Morphine Addiction Fort Lauderdale, FL

Is morphine addictive?

Morphine is the opioid by which all of the others are measured. The strength of oxycodone, hydromorphone, or fentanyl is stated as a comparison to morphine, and when a doctor moves a patient from one opioid to another, the arithmetic is done in morphine first.

It is also one of the most used painkillers in hospitals, because it works and because doctors know it well. Yet, the label that the Food and Drug Administration, or FDA, approves for every morphine product opens with a boxed warning about “addiction, abuse, and misuse” and about slowed breathing that can be fatal.

So, yes, morphine is addictive, in exactly the way that oxycodone, hydromorphone, and every other full opioid is addictive, and no milder. Yet, the real question is a different one. Is the person taking morphine for pain addicted to it, or dependent on it?

Morphine dependence is not morphine addiction.

Anyone who takes morphine every day for more than a short time develops physical dependence. The body adjusts, more drug is needed for the same relief, which is tolerance, and stopping brings on withdrawal. The morphine label states that both can develop during opioid therapy.

Addiction is a different condition, defined by behavior: compulsive use in spite of harm, loss of control over the dose, and secrecy around the drug. A patient with cancer pain who takes MS Contin on schedule may be profoundly dependent and not addicted at all. They do not have an addiction. They have a dependence.

Does addiction happen after prescribed morphine? Of course, it does. The label warns that it can occur even in patients who are prescribed morphine appropriately, and the risk is higher in a person with a personal or family history of addiction.

The distinction decides the treatment. Dependence alone calls for a gradual taper, worked out with the doctor who prescribes the morphine, or a switch to buprenorphine. Addiction calls for buprenorphine treatment, which addresses the dependence at the same time. Neither one requires a treatment center.

Heroin addiction is really morphine addiction.

Heroin is a street drug with no accepted medical use, and morphine tablets are prescribed by doctors every day. Yet, they are nearly the same drug. Heroin is converted into morphine in the body, so a person who is addicted to heroin is, in a sense, addicted to morphine.

Why, then, is heroin so much deadlier? The answer is the supply. The molecule is the same one that the hospital gives by injection, but street heroin is cut with whatever increases the dealer’s profit, and for years that has meant fentanyl, dosed by someone with no scale and no training.

Think of morphine as the yardstick nailed to the wall behind the counter of a hardware store. Nobody buys the yardstick. Everything else in the store is measured against it, and it never changes.

While this is not a perfect analogy, it explains why doctors trust morphine. A tablet from a pharmacy is a known quantity, and a bag of heroin is a guess. The person buying the bag has no way of knowing what is in it.

A known quantity is still a dangerous one. Crushing or chewing an extended-release morphine tablet releases the whole dose at once, which the label calls potentially fatal, and the same label warns that morphine taken with a benzodiazepine or alcohol can cause profound sedation, stopped breathing, and death.

Which forms of morphine are prescribed?

In the hospital, morphine is usually given by injection. At home, it comes as immediate-release tablets and as extended-release tablets and capsules, and while MS Contin is the long-acting brand most people know, the generics are the same drug.

Morphine tablets in a house with children or teenagers are a hazard of their own. The label’s boxed warning says that accidental ingestion of even one dose, especially by a child, can be fatal, and a locked box is not an overreaction.

Who becomes dependent on morphine?

Many people who become dependent on morphine started with a prescription for pain. Years of a daily opioid mean a tolerance that keeps rising, a dose that rises to meet it, and, often, a doctor who one day decides to stop prescribing.

While hospitals keep morphine under lock and count, doctors and nurses are not immune. A nurse or physician who becomes dependent on it has the same medical condition as anyone else, and what they usually lack is a doctor they can talk to about it in private.

A smaller group comes to morphine from the street. Whatever the route in, the way out is the same.

What does morphine withdrawal feel like, and is it dangerous?

Runny nose, yawning, sweating, muscle aches, anxiety, stomach cramps, diarrhea, and sleeplessness are the familiar symptoms, along with cravings that can be stronger than any of them. While opioid withdrawal is rarely physically dangerous in an otherwise healthy adult, it is so miserable that few people get through it without help. Nobody can say in advance how long it will last for any one person.

Unfortunately, the real danger comes afterward. Tolerance fades after stopping, sometimes within days, and a dose that was ordinary before the break can stop a person’s breathing. Anyone in that position should have naloxone, or Narcan, in the house, and the people around them should know where it is.

Nobody should stop morphine abruptly after long-term use. In April 2019, the FDA reported serious harm from sudden discontinuation of opioid pain medicines, and the morphine label now says not to rapidly reduce or abruptly stop it in anyone who may be physically dependent, because of the risk of severe withdrawal, uncontrolled pain, and suicide. Cold turkey is not a lesson. It is an injury.

How does Dr. Leeds treat morphine dependence and addiction?

There are two roads. For dependence alone, the answer is a slow taper of the morphine, patient directed and adjusted as tolerated, worked out with the doctor who prescribes it, with the pain treated on its own terms. In a consultation, Dr. Leeds can advise on pain options that do not rely on an ever-rising opioid dose, including buprenorphine, which can keep relieving pain while the dose comes down.

For a patient with addiction, the gold standard is buprenorphine, the active ingredient in Suboxone and ZubSolv, often called medication-assisted treatment, or MAT. According to its label, buprenorphine is a partial opioid agonist, meaning it occupies the same receptor as morphine without the full effect.

So, it relieves withdrawal and cravings with less risk of slowed breathing than a full opioid, and a person on a stable dose feels normal, not high. The buprenorphine label carries the same warning about benzodiazepines and alcohol as the morphine label, for addiction and for pain alike.

Does this require a facility? No. Dr. Leeds starts buprenorphine at home, with phone support, and the one rule of the first day is patience, because the buprenorphine label warns that starting it before withdrawal has clearly begun can set off a sudden withdrawal of its own. The wait is longer after long-acting morphine, which leaves the body slowly, and when fentanyl is in the picture, he can use a low-dose start when it is needed.

After that, visits are monthly, and weekly when needed. Some patients stay on buprenorphine for years and others taper off of it when they are ready, and that choice belongs to the patient. For a person who is already off of opioids and wants a medication that blocks them, naltrexone is the other option.

How do I find a doctor who prescribes buprenorphine for morphine addiction?

This is easier than it used to be. Until the end of 2022, a doctor needed a federal waiver to prescribe buprenorphine for opioid addiction, and patients were sent to a government list of waivered doctors. The Mainstreaming Addiction Treatment Act, part of the Consolidated Appropriations Act, 2023, removed the waiver. Any practitioner with a standard Drug Enforcement Administration, or DEA, registration may now prescribe it, and that list is gone.

Fortunately, the list was never the hard part. The hard part is finding a doctor who treats morphine dependence as the medical condition it is, who does not require a stay in a treatment center, and who will still be there in six months.

Dr. Leeds is an osteopathic physician who sees patients throughout Florida by telemedicine, with an office in Fort Lauderdale for in-person visits. Care is private and one on one, in a concierge practice rather than an insurance-based one. To ask whether buprenorphine treatment is the right fit, or to talk through the options in a consultation, contact the office to request a consultation.

If someone has taken an opioid and cannot be woken or is not breathing, call 911. If you are thinking about suicide, call or text 988, the Suicide and Crisis Lifeline.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.