Morphine Withdrawal Symptoms, Timeline, and Treatment

Morphine Withdrawal Symptoms, Timeline, and Treatment Addiction Coping and Recovery Print How Long Does Withdrawal From Morphine Last? By Corinne O’Keefe Osborn linkedin Corinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology. Learn about our editorial policy Corinne O’Keefe Osborn Medically reviewed by Medically reviewed by Steven Gans, MD on February 10, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on July 23, 2019 More in Addiction Coping and Recovery Methods and Support Overcoming Addiction Personal Stories Alcohol Use Addictive Behaviors Drug Use Nicotine Use In This Article Table of Contents Expand Overview Signs and Symptoms Coping and Relief Warnings Long-Term Treatment Resources View All Back To Top Morphine is a prescription narcotic, naturally derived from opium, used in the treatment of moderate to severe pain. Morphine was long used exclusively by injection, but today it can be found in a number of different forms. It is most commonly found in hospitals, where doctors use it to treat patients who have undergone surgery, suffered a serious injury, or experienced other forms of severe pain. Morphine is also available from the pharmacy, where it can be found as a generic or under brand names like MS-Contin, Oramorph SR, MSIR, Roxanol, Kadian, and RMS. Overview Morphine is highly addicting. Anyone using it for a prolonged period of time will develop a tolerance to its pain-relieving effects. Tolerance leads quickly to physical dependence. Once your body becomes dependent on the presence of morphine, it forgets how to operate normally without it. That means that when you take it away, your body is going to get mad. During morphine withdrawal, you can expect to feel like you’ve caught a bad flu. Most people begin experiencing symptoms 8 to 24 hours after their last dose. Early symptoms will probably include sweating, chills, and runny nose. As your withdrawal symptoms worsen, you can expect insomnia, muscle cramps, diarrhea, and nausea.     Of course, withdrawal is different for everyone. Some people experience relatively mild symptoms, while others experience intense discomfort. Your withdrawal experience will depend on a variety of factors, including but not limited to, the  way  you’ve been using opioids.   Physical dependence on a drug can quickly lead to psychological dependence and addiction, especially if you’ve been misusing your prescription. In 2017,  national survey data showed that more than 500,000 people had misused morphine within the last year.       If you are among the population of people who take morphine illicitly, take larger doses then you’re supposed to, or take it more often then you should, then it’s possible that your dependence has developed into a substance use disorder. Substance use disorders can complicate withdrawal, adding powerful emotions like guilt, shame, and hopelessness to an already difficult process. Signs and Symptoms Morphine withdrawal can be very uncomfortable. Most people experience a variety of physical symptoms that can range in severity from mild to severe. Severe symptoms may be beyond unpleasant, but they are rarely dangerous. To get a better idea of the range of possible symptoms, you may want to take a look at the  COWS withdrawal scale. This is a tool that doctors and nurses use to diagnose people who come in with opioid withdrawal symptoms. Keep in mind that this is for diagnostic purposes, so it is not predictive of your experience. You may experience all of the symptoms outlined here, or only one or two.   Morphine withdrawal typically follows a bell curve (which looks like a little rounded hilltop)â€"symptoms get progressively worse, peak, and then decrease. Symptoms usually begin within 8 to 12 hours of your last dose. Withdrawal can come on more slowly if you are using an extended-release version or a different extended-release opioid. Symptoms grow progressively worse over the course of the next two days until reaching their peak around day two or three. The most severe symptoms should only last about one day. After that, your symptoms will begin to decrease, before resolving completely around day five. Common morphine withdrawal symptoms include: Muscle aches and painFlu-like feelingSweatingRunny noseChillsNausea or vomitingCramping or diarrhea  Insomnia or disturbed sleepTeary eyesTremorsAnxiety or restlessness  GoosefleshHeart poundingAgitationSkin-crawling The acute (immediate) symptoms of opioid withdrawal rarely last longer than one week, but that doesn’t mean you’re out of the woods completely. There is a longer-lasting withdrawal syndrome, known as protracted withdrawal, that affects some people for as long as six months after their last dose. Protracted withdrawal is much less severe than acute withdrawal, and it tends to be more psychological than physical. Symptoms of protracted opioid withdrawal include: DepressionLow energy levels  A low tolerance for stress (short fuse)  Trouble sleepingThe inability to experience pleasure from anything  Problems with memory or concentrationIrritability or agitation Coping and Relief Although quitting morphine is never easy, there are many ways to manage and prevent the symptoms of withdrawal. Trying to quit cold turkey is never a good idea. It is rarely successful and causes unnecessary suffering. Instead, you should work with your current doctor or an addiction specialist to develop a detox plan.   If you have been taking morphine for pain and decide you want to stop, you should talk to your doctor about tapering down your dose. When you taper your morphine dose, you take progressively smaller doses over the course of several weeks or months. Depending on your situation, your doctor may reduce your dose once per week or every few weeks. By gradually reducing your dose, you give your body time to adjust to the absence of morphine.   If you have been misusing opioids, shown signs of addiction, or experienced other complicating factors, then you should consider using an opioid withdrawal medication like methadone or buprenorphine. Methadone and buprenorphine (the active ingredient in Suboxone) are long-acting opioids that can relieve the symptoms of withdrawal without getting you high.   Both opioid taper and opioid replacement therapy can help you avoid the brunt of opioid withdrawal and help reduce your risk of relapse, but they are not a withdrawal cure. It is not uncommon to have symptoms of withdrawal at different points when your dose is reduced. Withdrawal symptoms can also arise as your body adjusts to a new medication. Fortunately, there are several prescription and over-the-counter (OTC) medications that can treat the symptoms directly. These include:   Loperamide:  An OTC drug that treats diarrhea.  Ondansetron:  A prescription drug that treats nausea and vomiting.  Benzodiazepines:  Prescription drugs that treat symptoms of anxiety and agitation.  Acetaminophen or ibuprofen:  OTC drugs like Tylenol and Advil that can treat muscle aches and headaches.Antihistamines:  OTC drugs like Benadryl (not the non-drowsy types) can help you get a good night’s sleep.   There are a few other medications used to treat opioid withdrawal, reduce cravings, and prevent relapse. These include: Clonidine: A hypertension drug commonly prescribed off-label to treat opioid withdrawal symptoms. It is available as a pill or a transdermal patch.  Naltrexone: A medication that helps prevent relapse in the long-term by blocking the euphoric effects of opioids. It’s available as a pill or monthly injection.    Lucemyra (lofexidine hydrochloride): A brand-new, non-opioid medication that is FDA approved to treat most opioid withdrawal symptoms. It is available by prescription to take during the first two weeks after your last dose of opioids.   Warnings If you are planning to stop using morphine in the near future, there are a few things you should be aware of. Most healthy adults will be safe detoxing from morphine at home, but some people are better off under the direct supervision of a doctor. If your health is impaired due to cancer, surgery, or chronic disease, then you may want to consider an inpatient detox program. The same is true for people with a history of serious mental illness or suicidality. Inpatient detox involves living at a facility full-time for the duration of your treatment (about five days for detox only). It can take place in a hospital or a specialty addiction treatment center. Constant supervision by medical professionals can help prevent complications and ease discomfort.   If you have become pregnant while using morphine or other opioids, then you may also benefit from supervised detox. If you plan on following through with your pregnancy, then you will need to carefully transition to methadone. Morphine is not safe to use during pregnancy, but morphine withdrawal isn’t safe either. A stable dose of methadone throughout your pregnancy is generally considered to be the  safest option for mother and baby. If you are interested in pursuing inpatient treatment, the best place to start is with your insurance company. Most private insurers cover addiction treatment, as do most state and federal insurance programs. Be sure to ask which services are covered and for how long (three days, three months, etc.). You can find the phone number of your insurer on the back of your insurance card. If you don’t have insurance, don’t worry. There are many treatment centers that offer a sliding scale payment plan for those in need.     One last warning, before we move on. Many lay people have been touting the possibilities of the botanical drug kratom as a treatment for opioid withdrawal. Currently, there is no scientific evidence to suggest that kratom helps people beat opioid addiction. In 2018, after gathering the most up-to-date scientific research available, the  FDA issued a warning against kratom use. They found that kratom is essentially an opioid, which means that it can also lead to tolerance and addiction. Further, the potential side effects of kratom are not well understood and  kratom-related deaths are on the rise. To be safe, you should avoid kratom until the scientific community learns more about its safety. Kratom Uses and Side Effects Long-Term Treatment For some people, recovery from opioid dependence is a long-term, ongoing process. The best long-term treatment for you will depend on a few key factors, namely the presence of addiction and its severity. Some of the hallmarks of opioid addiction include: continuing to use drugs despite the negative consequences of your drug usespending excessive amounts of time using drugs or recovering from their effectsspending excessive amounts of time thinking about your next dose or how to get it  failing to meet your responsibilities at home, work, or school  experiencing intense cravings that interfere with your life  trying to quit but being unable to The  evidence overwhelmingly shows that once a moderate to severe opioid use disorder has developed, tapering without the support of medications is ineffective.  Evidence-based treatment for opioid use disorder includes a combination of medication and behavioral therapy. This means using medications like methadone or Suboxone in combination with talk therapy.  Research has found that combining therapy and medication works better than medication alone.   The goal of long-term treatment is to prevent relapse, so the best treatment is the one that you can commit to. In the year following your last dose, your treatment schedule should be vigilant. You should plan to work with a doctor to receive buprenorphine or attend a methadone clinic once per day. This should be combined with talk therapy and support group meetings.   Your talk therapy can take place with a therapist, addiction counselor, psychologist, or psychiatrist. Some people prefer one-on-one therapy, whereas others enjoy group therapy sessions. Long-term treatment can take place in a residential or outpatient setting.   As you stabilize yourself, physically and psychologically, you will be able to scale back on your treatment. You may find that 12-step meetings work well for you.   Resources To find a doctor or therapist who specializes in opioid use disorders, you can use this searchable directory from the  Substance Abuse and Mental Health Services Administration (SAMHSA) or call SAMHSA’s national helpline at 1-800-662-HELP (4357).   To find a doctor near you who is certified to prescribe buprenorphine, check out this  searchable directory. To learn more about Narcotics Anonymous (NA) check out their  website. You can find a meeting near you with their  searchable directory. A Word From Verywell   Whatever your reason for taking morphine, or for stopping it, withdrawal is inevitableâ€"unless you seek treatment. Don’t let shame prevent you from reaching out. Morphine is an incredibly addicting drug and your doctor will understand. In fact, your doctor will probably be downright thrilled that you are feeling well enough to stop your morphine and move on to the next stage of your life.   How Long Does Morphine Stay in Your System?