morphine

The term morphine becomes slang for the opiate Morphine used. It is one of the opioid analgesics and is strictly a prescription in every form of administration. Since the risk of abuse is very high and the drug also has many strong side effects in addition to the desired effects, it is subject to the Narcotics Act (BtmG) in every dosage form and may only be prescribed and issued on a BtmG prescription.

What is morphine?

morphine is a very strong opiate pain reliever because it is a major alcaloid in opium. It is used in medicine as one of the most powerful natural pain relievers ever.

It is an alkaloid isolated in its purest form. This isolation was achieved in 1805 by the pharmacist Friedrich Wilhelm Adam Sertürner from Paderborn, who named the newly discovered substance "Morpheus" after the Greek god of dreams. The composition, which is now widely known as a drug, was only named later as morphine.

Morphine has its origin in the milky sap of the opium poppy, which is dried for extraction. The synthesis from the basic substance of the opium poppy is very expensive and the result of the extraction process is relatively low at around 10%.

Pharmacological effect

morphine acts as a pain reliever in a completely different way than other analgesics. It acts centrally via so-called opioid receptors in the brain. The action of the agonist prevents the transmission of pain, which means that the morphine-consuming patient no longer perceives the pain or only perceives it in a weakened form.

This happens because the μ-receptors are activated by the action of the morphine. Morphine is usually very well absorbed by the body. Since the conversion or metabolism in the liver, which is also referred to as the first pass effect, is very high, the bioavailability is very low and the duration of action of 2-4 hours compared to the potency of the pain reliever is relatively short.

The so-called ceiling effect, also known as the saturation effect, cannot be recognized with morphine. This means that the effects also increase with increasing consumption. Since morphine not only has the positive effect of relieving pain but also a whole range of unpleasant side effects, life-threatening poisoning can occur due to the lack of a ceiling effect.

The undesirable side effects in pain therapy are very welcome in the case of intentional morphine abuse. These can be produced relatively quickly, which is why pure morphine in any dosage form has been subjected to the Narcotics Act.

Medical application & use

morphine It is primarily used in medicine as a highly effective analgesic when other painkillers are no longer strong enough to combat or alleviate the pain.

There are various forms of administration: liquid as drops and injection solution, for oral application as tablets, effervescent tablets, capsules, sustained-release capsules and granules and, in the event that swallowing is not possible and the injection is undesirable or inappropriate, as suppositories. The so-called morphine patch does not contain morphine as an active ingredient, as is often mistakenly assumed, but the much more potent opioid fentanyl.

In an international comparison, prescriptions are much less common in Germany than in neighboring Denmark. On the one hand, one is afraid of the strong side effects. The main reason why only around 5% of patients who need a pain reliever in this strength actually receive morphine in Germany is mainly due to the fact that morphine is unreservedly subject to the BtmG and the doctors based themselves on this before issuing these Btm prescriptions shy away from the additional effort and the obligation to provide evidence.

In order to reduce the unwanted and sometimes dangerous side effects, the WHO advises that morphine, if possible, be administered orally only and that the dose actually required be approached individually until pain titration. Morphine should also not be used for monotherapy to combat pain, but rather in combination with another, non-centrally acting painkiller.

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Risks & side effects

The more potent a drug, the higher its side effects and the associated risks. The very fact that morphine is a centrally acting analgesic, which is used in the treatment of severe to severe pain, makes the range of risks quite large.

Since the duration of action is relatively short at 2-4 hours and the central dampening, but mostly euphoric effect at the beginning of the treatment, is perceived as pleasant by the consuming patients, the desire for another dose arises very quickly. Morphine has a very high physical and psychological dependency potential.

In addition, it not only has an inhibiting effect on the transmission of pain to the opiate receptors in the brain, but with increasing dosage also inhibits the respiratory center, which can lead to respiratory failure. Other side effects include nausea with vomiting, especially at the start of treatment, and constipation. Hallucinations and impaired consciousness can be particularly unpleasant.