Morphine: Can It Be Addictive?
According to the book Addiction and Opiates, morphine is one of many drugs belonging to the opiate drug class (also referred to as the narcotic drug class). All of the opiate drugs are developed from substances found in the Asian poppy plant or synthetic substances that are similar to substances derived from opium. These substances are very effective at controlling an individual’s subjective experience of pain.
Their chemical structure is similar to the chemical structure of neurotransmitters that are involved in pain control, stress control, hormone release, regulation of breathing, and other functions like coughing. These neurotransmitters are often collectively referred to as endorphins and enkephalins. Because the chemical structure of the opiate drugs is similar to these endogenous substances, they have a readymade ability to attach to the specific neurons in the brain that are associated with these neurotransmitters. This makes them even more efficient in their medicinal uses.
An associated effect of the use of opiate drugs is their ability to affect numerous neurotransmitters, including serotonin and dopamine, which are involved in many different functions, including the experience of reinforcement or reward for repeating a particular behavior. Such associated functions contribute to the abuse potential of narcotic medications.
What Is Addiction?
The term addiction is used in a number of different contexts that are often inconsistent with one another. It is for this reason that many professional texts such as the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) published by the American Psychiatric Association (APA) has for many years avoided the use of the term in its diagnostic criteria. Instead, the diagnostic category for individuals who have issues with substance abuse is now labeled a substance use disorder, which allows for the inclusion of the misuse and abuse of, and dependence on, different types of drugs and/or alcohol. The term addiction is no longer used as a formal diagnostic category; however, it is still used as a descriptive term by professional and lay sources.
When professional mental health workers who are trained in issues with substance abuse use the term addiction, they are referring to a dysfunctional use of some type of drug, or they are referring to some type of dysfunctional compulsive behavior (e.g., compulsive gambling). Based on the clinical use of the term, addiction refers to the nonmedicinal use of drugs or the abuse of alcohol, whereas many laypersons refer to addiction as the development of physical dependence. These two terms need to be separated in order to avoid any potential confusion regarding what is meant when discussing issues with substance abuse.
Physical dependence refers to the development of the syndromes of both tolerance and withdrawal. Tolerance occurs when an individual needs to increase the amount of a drug or other substance in order to achieve the effects that were once achieved at lower amounts. Withdrawal symptoms occur after an individual has developed tolerance to some substance and then develops numerous physical, cognitive, and emotional symptoms when they stop using the substance or cuts down on the dosage they had been using. Addiction refers to the nonmedicinal misuse or abuse of drugs or alcohol despite the development of either of the symptoms associated with physical dependence. Individuals who legally use narcotic medications for pain control and continue to use them according to their prescribed purposes and under the supervision of a physician would not be described as having an “addiction” even if they have developed physical dependence on the drug.
According to data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), the overwhelming majority of people who have prescriptions for various medications, including narcotic medications, do not abuse them and would not be formally diagnosed as having a substance use disorder (an addiction). However, there is a relationship between the number of prescriptions written for a specific medication and its abuse. This is because the more readily a drug is available to individuals who are prone to abusing it, the more likely it is to be abused. In addition, many individuals who abuse narcotic drugs get them from friends who have prescriptions for them or purchase them illicitly from others with prescriptions or other individuals who get the drug illegally.
Is Morphine Addictive?
According to the above designations of addiction and physical dependence, morphine is both addictive and likely to produce physical dependence in individuals who use the drug for more than a few weeks.
Some of the information that supports these notions is outlined below:
- APA lists both the development of tolerance and the development of withdrawal symptoms as diagnostic criteria for individuals who have an opiate use disorder. Individuals who abuse morphine and suffer significant impairment and/or dysfunction would be diagnosed with this disorder.
- APA also lists criteria for opiate withdrawal.
- The United States Drug Enforcement Administration (DEA) classifies morphine as a Schedule II controlled substance, indicating that even while it does have significant medicinal utility, it is a drug that is extremely prone to being abused and can result in the development of significant physical dependence in individuals who use or abuse it. This classification is the most stringent classification of the controlled substances that can be acquired legally with a prescription. Any of the drugs in the next highest classification (Schedule I), such as heroin, cannot be legally acquired except with special permissions from the government, most often for research purposes. One exception to this rule is the classification of marijuana and other cannabis products, which remain classified as Schedule I controlled substances by the federal government, whereas many states have legalized their use for medicinal purposes and even for recreational purposes.
- The American Association of Addiction Medicine (ASAM) lists formal protocols for withdrawal management from opiate drugs, including morphine.
- The most current data available from SAMHSA indicates that it is estimated that 12.5 million individuals abused narcotic medications in 2015. This estimate includes approximately 697,000 individuals who reported abusing morphine products.
The majority of narcotic drugs that are substances of abuse are familiar drugs like Vicodin, OxyContin, Norco, etc. MS Contin is a drug in this category that contains morphine. Drugs containing morphine are not prescribed as often as other narcotic drugs, and this makes them less available on the street. Morphine is more commonly used in clinical settings, whereas many of the other prescription narcotics are more commonly prescribed by physicians and more readily available.
Thus, based on the above data, it is clear that morphine is both a drug that has a significant potential for the development of a substance use disorder (an addiction) and is likely to produce physical dependence in individuals who use it for more than a few weeks.
Signs of Morphine Abuse
The development of an opiate use disorder as a result of morphine abuse represents the development of a severe mental health disorder that leads to numerous issues with functioning, the development of significant distress, and potential physical and emotional damage.
According to APA, SAMHSA, and ASAM, the signs of morphine abuse can include:
- Using the drug in a manner that is inconsistent or contrary to its prescribed use (e.g., grinding pills and injecting or snorting the powder, combining morphine with other drugs or alcohol, using the drug more often or in greater amounts than its prescribed use, and using the drug for it psychoactive effects)
- Getting the drug illegally
- Using the drug in a manner that is contrary to its prescribed intent (e.g., using it more often than prescribed, using it in greater amounts than prescribed, etc.)
- Developing dysfunction or impairment as a result of morphine use that can include:
- Issues at work
- Problems in important relationships
- Issues at school
- Financial troubles due to attempting to purchase the drug
- Legal issues associated with morphine use or abuse
- Significant physical problems due to morphine abuse
- Significant psychological or emotional problems due to morphine abuse
- Developing an inability to control use of morphine that can include:
- Spending significant amounts of time trying to get the drug, using the drug, or recovering from its use
- Frequently using more of the drug than originally intended
- Experiencing frequent cravings for the drug
- Using the drug in situations where it is dangerous to do so
- Stating a desire to stop or cut down on use but being unable to do so
- Neglecting important obligations due to morphine use
- Realizing that one’s use of the drug is causing issues with physical health and/or emotional functioning but continuing use
- Frequently using the drug as a means to cope with normal life stressors and to escape
People who are using the drug under the supervision of a physician and have developed physical dependence on the drug may become concerned that they have developed “an addiction” to morphine. If a person needs a medicine for pain control or for some other reason and continues to use it as prescribed by their physician, they are not “addicted” to the drug even if they have developed physical dependence on it. Anyone who is using morphine under the supervision of their physician and wishes to discontinue its use should discuss this with their physician. The drug can be discontinued in a relatively safe manner while the individual is under the supervision of their prescribing doctor. Any person using morphine without a prescription or using it in a manner inconsistent with its prescribed purposes should consult with a licensed mental health physician regarding this practice.
Controls and Treatment Options
According to SAMHSA and ASAM, there are numerous controls that have been put into place to reduce the abuse of prescription medications. Physicians who prescribe opiate drugs are monitored by the government and must meet certain qualifications in order to be able to prescribe them. In addition, physicians should be trained in risk assessment techniques to ascertain potential abuse of these drugs.
Treatment for physical dependence on opiate drugs incorporates a physician-assisted withdrawal management program that involves the administration of an opiate replacement medication (e.g., methadone, buprenorphine, or Suboxone) on a tapering program, such that the patient is given initial doses to control any potential withdrawal effects and then slowly weaned off the medication over time. When this program is professionally administered, individuals will suffer few withdrawal effects. Other medications can also be used to control specific symptoms that may still be present even while the person is undergoing a formal withdrawal management program
For individuals who have opiate use disorders, the initial stages of treatment often also involve the use of a physician-assisted withdrawal management program. Prior to developing a treatment plan, the person should be thoroughly assessed for any co-occurring mental health, medical, or social conditions that could contribute to their potential for relapse. Once the individual has enrolled in a formal treatment program, these co-occurring conditions should also be addressed along with withdrawal management and formal substance use disorder treatment.