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Morphine

Production

A Hungarian chemist, János Kabay, found and internationally patented a method to extract morphine from "poppy straw": dried poppy pods and stem, and other parts of the dry plant, except for seeds and root. In natural form, in poppy plant, the alkaloids are bound to meconic acid. The method is to extract from the crushed plant with diluted sulfuric acid, which is a stronger acid than meconic acid, but not so strong to react with alkaloid molecules. The extraction is performed in many steps (one amount of crushed plant is at least six to ten times extracted, so practically every alkaloid goes into the solution). From the solution obtained at the last extraction step, the alkaloids are precipitated by either ammonium hydroxide or sodium carbonate. The last step is purifying and separating morphine from other opium alkaloids (opium poppy contains at least 15–20 different alkaloids, but most of them are of very low concentration). In the 1950s and 1960s, Hungary supplied nearly 60% of Europe's total medication-purpose morphine production. To this day, poppy farming is legal in Hungary, but poppy farms are limited by law to . It is also legal to sell dried poppy in flower shops for use in floral arrangements. It was announced in 1973 that a team at the National Institutes of Health in the United States had developed a method for total synthesis of morphine, using coal tar as a starting material. A shortage in codeine-hydrocodone class cough suppressants (all of which can be made from morphine in one or more steps) was the initial reason for the research.

Legal classification

- 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.
- In the United States, morphine is classified as a Schedule II (US)|Schedule II drug under the Controlled Substances Act.
- In Canada, morphine is classified as a Schedule I (Canada)|Schedule I drug under the Controlled Drugs and Substances Act.
- In Australia, morphine is classified as a Schedule 8 drug under the variously titled State and Territory Poisons Acts.
- In the Netherlands, morphine is classified as a List 1 drug under the Opium Law.
- Internationally, morphine is a Schedule I drug under the Single Convention on Narcotic Drugs.http://www.incb.org/pdf/e/list/yellow.pdf

History and non-medical use

Morphine was first isolated in 1804 in Paderborn, Germany,Dem Morphin auf der Spur by the German pharmacist Friedrich Sertürner|Friedrich Wilhelm Adam Sertürner, who named it ''morphium'' after Morpheus (mythology)|Morpheus, the Greek mythology|Greek god of dreams. But it was not until the development of the hypodermic needle in 1853 that its use spread.Who Invented the Hypodermic Needle or Syringe Needle It was used for pain relief, and as a "cure" for opium and alcohol addiction. Later it was found out that morphine was even more addictive than either alcohol or opium, and its extensive use during the American Civil War allegedly resulted in over 400,000ASA July 2004 Newsletter sufferers from the "soldier's disease" of morphine addiction.Canadian Government Commission - Opiate Narcotics Old Soldiers Disease This idea has been a subject of controversy, as there have been suggestions that such a disease was in fact a hoax.Mythical Roots of US Drug Policy - Soldier's Disease and Addicts in the Civil WarSoldiers Disease A Historical Hoax? Diacetylmorphine (better known as heroin) was synthesized from morphine in 1874 and brought to market by Bayer in 1898. Heroin is approximately 1.5–2 times more potent than morphine on a milligram-for-milligram basis. 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).Martin WR, Fraser HF. "A comparative study of physiological and subjective effects of heroin and morphine administered intravenously in postaddicts." ''Journal of Pharmacology and Experimental Therapeutics''. 1961 Sep;'''133''':388-99. PMID 13767429 The pharmacology of heroin and morphine is identical except the two acetyl groups increase the lipophilicity|lipid solubility of the heroin molecule, causing it to cross the blood-brain barrier and enter the brain more rapidly. Once in the brain, these acetyl groups are removed to yield morphine, which causes the subjective effects of heroin. Thus, heroin may be thought of as a more rapidly acting form of morphine.Klous MG, Van den Brink W, Van Ree JM, Beijnen JH. "Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients." ''Drug and Alcohol Dependence''. 2005 December 12;'''80'''(3):283-95. PMID 15916865. Morphine was the most commonly abused narcotic analgesic in the world up until heroin was synthesized and came into use. Even today, morphine is the most sought after prescription narcotic by heroin addicts when heroin is scarce. Morphine, heroin and cocaine became controlled substances in the United States|U.S. under the Harrison Narcotics Tax Act of 1914, and possession without a prescription in the U.S. is a criminal offense. In 1952, Dr. Marshall D. Gates, Jr. was the first person to chemically synthesize morphine at the University of Rochester. This breakthrough is well renowned in the field of organic chemistry.University of Rochester Press Releases Morphine is routinely carried by soldiers on operations in an autoinjector. Slang terms for morphine include M, Big M, Vitamin M, Miss Emma, morph, morpho, Murphy, cube, cube juice, White Nurse, Red Cross, mojo, hocus, 13, Number 13, mofo, unkie, happy powder, joy powder, first line, Aunt Emma, coby, em, emsel, morf, dope, glad stuff, goody, God's Medicine, God's Own Medicine, hard stuff, morfa, morphia, morphy, mud, sister, Sister Morphine, stuff, white stuff, white merchandise and others.

Addiction

Morphine is a highly Addiction|addictive substance, both Psychological dependence|psychologically and Physical dependence|physically, with an addiction potential identical to that of heroin. In controlled studies comparing the physiological and subjective effects of injected heroin and morphine in individuals formerly addicted to opiates, subjects showed no preference for either drug. Equipotent, injected doses had comparable action courses, with no difference in their ability to induce euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness.W. R. Martin 1 and H. F. Fraser 1 Data acquired from short-term addiction studies did not indicate that heroin tolerance develops more rapidly than tolerance to morphine. The findings have been discussed in relation to the physicochemical properties of heroin and morphine and the metabolism of heroin. When compared to other opioids — hydromorphone, fentanyl, oxycodone, and pethidine/meperidine, former addicts showed a strong preference for heroin and morphine, suggesting that heroin and morphine are particularly susceptible to abuse and addiction. Morphine and heroin were also much more likely to produce euphoria, and other subjective effects when compared to most opioid analgesics.1 National Institute of Mental Health, Addiction Research Center, U. S. Public Health Service Hospital, Lexington, KentuckyJournal of Pharmacology And Experimental Therapeutics, Vol. 133, Issue 3, pp. 388-399, 1961 Other studies such as the Rat Park experiments suggest that morphine is less physically addictive than others suggest, and most studies on morphine addiction merely show that "severely distressed animals, like severely distressed people, will relieve their distress pharmacology|pharmacologically if they can." Weissman, D. E. & Haddox, J. D. (1989). "Opioid pseudoaddiction: an iatrogenic syndrome," ''Pain'', 36, 363-366, cited in Alexander 2001, ''op cit''. In these studies rats with a morphine "addiction" overcome their addiction themselves when placed in decent living environments with enough space, good food, companionship, areas for exercise, areas for privacy. More recent research has shown that an Environmental enrichment (neural)|enriched environment may decrease morphine addiction in mice http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WFG-4MXBFC5-1&_user=1510518&_coverDate=04%2F30%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000053381&_version=1&_urlVersion=0&_userid=1510518&md5=4ef66824a4078f1d77000d9b0b262074.

Withdrawal syndrome

The withdrawal symptoms associated with morphine addiction are usually experienced shortly before the time of the next scheduled dose, sometimes within as early as a few hours (usually between 6–12 hours) after the last administration. Early symptoms include watery eyes, insomnia, diarrhea, runny nose, yawning, dysphoria, and sweating and in some cases a strong drug craving. Severe headache, restlessness, irritability, loss of appetite, body aches, severe abdominal pain, nausea and vomiting, tremors, and even stronger and more intense drug craving appear as the syndrome progresses. Severe depression and vomiting are very common. The heart rate and blood pressure are elevated and can lead to a heart attack, blood clot or stroke. Chills or cold flashes with goose bumps ("cold turkey") alternating with flushing (hot flashes), kicking movements of the legs ("kicking the habit"Heroin Information from the National Institute on Drug Abuse) and excessive sweating are also characteristic symptoms.Drugs and Human Performance FACT SHEETS - Morphine (and Heroin) Severe pains in the bones and muscles of the back and extremities occur, as do muscle spasms. At any point during this process, a suitable narcotic can be administered that will dramatically reverse the withdrawal symptoms. Major withdrawal symptoms peak between 48 and 96 hours after the last dose and subside after about 8 to 12 days. Sudden withdrawal by heavily dependent users who are in poor health is very rarely fatal. Morphine withdrawal is considered less dangerous than alcohol, barbiturate, or benzodiazepine withdrawal.DEA Briefs & Background, Drugs and Drug Abuse, Drug Descriptions, Narcotics The psychological dependence associated with morphine addiction is complex and protracted. Long after the physical need for morphine has passed, the addict will usually continue to think and talk about the use of morphine (or other drugs) and feel strange or overwhelmed coping with daily activities without being under the influence of morphine. Psychological withdrawal from morphine is a very long and painful process.Morphine withdrawal and depression Addicts often suffer severe depression, anxiety, insomnia, mood swings, amnesia (forgetfulness), low self-esteem, confusion, paranoia, and other psychological disorders. The psychological dependence on morphine can, and usually does, last a lifetime.O'Neal, Maryadele J. Merck Index: An Encyclopedia of Chemicals, Drugs, and Biologicals. Merck. October 18, 2006. There is a high probability that relapse will occur after morphine withdrawal when neither the physical environment nor the behavioral motivators that contributed to the abuse have been altered. Testimony to morphine's addictive and reinforcing nature is its relapse rate. Abusers of morphine (and heroin), have one of the highest relapse rates among all drug users.

Hepatitis C and morphine withdrawal

Researchers at the University of Pennsylvania have demonstrated that morphine withdrawal complicates hepatitis C by suppressing IFN-alpha-mediated immunity and enhancing virus replication. Hepatitis C|Hepatitis C virus (HCV) is common among intravenous drug users, with 70 to 80% of abusers infected in the United States. This high association has piqued interest in determining the effects of drug abuse, specifically morphine and heroin, on progression of the disease. The discovery of such an association would impact treatment of both HCV infection and drug abuse.Wang C-Q, Li Y, Douglas SD, Wang X, Metzger DS, Zhang T, Ho W-Z: Morphine withdrawal enhances hepatitis C virus (HCV) replicon expression. Am J Pathol 2005, 167:1333-1340

Access to morphine in poor 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, Britain, Canada, France, Germany, and the United States) consume 79 percent of the world’s morphine. The less affluent countries, accounting for 80 percent of the world's population, consumed only about 6 percent 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. 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.

Additional images

Image:Morphine.gif|Animated model of the Morphine molecule Image:Morphine_Space-fill.png|Morphine molecule space-fill model Image:MORPHINE_PovRay.png|Morphine molecule ball and stick model

References

Category:Analgesics Category:Class A drugs Category:Ethers Category:Mu-opioid agonists Category:Natural opium alkaloids Category:Opioids Category:Phenols Category:World Health Organization essential medicines simple:Morphine

Related Images

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- Morphine advertisement ca. 1900
- Raw morphine (opium)

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