Morphine is a drug that is used primarily to provide people with pain-relief. It is derived from the opium plant via chemical extraction. It was initially discovered in 1804 and was officially distributed in 1817. When utilized for intended purposes, it is regarded as one of the World Health Organization’s most “Essential Medicines.” Morphine is regarded as being among the most potent analgesics to treat severe pain.
Similar to other opioid drugs such as heroin and oxycodone, it acts directly on the central nervous system to provide pain relief. Although it is a drug that helps many individuals cope with severe physical pain, it is also associated with rapid psychological tolerance and dependence. It also has a high potential for addiction and abuse, which is why it is considered a “Schedule II” controlled substance in the United States.
In addition to taking morphine to help manage severe pain, some people take it on an illicit basis to “get high.” These individuals become addicted to the initial mood boosting properties as well as the anxiolytic effects that the drug typically provides. Regardless of reasons for taking this drug, once tolerance is established and a person becomes addicted and/or dependent on it for daily functioning, withdrawal symptoms can be very difficult to cope with.
Factors that influence Morphine withdrawal
Many factors play a role in determining the severity and duration of morphine withdrawal symptoms. These factors include things like: time span over which the drug was taken, dosage, level of tolerance, whether a person is addicted, how quickly a person tapers their dosage, as well as other individual factors such as physiology, social support, etc.
1. Time Span
How long were you taking morphine? Those who are on it for a relatively short duration shouldn’t experience the most extreme withdrawal symptoms. In general, the less time you’ve taken this drug, the lower your tolerance should be.
Those who have used this drug consistently everyday for years will likely have a much more difficult time getting through withdrawal compared to someone who was only on it for a couple months. Time span nearly always influences withdrawal because the longer you’ve been on it, the more your body becomes reliant on the drug’s effects for functioning.
2. Dosage + Tolerance
What dosage of morphine were you taking? Morphine is able to be taken orally via extended-release capsules. Morphine sulfate or MS Contin is prescribed for individuals that require prolonged opioid therapy. In the form of “Avinza” capsules, the maximum daily dose is 1600 mg. In the form of Kadian capsules, a person may take between 100 mg and 200 mg up to 2 times per day.
Other common methods of dosing include subcutaneous and intravenous. Subcutaneous dosing is typically within the range of 2.5 mg to 20 mg every few hours. Intravenous dosing is usually given slowly over an approximate 5 minute window with dose up to 15 mg every 4 hours. If you are at the higher end of the dosing spectrum for whichever type of morphine you use, it is thought that withdrawal symptoms will be more severe.
In people that have built up a significant tolerance to morphine, withdrawal is usually more difficult and longer lasting. An increased tolerance means a person’s nervous system has become accustomed to receiving higher dosages of the drug in order to function. When the drug is discontinued, it can take a significant period of time for the nervous system to make repairs and recover to sober functioning.
Are you addicted to the effects of morphine? Many people who take this drug become initially addicted to the mood-enhancing effect it has on them. In addition to providing pain relief, the drug can be very relaxing and a way for many to find relief from stress. People taking this drug to “get high” and cope with daily life stressors are going to have a much more difficult time dealing with withdrawal than those using it for its intended purpose: to treat pain.
Regardless of why a person is addicted to morphine, being addicted can make withdrawal significantly more difficult. If a person is addicted, they may be afraid to face the inevitable drop in mood that they will experience when coming off of the drug. Additionally those who had taken it for pain may not want to face the reemergence of pain that they could experience during withdrawal. Those who are addicted may need to work with a psychotherapist and/or a psychiatrist to successfully withdraw from morphine.
4. Cold Turkey vs. Tapering
How did you withdraw from morphine? Did you quit “cold turkey” or did you conduct a gradual taper? It is typically recommended to conduct a gradual taper off of any powerful opioid drug like morphine. By conducting a gradual taper, you are giving your nervous system some time to adjust itself to receiving less of the drug. If you quit cold turkey, it is thought that both acute and protracted withdrawal symptoms will be more severe.
For those with limited supply of their morphine, you may want to contact your doctor about tapering. Cold turkey withdrawal is possible, but some of the symptoms that you could experience (depending on your tolerance) may be dangerous and/or extremely debilitating. If you must quit cold turkey, brace yourself for a week of feeling sick. People have toughed out cold-turkey withdrawals, but they are considered the most difficult.
Another option you have if unable to taper is that of opioid replacement therapy. This involves transitioning to taking a less-powerful drug such as suboxone or methadone instead of your morphine. After you have successfully transitioned to a less potent opioid, the goal is to gradually reduce your dosage under doctor supervision. For many people, this is the easiest way to withdraw from their morphine.
5. Individual Factors
It is important to take into account other individual factors that play a role in withdrawal. Although many people can have similar withdrawal symptoms, some people have significantly more difficult withdrawals than others. Many things such as time span and dosage play important roles, but things like environment, habits, whether a person is on other drugs, individual physiology, and social support can also have an influence on recovery.
- Environment: Your environment can have a major influence on your withdrawal. Those who live in supportive environments may have an easier time dealing with the anxiety and depression during withdrawal. Individuals in high-stress environments may feel overwhelmed trying to cope with withdrawal and may feel as though they have no support.
- Habits: What are your daily habits? People who eat healthy, get adequate sleep, and light exercise are thought to recover at a quicker rate than those who don’t. Healthy habits are thought to allow the nervous system to heal more quickly.
- Other drugs: Are you taking any other medications or drugs? Those who take other drugs, whether illicit or prescribed may be influencing the withdrawal. Certain drugs can take the edge off of extreme symptoms and help people manage what they’re going through.
- Physiology: In many cases individual physiology plays a role in determining how quickly someone recovers. Those who are highly sensitive to medications and drug withdrawals may have a more difficult time coping with symptoms. Everyone’s nervous system responds differently.
- Social support: Having some sort of social support can go a long way during a withdrawal. Those who have an understanding family and/or close friends to talk with may have an easier time dealing with their experience. A psychotherapist may provide additional positive support to help someone during withdrawal.
Morphine Withdrawal Symptoms: List of Possibilities
Below are a list of possible symptoms that a person may experience when they withdraw from morphine. Keep in mind that you may not exhibit every last symptom on the list and that symptoms may vary in both intensity and duration based on the individual. This is a general list of what you may deal with so that you know A) You are in fact dealing with withdrawal, and B) It’s not all in your head.
- Abdominal cramps: One of the most common symptoms that people experience upon discontinuation is that of abdominal cramping. You may notice cramps in other areas besides your abdominal region, but this tends to be most pronounced.
- Anger: During withdrawal, it is very common to experience changes in mood. Many people end up having to deal with an array of psychological symptoms, including anger. The anger may be difficult to control, so if you find yourself feeling grumpy, chalk it up to withdrawal.
- Anxiety: Another very common psychological symptom is that of anxiety. The anxiety may range from being relatively mild to very extreme. Opioids like morphine tend to reduce anxiety, and when discontinued, anxiety can really flare up. Many people find medications like clonidine helpful to cope with it.
- Appetite changes: You may notice that you have completely lost your appetite upon quitting morphine. Usually within a day or two of your last dose, appetite loss is thought to be at its peak. It may take awhile for your appetite to fully recover, so do your best to continue eating healthy foods.
- Concentration problems: When dealing with an array of psychological and physical withdrawal symptoms, most people aren’t going to be able to concentrate. You may notice “brain fog” or an inability to think clearly in addition to a general confusion.
- Confusion: Most people feel confused about how they are feeling and aren’t able to think clearly. Moods are in fluctuation and concentration is poor, which results in confusion. Realize that your normal cognition will eventually return.
- Cravings: This is a drug with a very short half-life, which can make cravings very intense during withdrawal. Initially a person will crave the drug immediately when they quit. The longer a person remains sober, the more cravings are reduced.
- Crying spells: It’s common to cry as a result of hopelessness and depression that a person may face when they withdraw. However, it’s also common to cry as a result of “watery eyes” which is very common when coming off of an opiate.
- Depersonalization: Do you feel unlike your normal self? During withdrawal, some have described their feeling as a “trance-like” state. Some people have mood swings, depression, and feel as if they will never feel “normal” again. This is a combination of nervous system changes, anxiety, and brain function. With enough time, you will experience a full recovery.
- Depression: The depression that most people experience when they quit morphine is mild to moderate. In some cases, the depression may become severe, but most people notice mood improvements within 10 days of withdrawal. Although it may take significantly longer than 10 days to recover from the depression, you will eventually bounce back to normal mood.
- Diarrhea: The use of morphine tends to result in constipation. When you stop taking it, the exact opposite occurs and people experience diarrhea. If you are having trouble coping with this symptom, consider purchasing some over-the-counter Imodium.
- Dizziness: When withdrawing from morphine, it’s very common to feel dizzy. You may feel dizziness throughout the day and/or vertigo. The dizziness is generally more intense for those who quit their medication “cold turkey.”
- Fatigue: The degree of fatigue and lethargy may be severe. You may find yourself unable to get out of bed in the morning. You may also notice that performing one simple task such as: cooking breakfast, taking the dog for a walk, or doing the dishes – seems impossible. Your energy levels will continue to return the longer you are off of the drug.
- Flu-like symptoms: Many people have reported their withdrawal experience as being “flu-like.” They experience things such as: nausea, vomiting, dizziness, headaches, chills, and aches. The bulk of these flu-like symptoms tend to improve after the first week of withdrawal.
- Goosebumps: Another thing some people notice when they stop opiates is that they have goose bumps. These are uncontrollable sensations that occur across the skin as a result of nervous system readjustment.
- Headaches: Morphine can reduce and/or eliminate headaches while a person takes it. However, when they stop taking the medication, a person may notice that they experience headaches. These may range from being mild to full blown migraines. Like other symptoms, these will improve with time.
- High blood pressure: This drug has a depressant effect on the nervous system, meaning activity slows such as heart rate and blood pressure. When a person quits, they may experience a spike in blood pressure. If you think this may be a problem, talk to your doctor and monitor changes closely.
- Hormone imbalance: Not all cases of hormonal imbalance are due to opiate usage, but if you were on morphine for a lengthy period of time, it’s likely a contributing factor. During withdrawal your hormones may be imbalanced. Keep in mind that hormonal functioning will eventually normalize if you remain sober.
- Hot flashes: You may notice that you experience “hot flashes” or “cold flashes” as you come off of this drug. These may be uncomfortable and unexpected, but are one of many reactions people have during discontinuation.
- Insomnia: Some individuals may have no problem falling asleep at night, while others may be plagued with extreme insomnia. In many cases, this insomnia can be fueled by restlessness and anxiety. In order to best cope with this symptom, consider a melatonin supplement and/or relaxation exercises before bed to lower your arousal.
- Irritability: Do not be surprised if you become irritable during withdrawal. Many of the symptoms can result in increased stress, which can make even the most calm people have a short fuse. If you feel irritable and as though everyone is getting on your nerves, take a step back and realize that it’s partly due to withdrawal – this will go away.
- Itchiness: Withdrawal from morphine can result in itchiness and/or itch sensations across the skin. Some individuals end up thinking that this is a rash, when it’s really itching that’s caused by withdrawal. Conducting a slow taper may reduce this symptom, but not in all cases. The itching may be very uncomfortable, but will subside.
- Mood swings: Don’t be surprised if you notice that your moods are negative and that they constantly change. For example, one minute you may have bad anxiety, the next you may feel hopeless and depressed. Another minute you may have a glimmer of hope that your situation is going to improve. These are difficult to deal with, but eventually your mood will normalize.
- Muscle aches: While coming off of morphine, you may notice that your muscles ache. Some people report joint pain as well. Part of this pain has to do with your body’s natural endorphin levels being abnormally low as a result of morphine use. As your body readjusts and endorphin levels are reestablished, aches and pains should diminish.
- Nausea: The nausea some people experience during the first week of withdrawal is extreme. In fact, in many cases extreme nausea is so intense that it leads to vomiting. Some nausea may be an unavoidable part of withdrawal, but it will get better.
- Panic attacks: If your anxiety become severe, you could have a panic attack. A panic attack is a sensation of severe anxiety that is usually triggered by an event or stimulus. If you begin having panic attacks, do your best to learn some relaxation techniques to lower your level of arousal.
- Pupil dilation: Since taking this opioid will result in pupil constriction, the exact opposite occurs during withdrawal. If you notice that your pupils appear especially large, just know its caused by withdrawal.
- Rapid heartbeat: Many individuals notice an increased heart rate when they come off of morphine. The increased heart rate is a result of the body speeding itself back up after being on a depressant for a long period of time. Some people may also note palpitations, or sensations of a pounding or racing heart.
- Restlessness: Some people feel restless and unable to sit still as they discontinue morphine. This is usually a result of nervous system sensitivity and anxiety. Relaxation techniques may help you keep calm and cope with this symptom.
- Runny nose: A natural consequence of withdrawal from opiates is that of a runny nose. You may need to keep some extra tissues around to help deal with this symptom. This symptom should gradually improve, but may feel like a bad “cold.”
- Sleep changes: When you first come off of morphine, your sleep cycle may significantly change. You may find yourself feeling very tired at certain points throughout the day and/or anxious and unable to fall asleep at night. Your sleep patterns may be abnormal for awhile until you further recover.
- Spasms: Many people report muscle spasms upon discontinuation. These spasms can last for a few days or a few weeks. As more time passes, these usually reduce in frequency and length.
- Suicidal thinking: In some cases, the depression resulting from withdrawal can be severe. This could lead a person to feel suicidal during their withdrawal period. Although this feeling will eventually pass, it can be difficult to cope with. If you are feeling suicidal and think you may be of danger to yourself, seek immediate professional help.
- Sweating: Many people report heavy perspiration upon initially quitting morphine. Sweating is thought to be the body’s natural way of responding to drug discontinuation. You may sweat profusely throughout the day and/or notice uncomfortable night sweats.
- Vomiting: During the acute phases of withdrawal, you may end up getting sick to the point that you vomit. This is usually accompanied by an overwhelming nausea. The vomiting shouldn’t last longer than a few days.
- Yawning: You may get annoyed with the constant yawning that accompanies morphine withdrawal. Coming off of any opioid can result in yawning that’s completely out of your control. Do your best to put up with it, realizing that the yawns will eventually subside.
Morphine Withdrawal Duration: How long does it last?
There’s no universal opiate withdrawal timeline that can be followed for morphine because everyone recovers at a different rate. Some people may experience a normal withdrawal period without any protracted symptoms, while another person may have a severe acute withdrawal and lengthy protracted symptoms. You really won’t know what your experience will be like until you’ve been through withdrawal.
Certain individuals naturally recover at a quicker rate than others. Additionally if someone is receiving psychiatric drugs to help with withdrawal such as: antidepressants, benzodiazepines, and/or clonidine, it may be easier to cope with symptoms. Half life of morphine is 2 to 4 hours, which indicates that the drug is fully cleared from your body in approximately 8 hours. However, just because the drug is fully cleared from the body, doesn’t mean you have experienced withdrawal.
Acute withdrawal symptoms typically begin between 6 to 14 hours after discontinuation. The majority of acute symptoms peak within 3 days of withdrawal, but can last up to a full week. Acute psychological symptoms tend to peak within 6 to 10 days of withdrawal. Following the acute stage of withdrawal can come the “protracted” phase or “PAWS” (post-acute withdrawal syndrome), which can last anywhere from weeks to months.
The protracted phase is characterized by less intense physical symptoms and more psychological symptoms. While going through withdrawal, it is recommended to engage in healthy activities to ensure a steadfast recovery. Getting adequate sleep, some mild exercise (e.g. walking), being as productive as possible, eating healthy, and staying hydrated can go a long way towards helping your nervous system transition back to homeostatic functioning.
Although you may feel as if you are never going to get better, realize that this is merely withdrawal and you will eventually experience a full recovery. If you’ve had to deal with morphine withdrawal, sharing your experience in the comments section below may really help someone else.