Morphine Withdrawal: Symptoms, Timeline & Treatment

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Morphine is an opioid pain medication sold under the brand names Avinza, MS Contin, and Oramorph SR, among others. Morphine withdrawal symptoms can be uncomfortable, but they are seldom life-threatening. Supportive care and medications can help to reduce the unpleasant withdrawal experience.

Detox & Drug Withdrawal Info


Detox Symptoms

Withdrawal from morphine is characterized by physical and psychological symptoms that can range from mild to severe. Symptoms vary, but can include:

  • Agitation.
  • Anxiety.
  • Trouble sleeping.
  • Restlessness.
  • Irritability.
  • Fever.
  • Chills.
  • Goose bumps.
  • Muscle aches.
  • Stomach cramps.
  • Nausea.
  • Vomiting.
  • Diarrhea.
  • Dilated pupils.
  • Strong cravings.
  • Runny nose.
  • Sweating.
  • Tearing eyes.
  • Yawning.3, 4, 5, 6

The type and intensity of morphine withdrawal symptoms depends on:

  • The amount of morphine taken.
  • How frequently it was taken.
  • How it was administered.
  • How long it was used.
  • The basic personality and physical health of the person.1

Morphine withdrawal is rarely fatal regardless of the severity of the effects.3, 4

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Risks of Withdrawal

Someone going through morphine withdrawal may become dehydrated or experience an imbalance in electrolytes due to vomiting and diarrhea. Users can also develop an infection in the lungs as a result of frequent vomiting and inadvertent inhalation of stomach contents (aspiration).4

Further, relapse during or after withdrawal increases the likelihood of overdose and death.4 A user’s tolerance to the drug declines during withdrawal, and if the person takes the same dose as before, his or her system may become overwhelmed.

A medically supervised detox can make the process much easier, less painful, and ensure the safety of people in active withdrawal.


Withdrawal Timeline

Symptoms of withdrawal generally begin to appear within 6 to 12 hours after the last dose. They diminish over the course of 5 to 7 days.4, 6, 7, 8

  • 6-12 hours after last dose. Early physical symptoms include muscle aches, specifically in the back and legs, an increase in tearing, runny nose, yawning, sweating, and feeling pain more intensely. Psychological effects generally include an increase in irritability, anxiety, restlessness, and insomnia.4, 6
  • 24-72 hours. Advanced withdrawal takes place and includes all the symptoms of early withdrawal, as well as stomach cramps, nausea, vomiting, diarrhea, dilated pupils, chills or goose bumps, and fever.4, 6
  • 3-7 days. Effects begin to gradually improve each day until the person has completed the detox process.6,7

Post-Acute Withdrawal Syndrome

Although symptoms of morphine withdrawal generally resolve in a week or two, some individuals experience protracted or post-acute withdrawal symptoms for weeks or even months past the predicted timeline.8

These persisting symptoms can include:

  • Anxiety.
  • Agitation.
  • Irritability.
  • Depression.
  • Fatigue.
  • Insomnia.
  • Inability to focus on tasks.8

Support is especially crucial to maintain sobriety when a person is experiencing post-acute withdrawal symptoms. The symptoms can be managed with medication-assisted treatment and/or behavioral therapy techniques.


Causes of Morphine Withdrawal

Medical for morphine withdrawal spilled out on the table

Morphine carries a strong risk of abuse and addiction.1 It affects the pleasure and reward areas of the brain, and users may continue taking the drug due to feelings of well-being, a euphoric high, and a reduction in pain.2

Over time, chronic users can develop a tolerance, meaning they have to take more of the drug to attain the same effect as before.2

Eventually, these users can develop a dependence on morphine. The person’s body adjust to the regular presence of the drug, and the user will experience withdrawal symptoms if he or she stops taking it or reduces his or her dose.


Treatment for Morphine Withdrawal

Morphine withdrawal can be treated in a detox facility, inpatient or outpatient rehab program, or a partial hospitalization program. Specific treatment types are more suited for certain individuals based on the person’s needs and the severity of the addiction.

Attending detox followed by another type of treatment can dramatically improve the chances of successful recovery. Exploring core issues of addiction is crucial to avoid relapse. Additional treatment can provide a strong peer support group, education about relapse prevention, and professional support from counselors, therapists, or psychiatric staff.

  • Detox facilities provide medical supervision and may incorporate medication-assisted treatment for withdrawal. Morphine detox programs allow the person to avoid stressors or relapse triggers and recover in a safe, supportive environment. However, these facilities do not provide the comprehensive treatment available in other, more focused forms of treatment.
  • Inpatient rehab treatment lasts approximately 28 days but can last up to 90 days if necessary. Inpatient rehabilitation is more in-depth than detox centers or outpatient rehab facilities and often includes detox, individual therapy sessions, group counseling sessions, educational groups, sessions focused on acquiring and improving recovery-oriented skills, and self-help meetings.
  • Outpatient rehab treatment allows for tailored schedules based on treatment needs and availability. Participants attend treatment part-time and work, attend school, or socialize with family and friends while practicing their relapse prevention skills. Frequent relapses while in outpatient treatment can indicate a need for a higher level of care.
  • Partial hospitalization programs (PHPs) take place on an outpatient basis for about 4-6 hours each day on several days of the week. PHPs allow for highly individualized and intensive treatment within the least restrictive setting. These programs can be a natural “step down” from inpatient treatment, or they can provide a higher level of care while still allowing for personal freedom and the ability to work or attend school.

Medications

Medications include methadone, buprenorphine, and clonidine.


Medication-assisted treatment (MAT) involves using opioid medications and other forms of pharmaceutical intervention to reduce the pain of withdrawal, lower the risk of relapse, and ease the transition to sobriety. A physician may taper or lower the dose of medications or morphine itself over time, or keep the person on a maintenance dose. MAT can occur on an inpatient or outpatient basis and is most effective when paired with supportive treatment.4, 9, 11

A number of medications can be incorporated into the detox process, such as:

  • Methadone is a long-acting opioid that has similar effects to morphine. However, it is only available in government-regulated clinics, and it has the potential for abuse.
  • Buprenorphine(also combined with naloxone and distributed as Suboxone) is another long-acting opioid medication that can also block the effects of other opioids. It is only available from qualified physicians.
  • Clonidine is a blood pressure medication that can reduce certain withdrawal symptoms, including anxiety, agitation, muscle aches and cramps, sweating, and excessively runny nose.4
  • Zofran is prescribed to treat the nausea and vomiting associated with morphine withdrawal and can prevent electrolyte imbalances and minimize the risk of aspiration.
  • Baclofen is a central muscle relaxer that can be used to treat muscle cramps and aches.
  • Trazodone is another commonly prescribed medication that can treat insomnia or other sleep difficulties. Unlike some prescription sleep aids, trazodone has little abuse potential of its own.

Clonidine, Zofran (ondansetron), baclofen, and trazodone can be reduced or discontinued when the withdrawal symptoms resolve.


Find a Detox Center

If you or someone you love needs help with morphine withdrawal, call 1-888-319-2606 Who Answers? . A treatment support representative can help you choose a program based on your insurance and personal needs.

Sources

[1]. Drug Enforcement Administration. (2015). Drugs of abuse.

[2]. National Institute on Drug Abuse. (2014). America’s addiction to opioids: heroin and prescription drug abuse.

[3]. Harvard Health Publications. (2009). Treating opiate addiction, part I: detoxification and maintenance.

[4]. U.S. National Library of Medicine. (2016). Opiate and opioid withdrawal.

[5]. National Institute on Drug Abuse (2014). What are the possible consequences of opioid use and abuse?

[6]. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

[7]. Center for Substance Abuse Treatment.(2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45, HHS Publication No. (SMA) 15-4131, Rockville, MD.

[8]. Center for Substance Abuse Treatment. (2010). Protracted withdrawal. Substance Abuse Treatment Advisory, 9(1).

[9]. National Institute on Drug Abuse (2012). Types of treatment programs.

[10]. Substance Abuse and Mental Health Services Administration. (2015). Behavioral health treatments and services.

[11]. National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: a research-based guide (3rd edition).

[12]. Kosten, T.R. & George, T.P. (2002) The neurobiology of opioid dependence: implications for treatment. Science & Practice Perspectives, 1(1), 13-20.

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