album since 1990: Cure for Pain (1993)
In an era ruled by guitar-driven grunge rock, Morphine was a band without a guitarist. The trio's minimalist sound and guttural grooves evoked midnight passion, foreboding scenarios, and abstract dreams. Its sensual, bluesy music was often compared to the nightmarish qualities of the experimental films of David Lynch, or the crime fiction of Jim Thompson. College airplay and positive press made the group one of the 1990s' best-respected cult bands.
Morphine emerged out of Treat Her Right, a conventional blues group headed by bassist and vocalist Mark Sandman. Saxophonist Dana Colley lived near Sandman and the two began to experiment together, creating what would become their signature sound. Sandman's deadpan voice sat in the same low octaves as Colley's baritone saxophone, and together they worked to supplant a lead guitar line. Surprised to discover such a minimal approach led to wider possibilities, they enlisted area drummer Jerome Dupree to complete the trio. In 1991 Morphine released its debut album Good on the independent label Accurate/Distortion. Rykodisc Records re-released Good the next year and Morphine received its first batch of solid reviews and college airplay across the country. Good was named Independent Album of the Year at the 1992 Boston Music Awards. Soon after, Dupree was replaced by Treat Her Right drummer Billy Conway.
Morphine's second album, Cure for Pain (1993), pushed the band into the mainstream and a word-of-mouth campaign that led to international tours, national press, and shows booked on large outdoor festival stages and lengthy residencies in small clubs.
Much of the fascination with Morphine revolved around its distinctive sound without a guitar, the signature instrument in rock. Morphine looked more like a jazz combo. "[Guitars] don't really matter," Conway told the Chicago Daily Herald in 1997. "Jerry Lee Lewis played piano and he rocked and Little Richard rocked. There's no law I know of that rock and roll has to have a guitar. I think the [rock] attitude is hopefully reflected in [the playing style] and hopefully we deliver the song in the proper package."
In 1996 Morphine jumped to Dream Works, a major label, and the following year the group released its fourth album Like Swimming. By that point Sandman's lyrics had grown darker, with images appearing to have been transcribed from dreams. "I swam out as far as I could swim 'til I was too tired to swim anymore and then tried to get my strength back," Sandman sings on the song "Empty Box." Despite a push from Dream Works, the album failed to bring Morphine big commercial success. On July 3, 1999, while on tour in Rome to promote the album, Sandman died onstage of a heart attack.
Morphine left a deep vault. In 2000 the posthumous album The Night was released, followed by the live album Bootleg: Detroit. In early 2003 Rykodisc released a best-of collection that included unreleased material. Conway and Colley toured as Orchestra Morphine in 2000 to say goodbye to fans. In 2002 they debuted as Twinemen, a new trio featuring singer Laurie Sargent.
Morphine's unusual sound and Sandman's wry, sobering vocals distinguished the band from its peers. Its albums tried to redefine the essential elements of rock.
Good (Rykodisc, 1992); Cure for Pain (Rykodisc, 1993); Yes (Rykodisc, 1995); B-Sides and Otherwise (Rykodisc, 1997); Like Swimming (Dream Works, 1997); The Night (Dream-Works, 2000); Bootleg: Detroit (Rykodisc, 2000); The Best of Morphine 1992–1995 (Rykodisc, 2003).
Morphine, C17H19NO3 • H2O, is a narcotic analgesic drug used primarily in medicine for its pain killing properties. Morphine was isolated from opium in 1805 and named for Morpheus, the Greek god of sleep , by the German chemist and pharmacist Friedrich W. Sertürner (1783-1841). Morphine is the principle and most active alkaloid obtained from the unripe seed capsules of the opium poppy, Papaver somniferum. There is evidence that morphine was ingested, in the form of opium, thousands of years b.c. Morphine can be synthesized in a laboratory but because it is difficult to do so, the medical industry relies on countries that produce opium such as India and Turkey for their morphine supply. The drug occurs as a white crystalline powder or colorless crystals and is available for legal medical use. Morphine and synthetically made morphine-like drugs are most often given to people who have pain caused by physical trauma, or those who have intense pain caused by diseases such as cancer .
Morphine has similar painkilling properties to endorphins and enkephalins, a group of amino acid compounds produced in the pituitary gland. The molecular structure of morphine is so much like that of endorphins that it is able to bind to and occupy specialized receptor sites located in various pain centers in the central nervous system . Morphine also alters the release of neurotransmitters. The perception of pain is thus changed and the emotional reaction to pain (fear of, or anticipation of pain) is also affected. Morphine also affects the bowel and causes constipation. One's pain threshold is elevated by morphine's ability to induce an extreme state of relaxation. Other effects of morphine include drowsiness, slowing of respiration , cough suppression, changes in the endocrine and autonomic nervous systems, nausea, and vomiting. The most serious side effect of morphine, as with other drugs derived from opium, is its addictiveness. For this reason, scientists have strived to synthesize drugs that mimic the painkilling attributes of morphine but do not have the same addictive properties. Two semi-synthetic drugs that can be made from morphine are codeine , which is used for pain relief and cough suppression, and diacetylmorphine or heroin, an extremely potent and addictive drug.
Developed by the Bayer Company of Germany in 1898, heroin is obtained by treating morphine with acetic anhydride. Heroin, which is four to eight times as potent as morphine, was originally used as a cough suppressant and narcotic analgesic but proved to be even more addictive and have worse side effects than morphine and codeine. Although heroin is converted into morphine in the body, it acts on the brain faster than morphine. Heroin has greater lipid solubility and is able to cross the blood-brain barrier more easily. In the United States, heroin was sold over-the-counter as a cough suppressant until 1917. Because of its exceptional pain killing properties, heroin abuse has been a problem since it was discovered; however, addiction to heroin was not prevalent until after World War II. Today, the use and trafficking of heroin are a major problem throughout the world.
Goodman and Gilman. The Pharmacological Basis of Therapeutics. 6th ed. New York: Macmillan, 1980.
Morphine is a major component of opium, a product of the poppy plant. Named after Morpheus, the Greek god of sleep, morphine is a powerful analgesic (painkiller). Doctors frequently prescribe it to relieve moderate to severe pain, especially in cancer patients. In the 1800s morphine was available in stores to anyone who wanted to buy it. At that time, little was known about physical dependence, and many people became addicted to morphine. Today, morphine is considered a controlled substance and is regulated by law. Because doctors know more about physical dependence, few patients become addicted to it.
Morphine produces a wide variety of actions, some desired and others not. The definition of a desired action and a side effect depends on the reason for using the drug. For example, opiates such as morphine can be used to treat diarrhea. However, a person taking morphine for pain would find constipation an undesirable side effect.
Constriction (narrowing) of the pupils of the eyes is one of the most widely recognized signs of opiate use. In addition, morphine produces sedation . At higher doses, morphine depresses respiration, meaning that the patient loses the ability to breathe automatically. Very high doses of morphine stop a person's breathing entirely—a common occurrence in overdoses. Another common side effect of morphine use is nausea.
Morphine is given either by mouth or by injection. Injection has much more potent or powerful effects. Physicians who are experts in the treatment of pain increasingly give morphine through continuous infusion. In order to avoid uneven treatment of pain (total relief when the drug is at its peak in the body; continued pain as the medication wears off), the morphine is diluted and given with fluid directly into the veins, at a very slow but steady rate. This keeps the concentration of morphine in the body at a steady state, so that the patient does not have periods of relief alternating with periods of pain. Another method of administering morphine involves a pump that allows the patient to push a button, releasing a tiny dose of morphine. The pump is set up to allow a specific dose of morphine at a specific time interval (sometimes as frequently as every five minutes). Some studies have shown that these patient- controlled analgesia (PCA) pumps are very effective at keeping a patient's pain to a minimum.
With chronic use, the effect of morphine lessens. In other words, a person develops tolerance to the drug's effects. To maintain the effect the person received originally, it is necessary to increase the dose. When a person becomes physically dependent on morphine or other opiates, stopping the drug will bring on the withdrawal syndrome. Early symptoms of withdrawal include restlessness, tearing eyes, runny nose, yawning, and sweating. Eventually, further symptoms include dilated pupils, sneezing, elevations in heart rate and blood pressure, cramping, and gooseflesh. (The expression "cold turkey" comes from the look of the skin during withdrawal.)
Morphine is the most effective naturally-occurring compound used to relieve pain. It also induces sleep and produces euphoria (a feeling of well-being). Morphine is an opiate (derived from opium) and is named for Morpheus, the Greek god of dreams.
Morphine's Advantages and Disadvantages
Morphine is a narcotic (it dulls the senses). It acts on the central nervous system to allow a person to tolerate more pain than would otherwise be possible. Morphine produces a calming effect which protects the body in traumatic shock. Its greatest disadvantage is its addictiveness.
In 1898 the Bayer corporation synthesized methadone from morphine and marketed it as an antidote to morphine addiction. Methadone is a synthetic (artificial) drug that is less addictive than morphine. Today, methadone is often used in place of morphine as a pain killer. It is also used for the treatment of morphine and heroin addictions.