Morphine
Systematic (IUPAC) name
(5α,6α)-7,8-didehydro- 4,5-epoxy-17-methylmorphinan-3,6-diol
Identifiers
CAS number	57-27-2
ATC code	N02AA01
PubChem	5288826
DrugBank	APRD00215
Chemical data
Formula	C17H19NO3
Mol. mass	285. IUPAC Nomenclature is a system of naming Chemical compounds and of describing the science of Chemistry in general Morphinan is the base chemical structure of a subgroup of Opioids It is also an alternative name for the drug Dromoran, which is a racaemic parent drug of Levo-Dromoran® CAS registry numbers are unique numerical identifiers for Chemical compounds Polymers biological sequences mixtures and Alloys They are also referred to The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs It is controlled by the WHO Collaborating Centre for Drug A section of the Anatomical Therapeutic Chemical Classification System. PubChem is a Database of chemical Molecules The system is maintained by the National Center for Biotechnology Information (NCBI a component The DrugBank database available at the University of Alberta is a unique Bioinformatics and Cheminformatics resource that combines detailed drug (i A chemical formula is a way of expressing information about the Atoms that constitute a particular Chemical compound, and how the relationship between those atoms changes Carbon (kɑɹbən is a Chemical element with the symbol C and its Atomic number is 6 Hydrogen (ˈhaɪdrədʒən is the Chemical element with Atomic number 1 Nitrogen (ˈnaɪtɹəʤɪn is a Chemical element that has the symbol N and Atomic number 7 and Atomic weight 14 Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the The molecular mass (abbreviated m of a substance, more commonly referred to as molecular weight and abbreviated as MW, is the Mass of one 4
Pharmacokinetic data
Bioavailability	~25% (oral); 100% (IV);
Protein binding	30–40%
Metabolism	Hepatic 90%
Half life	2–3 hours
Excretion	Renal 90%, biliary 10%
Therapeutic considerations
Pregnancy cat.	C(AU) C(US)
Legal status	Controlled (S8)(AU) Schedule I(CA) Class A(UK) Schedule II(US)
Dependence Liability	Extremely high
Routes	Smoked/inhaled, insufflated, Oral, SC, IM, IV

Indicated for: Relief of severe pain Recreational uses: Euphoria Relaxation Sedation Other uses: Pain relief Cough suppressant Anti-diarrheal

Contraindications, relative: Alcohol Barbiturates and benzodiazepines Other hypnotics and sedatives β-blockers Other opioids

Side effects: Severe: Coma Hypoventilation Spontaneous abortion Respiratory arrest Cardiac arrest Death Atypical sensations: ? Cardiovascular: Bradycardia Palpitation Faintness Flushing of the face Ear, nose, and throat: Dry mouth Endocrinal: Eugonadism Eye: Pupil constriction Intermittent blurring Visual distortions Gastrointestinal: Nausea Constipation Hepatological: Renal failure Hematological: ? Musculoskeletal: Muscle twitch Neurological: Analgesia Psychological: Anxiolysis Confusion Euphoria Sedation Respiratory: Slow and shallow respiration Skin: Itchiness Flushing

Morphine (INN) (pronounced /ˈmɔrfiːn/) is a highly potent opiate analgesic drug and is the principal active agent in opium and the prototypical opioid. In Pharmacology, bioavailability is used to describe the fraction of an administered Dose of unchanged drug that reaches the Systemic circulation, one of A drug's efficiency may be affected by the degree to which it binds to the proteins within Blood plasma. Drug metabolism is the Metabolism of drugs, their Biochemical modification or degradation usually through specialized enzymatic systems The liver is a vital organ in the human body and is present in Vertebrates and some other animals The biological half-life of a substance is the time it takes for a substance (drug radioactive nuclide or other to lose half of its pharmacologic physiologic or radiologic activity Excretion is the process of eliminating waste products of Metabolism and other non-useful materials The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical if it is used as directed by the mother during For a topic outline on this subject see List of basic Australia topics. The United States of America —commonly referred to as the The regulation of therapeutic goods, that is drugs and therapeutic devices, varies by jurisdiction The Standard for the Uniform Scheduling of Drugs and Poisons, abbreviated SUSDP, is a document used in the regulation of drugs and poisons in Australia. For a topic outline on this subject see List of basic Australia topics. The Controlled Drugs and Substances Act is Canada 's federal drug control statute Country to "Dominion of Canada" or "Canadian Federation" or anything else please read the Talk Page The Misuse of Drugs Act 1971 (c38 is an Act of Parliament, by which the United Kingdom aims to control the possession and supply of numerous drugs The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control The United States of America —commonly referred to as the In Pharmacology and Toxicology, a route Recreational drug use is the use of Psychoactive drugs for Recreational purposes rather than for work, medical or spiritual purposes Inhalation (also known as respiration) is the movement of air from the external environment through the air ways and into the Alveoli. Insufflation (Latin insufflatio "blowing on or into" is the practice of inhaling substances into a Body cavity. The subcutaneous tissue or subcutis is the layer of Loose connective tissue directly underlying the Dermis. Intramuscular injection is the injection of a substance directly into a Muscle. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. Recreational drug use is the use of Psychoactive drugs for Recreational purposes rather than for work, medical or spiritual purposes Euphoria is a medically recognized emotional state related to Pleasure and Happiness. Sedation is a Medical procedure involving the administration of Sedative drugs generally to facilitate a medical procedure with Local anaesthesia. Pain management (also called pain medicine is the medical discipline concerned with the relief of Pain. A cough medicine is a medicinal drug used to treat Coughing and related conditions In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea In Medicine, a contraindication (pronounced as contra-indication is a condition or factor that increases the Risks involved in using a particular drug, Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation The benzodiazepines (pronounced, often abbreviated to "benzos") are a class of Psychoactive drugs with varying Hypnotic For the state of mind see Hypnosis. Hypnotic drugs induce Sleep (which differentiates them from the Sedative A sedative, or more specifically a sedative-hypnotic, is a substance that depresses the Central nervous system (CNS resulting in calmness relaxation sleepiness Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias An opioid is a chemical Substance that has a Morphine -like action in the body An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted negative consequences In Medicine, a coma (from the Greek koma, meaning deep sleep is a profound state of Unconsciousness. In Medicine, hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate ( hypo means "below" to perform needed Miscarriage or spontaneous abortion is the natural or spontaneous end of a Pregnancy at a stage where the embryo or fetus is incapable of surviving generally defined Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest. A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of Death is the termination of the biological functions that define living Organisms It refers both to a specific In Psychology, sensation is the first stage in the biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a This is an article about the rock music band "Circulatory System" Bradycardia, as applied to adult medicine is defined as a resting Heart rate of under 60 beats per minute though it is seldom symptomatic until the rate drops below 50 beat/min A palpitation (medical term ectopic heart beat) is an abnormal awareness of the beating of the Heart, whether it is too slow too fast irregular For a person to flush is to become markedly Red in the Face and often other areas of the skin from various physiological conditions The ear is the sense organ that detects Sounds The Vertebrate ear shows a common biology from Fish to Humans with variations Anatomically a nose is a protuberance in Vertebrates that houses the Nostrils or nares which admit and expel air for respiration in conjunction with the In Anatomy, the throat is the anterior part of the Neck, in front of the vertebral column. The endocrine system is an integrated system of small organs that involve the release of extracellular signaling molecules known as Hormones The endocrine system is instrumental Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain The visual system is the part of the Nervous system which allows organisms to see. Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that Hepatology is the branch of Medicine that incorporates study of Liver, Gallbladder, Biliary tree and Pancreas as well as management Renal failure or kidney Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the In Biology, the skeleton is a strong and often a rigid framework that supports the body of an animal holding it upright and giving it shape and strength (Also skeletal Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the Psychology (from Greek grc ψῡχή psȳkhē, "breath life soul" and grc -λογία -logia) is an Academic and An anxiolytic is a drug prescribed for the treatment of Symptoms of Anxiety. Confusion, of a Pathological degree usually refers to loss of orientation (ability to place oneself correctly in the world by time location and personal identity and Euphoria is a medically recognized emotional state related to Pleasure and Happiness. Sedation is a Medical procedure involving the administration of Sedative drugs generally to facilitate a medical procedure with Local anaesthesia. In Animal physiology, respiration is the transport of Oxygen from the outside air to the cells within tissues and the transport of Carbon dioxide The skin is the outer covering of living tissue of an animal (or plant An International Nonproprietary Name ( INN; also known as rINN, for recommended International Nonproprietary Name or pINN for proposed For other uses see Opiate (disambiguation, or for the class of drugs see Opioid. Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease Opium is a Narcotic formed from the Latex (ie sap released by lacerating (or "scoring" the immature seed pods of opium poppies ( An opioid is a chemical Substance that has a Morphine -like action in the body It is also a natural endocrine product in humans and other animals. Like other opioids, e. g. , diacetylmorphine (heroin), morphine acts directly on the central nervous system (CNS) to relieve pain, and at synapses of the nucleus accumbens in particular. Heroin ( INN: diacetylmorphine, BAN: diamorphine) is a semi-synthetic opioid synthesized from Morphine, a derivative Heroin ( INN: diacetylmorphine, BAN: diamorphine) is a semi-synthetic opioid synthesized from Morphine, a derivative In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Chemical synapses are specialized junctions through which Neurons signal to each other and to non-neuronal cells such as those in Muscles or Glands The nucleus accumbens (NAcc also known as the accumbens nucleus or as the nucleus accumbens septi (Latin for nucleus leaning against the Septum Studies done on the efficacy of various opioids have indicated that, in the management of severe pain, no other narcotic analgesic, other than Fentanyl, which has a higher potency, yet is shorter acting, is more effective or superior to morphine. Fentanyl is one of the most powerful Opioid Analgesics with a potency approximately 81 times that of Morphine. Morphine is highly addictive when compared to other substances; tolerance, physical and psychological dependences develop very rapidly. The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as Drug tolerance occurs when a subject's reaction to a Psychoactive drug (such as a painkiller or intoxicant decreases so that larger doses are required to achieve the same effect The word morphine is derived from Morpheus, one of the Greek gods of dreams. Morpheus ( Greek: Μορφέας Μορφεύς, "he who forms shapes moulds" from the Greek morphe) is the Greek In Greek mythology, the Oneiroi (Ὄνειροι were the brothers (According to Hesiod or sons (according to Ovid of Hypnos, the god of sleep

Contents 1 Medical uses 1.1 Contraindications 1.2 Further information 2 Pharmacology 2.1 Constipation 2.2 Gene expression 2.3 Effects on the immune system 3 Chemistry 4 Production 5 Legal classification 6 History and non-medical use 6.1 Addiction 6.2 Withdrawal syndrome 6.3 Hepatitis C and morphine withdrawal 7 Access to morphine in poor countries 8 Additional images 9 See also 10 References

Medical uses

Morphine is used legally:

• as an analgesic in hospital settings to relieve
  • pain in myocardial infarction
  • pain in sickle cell crisis
  • pain associated with surgical conditions, pre- and postoperatively
  • pain associated with trauma
• in the relief of severe chronic pain, e. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid g. ,
  • cancer
  • pain from kidney stones (renal colic, ureterolithiasis)
  • severe back pain
• as an adjunct to general anesthesia
• in epidural anesthesia or intrathecal analgesia
• for palliative care (i. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form Back pain (also known " dorsalgia " is Pain felt in the back that usually originates from the Muscles Nerves Bones In Linguistics, an adjunct is any word phrase or clause joined to another word or phrase to qualify or modify it In modern medical practice general anaesthesia ( AmE: anesthesia) is a state of total unconsciousness resulting from General anaesthetic drugs The term epidural is often short for epidural anesthesia, a form of Regional anesthesia involving injection of drugs through a Catheter placed into the Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms e. , to alleviate pain without curing the underlying reason for it, usually because the latter is found impossible)
• as an antitussive for severe cough
• in nebulized form, for treatment of dyspnea, although the evidence for efficacy is slim. A cough medicine is a medicinal drug used to treat Coughing and related conditions Dyspnea or dyspnoea (pronounced disp-nee-ah, IPA /dɪsp'niə/ from Latin dyspnoea, from Greek dyspnoia from ^[1] Evidence is better for other routes. ^[2]
• as an antidiarrheal in chronic conditions (e. An anti-diarrheal drug is any Medication which provides symptomatic relief for diarrhea. g. , for diarrhea associated with AIDS, although loperamide (a non-absorbed opioid acting only on the gut) is the most commonly used opioid for diarrhea). Loperamide, a synthetic Piperidine derivative is a drug effective against Diarrhea resulting from Gastroenteritis or Inflammatory

Contraindications

The following conditions are relative contraindications for morphine:

• acute respiratory depression
• renal failure (due to accumulation of the metabolite morphine-6-glucuronide)
• chemical toxicity (potentially lethal in low tolerance subjects)
• raised intracranial pressure, including head injury (exacerbation due pCO2 increases from respiratory depression)

Older literature, based upon studies of animals with acute pancreatitis, claimed that morphine caused significant spasm of the sphincter of Oddi and could therefore worsen the pain of the disease; however, there is no evidence to support this common misconception. In Medicine, a contraindication (pronounced as contra-indication is a condition or factor that increases the Risks involved in using a particular drug, In Medicine, hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate ( hypo means "below" to perform needed Renal failure or kidney Morphine-6-glucuronide (M6G is a major active Metabolite of Morphine, and as such is the Molecule responsible for much of the pain-relieving effects of Toxicity is the degree to which a substance is able to damage an exposed organism Acute Pancreatitis is a sudden Inflammation of the Pancreas. Depending on its severity it can have severe complications and high mortality despite This myth persists in medical practice with no basis in fact.

Further information

See Opioids

Pharmacology

Main article: Opioid receptor

Morphine is the prototype narcotic drug and is the standard against which all other opioids are tested. An opioid is a chemical Substance that has a Morphine -like action in the body Opioid receptors are a group of G-protein coupled receptors with Opioids as Ligands The Endogenous Opioids are Dynorphins It interacts predominantly with the μ-opioid receptor. The μ opioid receptors (MOR are a class of Opioid These 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. The la amygdalae ( Latin, also la corpus amygdaloideum, singular la amygdala, from Greek el αμυγδαλή grc-Latn amygdalē, 'almond' The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis The thalamus (from Greek θάλαμος = room chamber, IPA= /ˈθæləməs/ is a pair and symmetric part of the brain The caudate nucleus is a nucleus located within the Basal ganglia of the Brains of many animal species "Putamen" is also a botanical term for the stone in a Fruit, such as a Peach. 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. Chemical synapses are specialized junctions through which Neurons signal to each other and to non-neuronal cells such as those in Muscles or Glands The posteromarginal nucleus, Rexed lamina I is located at the most dorsal aspect of the Dorsal horn of the Spinal cord. The apex of the Posterior horn of the gray matter of the Spinal cord is capped by a V-shaped or crescentic mass of translucent gelatinous neuroglia termed the substantia The trigeminal nerve (the fifth Cranial nerve, also called the fifth nerve or simply V) is responsible for sensation in the face ^[3]

Morphine is a phenanthrene opioid receptor agonist – its main effect is binding to and activating the μ-opioid receptors in the central nervous system. Phenanthrene is a Polycyclic aromatic hydrocarbon composed of three fused Benzene rings Opioid receptors are a group of G-protein coupled receptors with Opioids as Ligands The Endogenous Opioids are Dynorphins An agonist is a term used to describe a type of ligand or drug that binds and alters the activity of a receptor. The μ opioid receptors (MOR are a class of Opioid In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. 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 μ-opioid receptors is associated with analgesia, sedation, euphoria, physical dependence, and respiratory depression. The μ opioid receptors (MOR are a class of Opioid Euphoria is a medically recognized emotional state related to Pleasure and Happiness. Physical dependence (or drug dependence) refers to a state resulting from habitual use of a drug where negative physical Withdrawal symptoms result from abrupt discontinuation In Medicine, hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate ( hypo means "below" to perform needed Morphine is a rapid-acting narcotic, and it is known to bind very strongly to the μ-opioid receptors, and for this reason, it often has a higher incidence of euphoria/dysphoria, respiratory depression, sedation, pruritus, tolerance, and physical and psychological dependence when compared to other opioids at equianalgesic doses. The μ opioid receptors (MOR are a class of Opioid Morphine is also a κ-opioid and δ-opioid receptor agonist, κ-opioid's action is associated with spinal analgesia, miosis (pinpoint pupils) and psychotomimetic effects. The κ-Opioid receptor is a type of Opioid receptor which binds the peptide opioid Dynorphin as the primary Endogenous ligand. The δ-opioid receptors, also known as delta opioid receptor or simply delta receptor, abbreviated DOR, is an Opioid receptor that has Miosis is Constriction of the Pupil of the Eye. This is a normal response to an increase in light but can also be associated with certain Pathological A drug with psychotomimetic actions mimics the symptoms of Psychosis, including Delusions and/or Hallucinations Some drugs of the Opioid class δ-opioid is thought to play a role in analgesia. ^[4]

The effects of morphine can be countered with opioid antagonists such as naloxone and naltrexone; the development of tolerance to morphine may be inhibited by NMDA antagonists such as ketamine or dextromethorphan. A receptor antagonist is a type of receptor ligand or Drug that does not provoke a biological response itself upon binding to a receptor, but blocks Naloxone is a drug used to counter the effects of Opioid overdose, for example Heroin or Morphine overdose Naltrexone is an Opioid receptor antagonist used primarily in the management of Alcohol dependence and Opioid dependence. NMDA (N-methyl-D-aspartic acid is an Amino acid derivative acting as a specific Agonist at the NMDA receptor, and therefore mimics the action of the Ketamine is a drug for use in human and veterinary medicine developed by Parke-Davis (today a part of Pfizer) in 1962 Dextromethorphan ( DXM or DM) is an Antitussive (cough suppressant drug found in many over-the-counter cold and Cough medicines ^[5]

Morphine is primarily metabolized into morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G)^[6] via glucuronidation by phase II metabolism enzyme UDP-glucuronosyl transferase-2B7 (UGT2B7). Morphine-3-glucuronide is a metabolite of Morphine produced by UGT2B7. Morphine-6-glucuronide (M6G is a major active Metabolite of Morphine, and as such is the Molecule responsible for much of the pain-relieving effects of Glucuronic acid (from Greek γλυκερός - "sweet" is a Carboxylic acid. UGT2B7 (UDP-Glucuronosyltransferase-2B7 is a phase II Metabolism isoenzyme found to be active in the Liver, Kidneys epithelial cells The phase I metabolism cytochrome P450 (CYP) family of enzymes has a role in the metabolism to a lesser extent. Not only does the metabolism occur in the liver but it may also take place in the brain and the kidneys. M6G has been found to be a far more potent analgesic than morphine when dosed to rodents, but crosses the blood-brain barrier with difficulty. The blood-brain barrier (BBB is a metabolic or cellular structure in the Central nervous system (CNS that restricts the passage of various chemical substances and microscopic M6G has been shown to be relatively more selective for mu-receptors than for delta- and kappa-receptors, whereas M3G does not appear to compete for opioid receptor binding. The significance of M6G formation on the observed effect of a dose of morphine is the subject of extensive debate among pharmacologists.

Constipation

Like loperamide and other opioids, morphine acts on the myenteric plexus in the intestinal tract, reducing gut motility, causing constipation. Loperamide, a synthetic Piperidine derivative is a drug effective against Diarrhea resulting from Gastroenteritis or Inflammatory Part of the Enteric nervous system, Auerbach's Plexus (or myenteric plexus) exists between the longitudinal and circular layers of Muscularis externa The gastrointestinal effects of morphine are mediated primarily by μ-opioid receptors in the bowel. An opioid is a chemical Substance that has a Morphine -like action in the body By inhibiting gastric emptying and reducing propulsive peristalsis of the intestine, morphine decreases the rate of intestinal transit. Reduction in gut secretion and increases in intestinal fluid absorption also contribute to the constipating effect. Opioids also may act on the gut indirectly through tonic gut spasms after inhibition of nitric oxide generation. This effect was shown in animals when a nitric oxide precursor reversed morphine-induced changes in gut motility.

Gene expression

Studies have shown that morphine can alter the expression of a number of genes. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance 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. In Cell biology, a mitochondrion (plural mitochondria) is a membrane-enclosed Organelle found in most eukaryotic cells. cytoskeleton (also CSK is a cellular " Scaffolding " or " Skeleton " contained within the Cytoplasm. ^[7]

Effects on the immune system

Morphine has long been known to act on receptors expressed on cells of the central nervous system resulting in pain relief and analgesia. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. In the 1970s and '80s, evidence suggesting that opiate drug addicts show increased risk of infection (such as increased pneumonia, tuberculosis, and HIV) led scientists to believe that morphine may also affect the immune system. Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor This possibility increased interest in the effect of chronic morphine use on the immune system.

The first step of determining that morphine may affect the immune system was to establish that the opiate receptors known to be expressed on cells of the central nervous system are also expressed on cells of the immune system. One study successfully showed that dendritic cells, part of the innate immune system, display opiate receptors. Dendritic cells (DCs are Immune cells and form part of the Mammalian Immune system. Dendritic cells are responsible for producing cytokines, which are the tools for communication in the immune system. Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular This same study showed that dendritic cells chronically treated with morphine during their differentiation produce more interleukin-12 (IL-12), a cytokine responsible for promoting the proliferation, growth, and differentiation of T-cells (another cell of the adaptive immune system) and less interleukin-10 (IL-10), a cytokine responsible for promoting a B-cell immune response (B cells produce antibodies to fight off infection). For Il-12 see also Ilyushin Il-12 Interleukin 12 ( IL-12) is an Interleukin that is naturally produced by Dendritic Interleukin -10 (IL-10 or IL10 also known as human cytokine synthesis inhibitory factor (CSIF is an anti- Inflammatory Cytokine. ^[8]

This regulation of cytokines appear to occur via the p38 MAPKs (mitogen activated protein kinase) dependent pathway. See also Mitogen-activated protein kinases P38 mitogen-activated protein kinases are a class of Mitogen-activated protein kinases which are responsive Usually, the p38 within the dendritic cell expresses TLR 4 (toll-like receptor 4), which is activated through the ligand LPS (lipopolysaccharide). Toll-like receptor 4, also known as TLR4, is a human Gene. TLR 4 is a Toll-like receptor. Lipopolysaccharides ( LPS) are large Molecules consisting of a Lipid and a Polysaccharide joined by a Covalent bond; they are found This causes the p38 MAPK to be phosphorylated. Phosphorylation is the addition of a Phosphate (PO4 group to a Protein molecule or a small molecule This phosphorylation activates the p38 MAPK to begin producing IL-10 and IL-12. When the dendritic cell is chronically exposed to morphine during their differentiation process then treated with LPS, the production of cytokines is different. Once treated with morphine, the p38 MAPK does not produce IL-10, instead favoring production of IL-12. The exact mechanism through which the production of one cytokine is increased in favor over another is not known. Most likely, the morphine causes increased phosphorylation of the p38 MAPK. Transcriptional level interactions between IL-10 and IL-12 may further increase the production of IL-12 once IL-10 is not being produced. Future research may target the exact mechanism that increases the production of IL-12 in morphine treated dendritic cells. This increased production of IL-12 causes increased T-cell immune response. This response is due to the ability of IL-12 to cause T helper cells to differentiate into the Th1 cell, causing a T cell immune response.

Chemistry

Most of the licit morphine produced is used to make codeine by methylation. Codeine ( INN) or methylmorphine is an Opiate used for its Analgesic, antitussive and antidiarrheal properties It is also a precursor for both heroin (diacetylmorphine), hydromorphone, and oxymorphone. Hydromorphone, a more common synonym for dihydromorphinone hydrochloride (trade names Palladone IR, Palladone SR, Dilaudid and numerous others Oxymorphone ( Opana, Numorphan, Numorphone) or 14-Hydroxydihydro Morphinone is a powerful semi-synthetic Opioid Analgesic Replacement of the N-methyl group of morphine with an N-phenylethyl group results in a product that is 18 times more powerful than morphine in its opiate agonist potency. Combining this modification with the replacement of the 6-hydroxyl with a 6-methylene produces a compound some 1,440 times more potent than morphine, stronger than the Bentley compounds such as etorphine. Hydroxyl in Chemistry stands for a molecule consisting of an Oxygen atom and a Hydrogen atom connected by a Covalent bond. Methylene is the chemical species R2C named after Methane, in which two of the carbon atom's valence electrons form no bonds Etorphine ( Immobilon or M99) is a semi-synthetic Opioid possessing an Analgesic potency approximately 10000 times that of Morphine

Both morphine and its hydrated form, C₁₇H₁₉NO₃H₂O, are sparingly soluble in water. In five liters of water, only one gram of the hydrate will dissolve. For this reason, pharmaceutical companies produce sulfate and hydrochloride salts of the drug, both of which are over 300 times more water-soluble than their parent molecule. Whereas the pH of a saturated morphine hydrate solution is 8. 5, the salts are acidic. Since they derive from a strong acid but weak base, they are both at about pH = 5; as a consequence, the morphine salts are mixed with small amounts of NaOH to make them suitable for injection. Sodium hydroxide ( Na[[hydroxide OH]]) also known as Lye, caustic soda and (incorrectly according to IUPAC nomenclature ^[9]

It is interesting to note that morphine has recently been found to be endogenously produced by humans, made by cells in the heart, pancreas and brain. ^[10] It has also been isolated from a range of other mammals, as well as toads and some invertebrates. It is unclear, however, what the normal endogenous role of morphine is.

A number of salts of morphine are used, and the opioids Morphine-N-Oxide (Genomorphine) and Pseudomorphine form as degradation products of morphine. The salts listed by the United States Drug Enforcement Administration, in addition to a few others, are as follows:

Salt or drug	CSA schedule	ACSCN	Free base conversion ratio
Morphine	II	9300	1
Morphine acetate	II	9300	0. The Drug Enforcement Administration ( DEA) is a United States Department of Justice Law enforcement agency tasked with combating drug smuggling and The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control The Administrative Controlled Substances Code Number ( ACSCN) is a number assigned to drugs listed on the schedules created by the Controlled Substances Act. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 71
Morphine citrate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 81
Morphine bitartrate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 66
Morphine stearate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 51
Morphine phthalate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 89
Morphine hydrobromide	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 78
Morphine hydrobromide (2H2O)	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 71
Morphine hydrochloride	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 89
Morphine hydrochloride (3H2O)	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 76
Morphine hydriodide (2H2O)	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 64
Morphine lactate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 76
Morphine monohydrate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 94
Morphine meconate (5H2O)	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 66
Morphine mucate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 57
Morphine nitrate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 82
Morphine phosphate (1/2 H2O)	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 73
Morphine phosphate (7H2O)	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 73
Morphine salicylate	II	9300
Morphine phenylpropionate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 65
Morphine methyliodide	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 67
Morphine isobutyrate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 76
Morphine hypophosphite	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 81
Morphine sulfate (5H2O)	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 75
Morphine tannate	II	9300
Morphine tartrate (3H2O)	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 74
Morphine valerate	II	9300	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 74
Morphine methylbromide	I	9305	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 75
Morphine methylsulfonate	I	9306	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 75
Morphine-N-oxide	I	9307	1
Morphine-N-oxide quinate	I	9307	0. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control 60
Pseudomorphine	I	not mentioned

Production

A Hungarian chemist, Janos 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. The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control A poppy is any of a number of showy Flowers typically withone per stem, belonging to the poppy family. In natural form, in poppy plant, the alkaloids are bound to meconic acid. Meconic acid, also known as acidum meconicum and poppy acid, is a Chemical substance found in certain plants of the Papaveraceae family 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). This article is about the chemical compounds alkaloids For the Pharmaceutical company in the Republic of Macedonia see Alkaloid (company. 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). Opium is a Narcotic formed from the Latex (ie sap released by lacerating (or "scoring" the immature seed pods of opium poppies ( In the 1950s and 1960s, Hungary supplied nearly 60% of Europe's total legal, medication-purpose morphine production. Hungary (Magyarország 'mɔɟɔrorsaːg) officially in English the Republic of Hungary ( Magyar Köztársaság, literally Magyar (Hungarian Republic To this day, poppy farming is legal in Hungary, but poppy farms are limited by law to 2 acres. It is also legal to sell dried poppy in flowershops for use in floral arrangements.

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. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Misuse of Drugs Act 1971 (c38 is an Act of Parliament, by which the United Kingdom aims to control the possession and supply of numerous drugs

• In the United States, morphine is classified as a Schedule II drug under the Controlled Substances Act. The United States of America —commonly referred to as the The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control The Controlled Substances Act ( CSA) was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control

• In Canada, morphine is classified as a Schedule I drug under the Controlled Drugs and Substances Act. Country to "Dominion of Canada" or "Canadian Federation" or anything else please read the Talk Page The Controlled Drugs and Substances Act is Canada 's federal drug control statute The Controlled Drugs and Substances Act is Canada 's federal drug control statute

• In Australia, morphine is classified as a Schedule 8 drug under the variously titled State and Territory Poisons Acts. For a topic outline on this subject see List of basic Australia topics. The Standard for the Uniform Scheduling of Drugs and Poisons, abbreviated SUSDP, is a document used in the regulation of drugs and poisons in Australia.

• In the Netherlands, morphine is classified as a List 1 drug under the Opium Law. The Netherlands ( Dutch:, ˈnedərlɑnt is the European part of the Kingdom of the Netherlands, which consists of the Netherlands the Netherlands The Opium Law (or Opium Wet in Dutch is the section of the Dutch Law which covers nearly all psychotropic drugs

• Internationally, morphine is a Schedule I drug under the Single Convention on Narcotic Drugs. The Single Convention on Narcotic Drugs is an international Treaty to prohibit production and supply of specific (nominally Narcotic) Drugs and of drugs ^[11]

History and non-medical use

Morphine was first isolated in 1804 in Paderborn, Germany,^[13] by the German pharmacist Friedrich Wilhelm Adam Sertürner, who named it morphium after Morpheus, the Greek god of dreams. Paderborn (paːdɐˈbɔʁn is a city in North Rhine-Westphalia, Germany, capital of the Paderborn district. Friedrich Wilhelm Adam Sertürner (born 19 June 1783 in Neuhaus (near Paderborn) died 20 February 1841 in Hamelin) was a German pharmacist who discovered Morpheus ( Greek: Μορφέας Μορφεύς, "he who forms shapes moulds" from the Greek morphe) is the Greek Greek mythology is the body of stories belonging to the ancient Greeks concerning their gods and Heroes the nature of the world and the origins and significance But it was not until the development of the hypodermic needle in 1853 that its use spread. A hypodermic needle is a hollow needle commonly used with a Syringe to inject substances into the body ^[14] 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 400,000^[15] sufferers from the "soldier's disease" of morphine addiction. Causes of the war See also Origins of the American Civil War, Timeline of events leading to the American Civil War The coexistence of a slave-owning South ^{[16] [17]} This idea has been a subject of controversy, as there have been suggestions that such a disease was in fact a hoax and soldier's disease did not occur after the Civil War. ^[18][19]

Diacetylmorphine (better known as heroin) was synthesized from morphine in 1874 and brought to market by Bayer in 1898. Heroin ( INN: diacetylmorphine, BAN: diamorphine) is a semi-synthetic opioid synthesized from Morphine, a derivative Heroin ( INN: diacetylmorphine, BAN: diamorphine) is a semi-synthetic opioid synthesized from Morphine, a derivative For other uses see Bayer (disambiguation or Beyer or Buyer. Bayer AG (German ˈbaɪə () is a German 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). ^[20] The pharmacology of heroin and morphine is identical except the two acetyl groups increase the lipid solubility of the heroin molecule, causing it to cross the blood-brain barrier and enter the brain more rapidly. In Organic chemistry, acetyl (ethanoyl is a Functional group, the Acyl of Acetic acid, with Chemical formula - C[[Oxygen Lipophilicity, fat-liking, refers to the ability of a Chemical compound to dissolve in fats oils lipids and non-polar solvents such as Hexane or The blood-brain barrier (BBB is a metabolic or cellular structure in the Central nervous system (CNS that restricts the passage of various chemical substances and microscopic 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. ^[21] 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 U.S. under the Harrison Narcotics Tax Act of 1914, and possession without a prescription in the U. Cocaine ( benzoylmethyl ecgonine) is a Crystalline Tropane Alkaloid that is obtained from the leaves of the Coca plant The United States of America —commonly referred to as the The Harrison Narcotics Tax Act (Ch 1) was a United States federal law that regulated and taxed the production importation and distribution of Opiates. 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. The University of Rochester ( U of R UR) is a private, nonsectarian Coeducational Research University located in Rochester This breakthrough is well renowned in the field of organic chemistry. ^[22]

Morphine is routinely carried by soldiers on operations in an autoinjector. An autoinjector (or auto-injector) is a Medical device designed to deliver a single Dose of a particular (typically life-saving drug.

Slang terms for morphine include M, Big 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 addictive substance, both psychologically and physically, with an addiction potential comparable to that of heroin. The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as Physical dependence (or drug dependence) refers to a state resulting from habitual use of a drug where negative physical Withdrawal symptoms result from abrupt discontinuation In a study comparing the physiological and subjective effects of heroin and morphine administered intravenously to a small number of post-addicts, post-addicts showed no preference for one or the other of these drugs when administered the drugs on a single injection basis, and equipotent doses of each drug had comparable effects on a number of different subjective variables. Nonetheless, most preferred heroin after multiple injections, and both heroin and morphine were strongly preferred over several other opioid analgesics (hydromorphone, fentanyl, oxycodone, and meperidine). Hydromorphone, a more common synonym for dihydromorphinone hydrochloride (trade names Palladone IR, Palladone SR, Dilaudid and numerous others Fentanyl is one of the most powerful Opioid Analgesics with a potency approximately 81 times that of Morphine. Oxycodone is an Opioid Analgesic Medication synthesized from Thebaine. Pethidine ( INN) or meperidine ( USAN) (commonly referred to as Demerol but also referred to as isonipecaine lidol pethanol piridosal Algil Alodan ^[20]

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. 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"^[23]) and excessive sweating are also characteristic symptoms. ^[24] 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. ^[25]

The psychological dependence associated with morphine addiction is complex and protracted. The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as 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. ^[26] 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. ^[27] 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 the highest relapse rates among all drug users, including abusers of other opioids, cocaine, and methamphetamine. An opioid is a chemical Substance that has a Morphine -like action in the body Cocaine ( benzoylmethyl ecgonine) is a Crystalline Tropane Alkaloid that is obtained from the leaves of the Coca plant A complication that may arise from long-term morphine use or abuse is neurotoxicity. Neurotoxicity occurs when the exposure to natural or artificial toxic substances which are called Neurotoxins alters the normal activity of the Nervous system in Morphine is more often associated with nightmares where oxycodone is not. It is not fully understood yet exactly how morphine may cause neurotoxicity. Morphine neurotoxicity, such as delirium, resolves when rotating from morphine to oxycodone. Oxycodone is an Opioid Analgesic Medication synthesized from Thebaine. Oxycodone's neurological side effects are more cognitive than motor (myoclonus) and hallucinations are reported less frequently with oxycodone than with morphine. [2] ^[28] It is possible that these effects arise from the stronger binding affinity of morphine to kappa receptors than oxycodone.

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 virus (HCV) is common among intravenous drug users, with 70 to 80% of abusers infected in the United States. Hepatitis C is a blood-borne infectious disease that is caused by the Hepatitis C virus ( HCV) affecting the Liver. 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. ^[29]

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 consume 79 percent of the world’s morphine. The International Narcotics Control Board (INCB is the independent and quasi-judicial control organ for the implementation of the United Nations drug conventions 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. ^[30]

Additional images

Animated model of the Morphine molecule

Morphine molecule space-fill model

Morphine molecule ball and stick model

See also

• Alphamethylfentanyl
• Cheese (recreational drug)
• Diacetyldihydromorphine
• Dihydromorphine
• Dipropanoylmorphine
• Drug addiction
• Drug injection
• Drugs and prostitution
• Entomotoxicology
• Etorphine
• Heroin
• Illegal drug trade
• Methadone
• Monoacetylmorphine
• Opioid
• Opium
• Opium licensing
• Opium poppy
• Polish heroin
• Psychoactive drug
• Recreational drug use

References

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