Morphine

Effects

EuphoriaDry MouthMood liftItchinessRelaxantConstipationPupil constrictionAnalgesia TS

Overview

Morphine is a naturally-occurring opioid substance of the morphinan class. It is one of the natural plant alkaloids found in opium, along side codeine which is extracted from Papaver somniferum (also known as the poppy plant). Additionally, it is considered to be the prototype opiate (i.e. the standard to which others are compared) and the basis of derivatives such as codeine, diacetylmorphine (heroin), and hydrocodone.[1] PW

The prototypical opioid drug, a powerful analgesic with euphoric qualities, found in the seeds and wax of the plant papaver somniferum (opium poppy). First isolated by Friedrich Sertürner in 1805, named for its sleep-inducing qualities. Do not combine with other depressants, may cause dangerous respiratory depression in overdose.[2–13] TS

Morphine, formerly known as morphium, is an opiate found naturally in opium, a dark brown resin produced by drying the latex of opium poppies (Papaver somniferum). It is mainly used as an analgesic (pain medication). There are multiple methods used to administer morphine: oral; sublingual; via inhalation; injection into a muscle, injection under the skin, or injection into the spinal cord area; transdermal; intravenously; or via rectal suppository. It acts directly on the central nervous system (CNS) to induce analgesia and alter perception and emotional response to pain. Physical and psychological dependence and tolerance may develop with repeated administration. It can be taken for both acute pain and chronic pain and is frequently used for pain from myocardial infarction, kidney stones, and during labor. Its maximum effect is reached after about 20 minutes when administered intravenously and 60 minutes when administered by mouth, while the duration of its effect is 3–7 hours. Long-acting formulations of morphine are sold under the brand names MS Contin and Kadian, among others. Generic long-acting formulations are also available.[14][15][16] WP

Common side effects of morphine include drowsiness, euphoria, nausea, dizziness, sweating, and constipation. Potentially serious side effects of morphine include decreased respiratory effort, vomiting, and low blood pressure. Morphine is highly addictive and prone to abuse. If one's dose is reduced after long-term use, opioid withdrawal symptoms may occur. Caution is advised for the use of morphine during pregnancy or breastfeeding, as it may affect the health of the baby.[14][17] WP

Morphine was first isolated in 1804 by German pharmacist Friedrich Sertürner. This is believed to be the first isolation of a medicinal alkaloid from a plant. Merck began marketing it commercially in 1827. Morphine was more widely used after the invention of the hypodermic syringe in 1853–1855. Sertürner originally named the substance morphium, after the Greek god of dreams, Morpheus, as it has a tendency to cause sleep.[18–22] WP

The primary source of morphine is isolation from poppy straw of the opium poppy. In 2013, approximately 523 tons of morphine were produced. Approximately 45 tons were used directly for pain, an increase of 400% over the last twenty years. Most use for this purpose was in the developed world. About 70% of morphine is used to make other opioids such as hydromorphone, oxymorphone, and heroin. It is a Schedule II drug in the United States, Class A in the United Kingdom, and Schedule I in Canada. It is on the World Health Organization's List of Essential Medicines. In 2023, it was the 156th most commonly prescribed medication in the United States, with more than 3 million prescriptions. It is available as a generic medication.[23–32] WP⚠ A word may be missing here. It reads this way in the source too.

History

History

The earliest known reference to morphine can be traced back to Theophrastus in the 3rd century BC, however, possible references to morphine may go as far back as 2100 BC as Sumerian clay tablets which records lists of medical prescriptions including opium-based cures.[41] WP

An opium-based elixir has been ascribed to alchemists of Byzantine times, but the specific formula was lost during the Ottoman conquest of Constantinople (Istanbul). Around 1522, Paracelsus made reference to an opium-based elixir that he called laudanum from the Latin word laudāre, meaning "to praise". He described it as a potent painkiller but recommended that it be used sparingly. The recipe given differs substantially from that of modern-day laudanum.[42][43] WP

Morphine was discovered as the first active alkaloid extracted from the opium poppy plant in December 1804 in Paderborn by German pharmacist Friedrich Sertürner. Sertürner noticed the compound induced drowsiness in rats and stray dogs and he reported his findings in 1805. In 1817, Sertürner reported experiments in which he administered morphine to himself, three young boys, three dogs, and a mouse; all four people almost died. Sertürner originally named the substance morphium after the Greek god of dreams, Morpheus, as it has a tendency to cause sleep. Sertürner's morphium was six times stronger than opium. He hypothesized that, because lower doses of the drug were needed, it would be less addictive. However, Sertürner became addicted to the drug, warning that "I consider it my duty to attract attention to the terrible effects of this new substance I called morphium in order that calamity may be averted."[18][20][21][44–48] WP

The drug was first marketed to the general public by Sertürner and Company in 1817 as a pain medication, and also as a treatment for opium and alcohol addiction. It was first used as a poison in 1822 when Edme Castaing of France was convicted of murdering a patient. Commercial production began in Darmstadt, Germany, in 1827 by the pharmacy that became the pharmaceutical company Merck, with morphine sales being a large part of their early growth. In the 1850s, Alexander Wood reported that he had injected morphine into his wife Rebecca as an experiment; the myth goes that this killed her because of respiratory depression, but she outlived her husband by ten years.[46][49–52] WP

Later it was found that morphine was more addictive than either alcohol or opium, and its extensive use during the American Civil War allegedly resulted in over 400,000 people with the "soldier's disease" of morphine addiction. This idea has been a subject of controversy, as there have been suggestions that such a disease was in fact a fabrication; the first documented use of the phrase "soldier's disease" was in 1915.[53–56] WP

Diacetylmorphine (better known as heroin) was synthesized from morphine in 1874 and brought to market by Bayer in 1898. Heroin is approximately 1.5 to 2 times more potent than morphine weight for weight. Due to the lipid solubility of diacetylmorphine, it can cross the blood–brain barrier faster than morphine, subsequently increasing the reinforcing component of addiction. Using a variety of subjective and objective measures, one study estimated the relative potency of heroin to morphine administered intravenously to post-addicts to be 1.80–2.66 mg of morphine sulfate to 1 mg of diamorphine hydrochloride (heroin).[57][58] WP

Morphine became a controlled substance in the US under the Harrison Narcotics Tax Act of 1914, and possession without a prescription in the US is a criminal offense. Morphine was the most commonly abused narcotic analgesic in the world until heroin was synthesized and came into use. In general, until the synthesis of dihydromorphine (c. 1900), the dihydromorphinone class of opioids (1920s), and oxycodone (1916) and similar drugs, there were no other drugs in the same efficacy range as opium, morphine, and heroin, with synthetics still several years away (pethidine was invented in Germany in 1937) and opioid agonists among the semi-synthetics were analogues and derivatives of codeine such as dihydrocodeine (Paracodin), ethylmorphine (Dionine), and benzylmorphine (Peronine). Even today, morphine is the most sought-after prescription narcotic by heroin addicts when heroin is scarce, all other things being equal; local conditions and user preference may cause hydromorphone, oxymorphone, high-dose oxycodone, or methadone as well as dextromoramide in specific instances such as 1970s Australia, to top that particular list. The stop-gap drugs used by the largest absolute number of heroin addicts is probably codeine, with significant use also of dihydrocodeine, poppy straw derivatives like poppy pod and poppy seed tea, propoxyphene, and tramadol. WP

The structural formula of morphine was determined by 1925 by Robert Robinson. At least three methods of total synthesis of morphine from starting materials such as coal tar and petroleum distillates have been patented, the first of which was announced in 1952, by Marshall D. Gates, Jr. at the University of Rochester. Still, the vast majority of morphine is derived from the opium poppy by either the traditional method of gathering latex from the scored, unripe pods of the poppy, or processes using poppy straw, the dried pods and stems of the plant, the most widespread of which was invented in Hungary in 1925 and announced in 1930 by Hungarian pharmacologist János Kabay.[59][60][61] WP

In 2003, there was a discovery of endogenous morphine occurring naturally in the human body. Thirty years of speculation were made on this subject because there was a receptor that, it appeared, reacted only to morphine: the μ₃-opioid receptor in human tissue. Human cells that form in reaction to cancerous neuroblastoma cells have been found to contain trace amounts of endogenous morphine.[62][63] WP

Legal status

• Internationally, morphine is a Schedule I drug under the Single Convention on Narcotic Drugs. It is on the WHO Model List of Essential Medicines, a list of the most important medications needed in a basic health system.[64][65] PW
• Australia: Morphine is classified as a Schedule 8 drug under the variously titled State and Territory Poisons Acts. PW⚠ PsychonautWiki itself has flagged this text: citation needed.
• Austria: Morphine is legal for medical use under the AMG (Arzneimittelgesetz Österreich) and illegal when sold or possessed without a prescription under the SMG (Suchtmittelgesetz Österreich). PW⚠ PsychonautWiki itself has flagged this text: citation needed.
• Canada: Morphine is classified as a Schedule I drug under the Controlled Drugs and Substances Act.[66] PW
• France: Morphine is in the strictest schedule of controlled substances, based upon the December 1970 French controlled substances law. PW⚠ PsychonautWiki itself has flagged this text: citation needed.
• Germany: Morphine is a controlled substance under Anlage III of the BtMG. It can only be prescribed on a narcotic prescription form.[67] PW
• Japan: Morphine is classified as a narcotic under the Narcotic and Psychotropic Drugs Control Act (麻薬及び向精神薬取締法).[68] PW
• Netherlands: Morphine is classified as a List 1 drug under the Opium Law. PW⚠ PsychonautWiki itself has flagged this text: citation needed.
• Russia: Morphine is a Schedule II controlled substance.[69] PW
• Sweden: Morphine is legal for medical use and is a controlled substance.[70] PW
• Switzerland: Morphine is a controlled substance specifically named under Verzeichnis A. Medicinal use is permitted.[71] PW
• Turkey: Morphine is a 'red prescription' only substance and illegal when sold or possessed without a prescription.[72] PW⚠ PsychonautWiki itself has flagged this text: citation needed.
• United Kingdom: Morphine is listed as a Class A drug under the Misuse of Drugs Act 1971 and a Schedule 2 Controlled Drug under the Misuse of Drugs Regulations 2001.[73][74] PW
• United States: Morphine is classified as a Schedule II controlled substance under the Controlled Substances Act with a main Administrative Controlled Substances Code Number (ACSCN) of ACSCN 9300. Morphine pharmaceuticals in the US are subject to annual manufacturing quotas; morphine production for use in extremely dilute formulations and its production as an intermediate, or chemical precursor, for conversion into other drugs is excluded from the US manufacturing quota.[75] PW

Legal status

• In Australia, morphine is classified as a Schedule 8 drug under the variously titled State and Territory Poisons Acts. WP
• In Canada, morphine is classified as a Schedule I drug under the Controlled Drugs and Substances Act. WP
• In France, morphine is in the strictest schedule of controlled substances, based upon the December 1970 French controlled substances law. WP
• In Germany, morphine is a verkehrsfähiges und verschreibungsfähiges Betäubungsmittel listed under Anlage III (the equivalent of CSA Schedule II) of the Betäubungsmittelgesetz.[67] WP
• In Switzerland, morphine is scheduled similarly to Germany's legal classification of the drug. WP
• In Japan, morphine is classified as a narcotic under the Narcotics and Psychotropics Control Act (麻薬及び向精神薬取締法, mayaku oyobi kōseishinyaku torishimarihō). WP
• In the Netherlands, morphine is classified as a List 1 drug under the Opium Law. WP
• In New Zealand, morphine is classified as a Class B drug under the Misuse of Drugs Act 1975.[76] WP
• In the United Kingdom, morphine is listed as a Class A drug under the Misuse of Drugs Act 1971 and a Schedule 2 Controlled Drug under the Misuse of Drugs Regulations 2001. WP
• In the United States, morphine is classified as a Schedule II controlled substance under the Controlled Substances Act under main Administrative Controlled Substances Code Number 9300. Morphine pharmaceuticals are subject to annual manufacturing quotas; in 2017 these quotas were 35.0 tonnes of production for sale, and 27.3 tonnes of production as an intermediate, or chemical precursor, for conversion into other drugs. Morphine produced for use in extremely dilute formulations is excluded from the manufacturing quota.[77] WP⚠ Wikipedia itself has flagged this text: citation needed.
• Internationally (UN), morphine is a Schedule I drug under the Single Convention on Narcotic Drugs.[64] WP

Names

Morphine is marketed under multiple different brand names in various parts of the world. It was formerly called morphia in British English.[78][79] WP

Informal names

Informal names for morphine include: cube juice, dope, dreamer, emsel, first line, God's drug, hard stuff, hocus, hows, Lydia, lydic, M, miss Emma, mister blue, monkey, morf, morph, morphide, morphie, morpho, mother, MS, mud, new jack swing (if mixed with heroin), sister, tab, unkie, unkie white, and stuff.[80] WP

MS Contin tablets are known as misties, and the 100 mg extended-release tablets as greys and blockbusters. The speedball can use morphine as the opioid component, which is combined with cocaine, amphetamines, methylphenidate, or similar drugs. Blue Velvet is a combination of morphine with the antihistamine tripelennamine taken by injection. WP

Trade names

Trade names include the following WP

• Actimorph – in the UK WP

Access in developing countries

Although morphine is cheap, people in poorer countries often do not have access to it. According to a 2005 estimate by the International Narcotics Control Board, six countries (Australia, Canada, France, Germany, the United Kingdom, and the United States) consume 79% of the world's morphine. The less affluent countries, accounting for 80% of the world's population, consumed only about 6% of the global morphine supply. Some countries import virtually no morphine, and in others the drug is rarely available even for relieving severe pain while dying.[81][82] WP

Experts in pain management attribute the under-distribution of morphine to an unwarranted fear of the drug's potential for addiction and abuse. While morphine is clearly addictive, Western doctors believe it is worthwhile to use the drug and then wean the patient off when the treatment is over.[83] WP⚠ Part of this sentence could not be copied from the source. Open the source to read it in full.

Pharmacology

Pharmacodynamics

Due to its long history and established use as a pain medication, this compound has become the benchmark to which all other opioids are compared. It interacts predominantly with the μ–δ-opioid (mu–delta) receptor heteromer. The μ-binding sites are discretely distributed in the human brain, with high densities in the posterior amygdala, hypothalamus, thalamus, nucleus caudatus, putamen, and certain cortical areas. They are also found on the terminal axons of primary afferents within laminae I and II (substantia gelatinosa) of the spinal cord and in the spinal nucleus of the trigeminal nerve.[84–87] WP

Morphine is a phenanthrene opioid receptor agonist – its main effect is binding to and activating the μ-opioid receptor (MOR) in the central nervous system. Its intrinsic activity at the MOR is heavily dependent on the assay and tissue being tested; in some situations it is a full agonist while in others it can be a partial agonist or even antagonist. In clinical settings, morphine exerts its principal pharmacological effect on the central nervous system and gastrointestinal tract. Its primary actions of therapeutic value are analgesia and sedation. Activation of the MOR is associated with analgesia, sedation, euphoria, physical dependence, and respiratory depression. Morphine is also a κ-opioid receptor (KOR) and δ-opioid receptor (DOR) agonist. Activation of the KOR is associated with spinal analgesia, miosis (pinpoint pupils), and psychotomimetic effects. The DOR is thought to play a role in analgesia. Although morphine does not bind to the σ receptor, it has been shown that σ receptor agonists, such as (+)-pentazocine, inhibit morphine analgesia, and σ receptor antagonists enhance morphine analgesia, suggesting downstream involvement of the σ receptor in the actions of morphine.[87][88][89] WP⚠ Wikipedia itself has flagged this text: failed verification.

The effects of morphine can be countered with opioid receptor antagonists such as naloxone and naltrexone; the development of tolerance to morphine may be inhibited by NMDA receptor antagonists such as ketamine, dextromethorphan, and memantine. The rotation of morphine with chemically dissimilar opioids in the long-term treatment of pain will slow down the growth of tolerance in the longer run, particularly agents known to have significantly incomplete cross-tolerance with morphine such as levorphanol, ketobemidone, piritramide, and methadone and its derivatives; all of these drugs also have NMDA antagonist properties. It is believed that the strong opioid with the most incomplete cross-tolerance with morphine is either methadone or dextromoramide.[90][91][92] WP⚠ Wikipedia itself has flagged this text: citation needed.

Analgesia creation

Morphine creates analgesia through the activation of a specific group of neurons in the rostral ventromedial medulla, called the "morphine ensemble". This ensemble includes glutamatergic neurons that project to the spinal cord, known as RVM^BDNF neurons. These neurons connect to inhibitory neurons in the spinal cord, called SC^Gal neurons, which release the neurotransmitter GABA and the neuropeptide galanin. The inhibition of SC^Gal neurons is crucial for morphine's pain-relieving effects. Additionally, the neurotrophic factor BDNF, produced within the RVM^BDNF neurons, is required for morphine's action. Increasing BDNF levels enhances morphine's analgesic effects, even at lower doses.[93][94] WP

Gene expression

Studies have shown that morphine can alter the expression of several genes. A single injection of morphine has been shown to alter the expression of two major groups of genes, for proteins involved in mitochondrial respiration and for cytoskeleton-related proteins.[95] WP

Absorption and metabolism

Morphine can be taken orally, sublingually, bucally, rectally, subcutaneously, intranasally, intravenously, intrathecally or epidurally and inhaled via a nebulizer. As a recreational drug, it is becoming more common to inhale ("Chasing the Dragon"), but, for medical purposes, intravenous (IV) injection is the most common method of administration. Morphine is subject to extensive first-pass metabolism (a large proportion is broken down in the liver), so, if taken orally, only 40% to 50% of the dose reaches the central nervous system. Resultant plasma levels after subcutaneous (SC), intramuscular (IM), and IV injection are all comparable. After IM or SC injections, morphine plasma levels peak in approximately 20 min, and, after oral administration, levels peak in approximately 30 min. Morphine is metabolised primarily in the liver and approximately 87% of a dose of morphine is excreted in the urine within 72 h of administration. Morphine is metabolized primarily into morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) via glucuronidation by phase II metabolism enzyme UDP-glucuronosyl transferase-2B7 (UGT2B7). About 60% of morphine is converted to M3G, and 6% to 10% is converted to M6G. Not only does the metabolism occur in the liver but it may also take place in the brain and the kidneys. M3G does not undergo opioid receptor binding and has no analgesic effect. M6G binds to μ-receptors and is half as potent an analgesic as morphine in humans. Morphine may also be metabolized into small amounts of normorphine, codeine, and hydromorphone. Metabolism rate is determined by gender, age, diet, genetic makeup, disease state (if any), and use of other medications. The elimination half-life of morphine is approximately 120 min, though there may be slight differences between men and women. Morphine can be stored in fat, and, thus, can be detectable even after death. Morphine can cross the blood–brain barrier, but, because of poor lipid solubility, protein binding, rapid conjugation with glucuronic acid, and ionization, it does not cross easily. Heroin, which is derived from morphine, crosses the blood-brain barrier more easily, making it more potent.[18][96][97][98] WP

Extended-release

There are extended-release formulations of orally administered morphine whose effect lasts longer, which can be given once per day. Brand names for this formulation of morphine include Avinza, Kadian, MS Contin, Dolcontin, and DepoDur. For constant pain, the relieving effect of extended-release morphine given once (for Kadian) or twice (for MS Contin) every 24 hours is roughly the same as multiple administrations of immediate release (or "regular") morphine. Extended-release morphine can be administered together with "rescue doses" of immediate-release morphine as needed in case of breakthrough pain, each generally consisting of 5% to 15% of the 24-hour extended-release dosage.[99–102] WP

Detection in body fluids

Morphine and its major metabolites, morphine-3-glucuronide, and morphine-6-glucuronide, can be detected in blood, plasma, hair, and urine using an immunoassay. Chromatography can be used to test for each of these substances individually. Some testing procedures hydrolyze metabolic products into morphine before the immunoassay, which must be considered when comparing morphine levels in separately published results. Morphine can also be isolated from whole blood samples by solid phase extraction (SPE) and detected using liquid chromatography-mass spectrometry (LC-MS). WP

Ingestion of codeine or food containing poppy seeds can cause false positives.[103] WP

A 1999 review estimated that relatively low doses of heroin (which metabolizes immediately into morphine) are detectable by standard urine tests for 1–1.5 days after use. A 2009 review determined that, when the analyte is morphine and the limit of detection is 1 ng/ml, a 20 mg intravenous (IV) dose of morphine is detectable for 12–24 hours. A limit of detection of 0.6 ng/ml had similar results.[104][105] WP

Pharmacogenomics

Genetic factors explain 49% of the pain response variance in the cold pressor test. Further the response variance to analgesia using alfentanil in the cold pressor test can be attributed to genetic effects at 60%.[106] WP

Morphine and its metabolites directly interact with several proteins, including: UGT2B7, OCT1 (SLC22A1), μ-opioid receptor (OPRM1), and P-glycoprotein (ABCB1 or MDR1). Furthermore catechol-O-methyltransferase indirectly affects efficacy of morphine.[107–110] WP

• Solute carrier family 22 member 1 (organic cation transporter isoform 1) is an efflux pump and expressed predominantly in hepatic cells, where morphine is metabolised by UGT2B7, loss of function mutations increase the area under the curve (AUC) by 1.5 (one allele) to 1.7 times (no active allele).[107] WP
• μ-opioid receptor: homozygous G/G carriers of the OPRM1 118 A>G variant (rs1799971) are shown to require more morphine.[107] WP
• P‐glycoprotein is expressed in the blood-brain barrier, small intestine, liver and kidneys and therefore affects the pharmacokinetics. The 3435T allele of the SNP rs1045642 reduces mRNA stability and results in lower efflux function, and is associated with better response to morphine.[107][111] WP
• UDP-Glucuronosyltransferase-2B7: The most common polymorphism is 802 C>T (rs7439366, UGT2B7*2), which depending on the substrate increases or decreases function. The T allele is associated with lower glucoronidation of morphine and extended analgesia.[107][112] WP

Chirality and biological activity

Morphine is a pentacyclic 3°amine (alkaloid) with 5 stereogenic centers and exists in 32 stereoisomeric forms. But the desired analgesic activity resides exclusively in the natural product, the (-)-enantiomer with the configuration (5R,6S,9R,13S,14R).[113][114] WP

Chemistry

Formula

C17H19NO3 PC

CAS number

57-27-2 PC

Molar mass (g/mol)

285.34 PC

IUPAC name (computed by PubChem)

(4R,4aR,7S,7aR,12bS)-3-methyl-2,4,4a,7,7a,13-hexahydro-1H-4,12-methanobenzofuro[3,2-e]isoquinoline-7,9-diol PC

SMILES

CN1CC[C@]23[C@@H]4[C@H]1CC5=C2C(=C(C=C5)O)O[C@H]3[C@H](C=C4)O PC

InChIKey

BQJCRHHNABKAKU-KBQPJGBKSA-N PC

PubChem CID

5288826

Pop culture

No references added yet.

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