Morphine has become the benchmark by which all pain-killing medications are measured. This designation exists for a good reason. For one, morphine was the earliest discovery of the drugs known today as opioids. Ever since its detection in the 19th century, it has all but revolutionized pain-relief measures in the field of medicine.
Morphine itself is naturally occurring. The medicine is found within opium poppies, a plant used for its medicinal properties for thousands of years prior to morphine being directly extracted from it.
Medical and recreational morphine use can lead to more than diminished pain and euphoric highs. Like all opioids and opiates, morphine is highly addictive with extended use over time. Opioid dependence is among the most destructive of any in the world of drugs; Each use opens up the doorway for a future substance use disorder to develop down the line. It is no wonder why morphine and similar drugs are responsible for one of the costliest and deadliest epidemics facing the United States.
Fortunately, there are methods of morphine application in place to combat any misuse. Some morphine tablets, for example, use extended-release formulas to allow constant dosages. However, this preventative measure can be overcome by crushing the pills. Morphine administered via an IV occurs almost exclusively under the supervision of professionals in a medical setting, making it perhaps the most stable way to effectively use the pain medication.
The recommended dosage amount for IV morphine varies depending on the patient’s needs. The average starting dose is between 2.5 and 5mg every 4 hours, but patients with previous opioid exposure may require higher doses. Morphine delivered into the body intravenously is a rapid process, which eliminates inconsistencies with other variants like issues with absorption. As mentioned, the approach often requires a doctor or registered nurse to be present. This makes IV usage inherently safer, but it comes at the expense of ease of use for patients wishing to manage their pain at home. Such tradeoffs are important discussion points for prospective patients to have with their physician.
There are myriad opioids and opiates available to people, both medically and recreationally. This can lead to difficulties in treatment when attempting to determine the dangerous dose of each drug, for each patient. Researchers needed the means to convert all opioids to a standard value that was easily tracked. The morphine equivalent dose (MED) was the solution they needed. Understanding the amount of morphine that equates to the dosage of any other opioid allows for stabilizations in rehabilitation and transitions to safer opioids like methadone, and Suboxone.
A normal dose of morphine is also wholly subjective on the patient. Some individuals have used opioids for months or years, and thus require doses as high as 200 mg per day to effectively treat their pain. On the other end of the spectrum, someone who had never used opioids before might be prescribed closer to 30 mg to treat their pain. To accomplish these dosage amounts, physicians may choose the IV route or possibly morphine in tablet form. Some morphine doses start at 15 mg and increase to 30 mg, 60 mg, 100 mg, and 200 mg.
Pain management can be a finicky proposition. Each patient is different genetically, psychologically, emotionally and situationally. Pain is a complex phenomenon. It is quantifiable to an extent, but personal experience, which is mostly incalculable, is equally significant in its study. If one patient determines that their morphine dosage regimen is inadequately treating their pain, they may resort to self-medicating to overcome the differential. Whenever amplified morphine usage takes place to overcorrect for pain, there is potential for increased side effects to emerge. Even overdoses are not out of the question at such a point.
When taken as directed, side effects may be infrequent or nonexistent. The same cannot necessarily be said of misuse or overuse. If side effects do arise, they may take the form of the following:
- Relaxation to the point of lethargy
- Uncoordinated or confused behavior
- Constipation or painful bowel movements
Severe side effects are also possible. Some of the most hazardous of these include failed respiration, coma, hallucinations, seizures, and, very rarely, anemia.
The aforementioned MED calculations can be found in part below. Note: one’s opioid of choice must be multiplied by the conversion factor to get the mg/day equivalent of the oral form of morphine. (Oral: IV morphine is 3:1.)
Daily codeine dose x 0.15
Daily hydrocodone dose x 1
Daily oxycodone dose x 1.5
Daily fentanyl dose x 2.4 (based on mcg/hour)
If a patient is using multiple opioids, then a calculation must be made for each and then added together to create the total morphine equivalent dosage. Always consult with a medical professional to lay out a proper schedule of IV morphine usage.
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The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.