A Guide to Morphine vs Methadone
Morphine vs. Methadone: Breaking Down the Key Differences
While on the surface this might seem like an odd comparison, morphine and methadone share a lot more in common than you might think. Common misconceptions would tell you that morphine was just used to treat wounded soldiers during wars and methadone is used to help addicts in recovery. While they are indeed both of those things, morphine and methadone are each still used today for pain relief.
What Is Morphine?
Morphine is a powerful opiate used to treat chronic and moderate to severe pain. Morphine has been around for centuries, first being harvested in opium poppy fields by the ancient Egyptians. It was first used in America to cure alcoholism and also as a battlefield painkiller for wounded soldiers during the American Civil War. However, it was soon found to be highly addictive, with many soldiers becoming addicted to the drug.
Morphine is an opiate, meaning a natural substance that is derived from the opium poppy plant. Morphine is the most active alkaloid that naturally occurs in opium, making it an extremely powerful narcotic. It is most often used today by doctors for cancer patients or post-surgery, even for patients with chronic arthritis. Morphine is most typically administered to patients through an IV but can be prescribed in pill form.
What Is Methadone?
Methadone is a synthetic opioid, meaning it was created in a lab. It is a powerful medication that can help to reduce the withdrawal symptoms people feel when they are addicted to other opioids or opiates, such as heroin, without producing the high that is associated with these drugs. But contrary to popular belief, methadone is not used solely as an aid in drug detoxification, it is also a very effective painkiller itself.
Like morphine, methadone was created to be used as a painkiller for wounded soldiers during a war, this time during World War II. Later, it began to be used to help with treatment for addiction, as it is more commonly known today. It is important to note that methadone is not a cure, rather part of a treatment program. Methadone comes in pill, liquid, and tablet forms and is typically taken once a day.
Morphine vs. Methadone – How Do They Work?
Morphine and methadone, as well as all other opiates and opioids, operate by altering how the brain and nervous system perceive pain.
Morphine produces large amounts of dopamine, which is a chemical responsible for feelings of euphoria, pleasure, and contentment. This drug attaches to opioid receptors in the brain and spinal cord and produces these feelings while blocking out the feeling of pain. This doesn’t take the pain away but changes how the person taking the drug perceives the pain, relieving its symptoms and replacing them with a feeling of calm. Because of this euphoric feeling, many people develop this painkiller addiction.
Where methadone is different than morphine, is that while it also lessens the symptoms of pain, it does not have the euphoric effects. It also takes away much of the dangerous withdrawal symptoms seen in drugs like morphine and heroin, or even oxycodone and hydrocodone, which is why methadone is used as part of treatment for those in recovery.
Is Methadone Only Used In Addiction Treatment?
No. As we mentioned above, methadone was developed and is still sometimes used today as a painkiller similar to morphine. The more interesting question is: Why is methadone used to treat addiction?
The safest way to quit an opiate or opioid addiction is actually to take another drug as a supportive measure when the addict stops taking the original drug. This is because the withdrawal symptoms of opiates and opioids are extremely severe, making quitting cold turkey very dangerous to the user. The best course of action is to wean off of the drug using another long-acting drug with a long half-life.
Methadone fits this bill, and is also very affordable, making it popular in the treatment for opiate and opioid addictions. Methadone lacks the euphoric effects of the other drugs, but still offers the sedative qualities. It is easy to reduce or elevate a person’s methadone dosage, and though it still does have the potential to be abused, it does much more good than harm to the thousands who have used it in treatment.
Morphine isn’t used in the treatment of addiction because it does produce those euphoric effects. Morphine addiction symptoms can be severe as well as the withdrawal symptoms. The controlled withdrawal from opioids using methadone is milder and much less acute than from morphine. Many patients also will see a decrease in side effects when they switch to methadone from another opiate.
Morphine vs. Methadone For Treating Pain
Although most commonly used to help people recover from addiction of other opiates and opioids, methadone is also used to treat pain. In fact, it is a very effective medication for treating moderate to severe pain. But since morphine is often considered the gold standard for treating higher levels of pain, why would methadone ever be used?
The answer lies in the type of pain or injury that has occurred. Pain can be divided into two types: nociceptive, including injury to tissues and internal organs, and neuropathic, which involves the central nervous system.
Opioid receptors in our brains allow our bodies to have reactions to opioid pain medications like morphine and methadone. Nociceptive pain is mainly mediated by the mu receptors while neuropathic pain is controlled by delta and NMDA receptors. Morphine is known to bind only to mu receptors, making it the powerful pain reliever it is. However, methadone binds to all three.
A benefit of using methadone over morphine for pain treatment is Methadone extended half-life. A drug’s half-life refers to how long it takes for half of the drug to be metabolized by the body. Because of its longer half-life, methadone is able to produce a pain-relieving effect for much longer than morphine. Methadone effects can last eight to 10 hours, while regular non-extended release morphine will only relieve pain for two to four hours. This means patients can take doses of the drug less frequently.
Methadone is also a much cheaper option than morphine, with a month’s supply typically costing around $8, while the same amount of morphine will cost the user over $100. Oxycontin and Fentanyl cost even more.
Morphine vs. Methadone – Which Is Safer?
Both morphine and methadone are relatively safe drugs as long as they are taken according to the prescribed dosage given by your doctor. If the dosage or frequency are increased, there is the greater potential to develop a morphine addiction. In the case this happens, morphine is the more addictive of the two, and has some dangerous withdrawal symptoms.
People taking morphine may experience nausea, constipation, lightheadedness, dizziness, drowsiness, or sweating. Morphine side effects may lessen after you have been taking the drug for a while, but if they worsen, tell your doctor immediately.
With methadone, the short-term effects of a dose of methadone include sedation, drowsiness, and relaxation. They are similar effects to other opiates and opioids, but much less intense and longer lasting. As the user takes more of the drug, they may see other side effects, such as a slowed reaction time, respiratory depression, excessive sedation, growing lethargy, nausea, and mood swings. Some patients may also deal with depression.
A unique side effect of methadone includes QT interval prolongation, which is a heart rhythm disorder. If a person has a prolonged QT interval, your heart muscle takes longer than normal to recharge between beats, meaning it can go into a potentially lethal rhythm. People taking methadone on a routine basis should be monitored by a cardiologist due to its effects on the heart.
If a user experiences more serious side effects like allergic reactions, breaking out in hives, having difficulty breathing, chest pain, a fast or irregular heartbeat, severe constipation, hallucinations or confusion, and any swelling in their face, lips, tongue, or throat, you should seek immediate medical attention.
Users of morphine and methadone can try to prevent constipation by drinking plenty of water, eating a diet high in fiber, and making sure to exercise daily.
While methadone seems to produce fewer side effects than morphine, it can also be addictive. It is imperative that people who are prescribed either medication use them exactly as directed by their doctor. When taken as prescribed, morphine and methadone are both safe and effective. Morphine can extend the lives or those who are terminally ill, while methadone allows people to recover from their addiction and to reclaim active and meaningful lives.
Methadone, in particular, is specifically tailored to the individual patient. Doses will be adjusted and readjusted as the person goes through their recovery. If a person is taking other medications, they may interact with methadone and cause dangerous heart conditions. Even after the effects of methadone wear off, the medication’s active ingredients remain in the body for much longer. In these situations, taking more methadone can cause an unintentional overdose.
An opiate like morphine produces metabolites when it is broken down by the body. As the user takes more of the drug, these metabolites can build up to poisonous levels within the body and cause symptoms of opiate toxicity, which is essentially an overdose. Methadone doesn’t produce these metabolites and therefore doesn’t have a maximum dose when taken on its own. However, patients can still overdose from methadone if they mix the drug with other medications or alcohol.
For the best treatment results, users of methadone should never take more than their prescribed amount, and stick to their schedule. Taking other medications while using methadone can cause dangerous interactions. Make sure you let your doctor know if you are currently on any medications before you begin a methadone program.
For Methadone – What If I Miss A Dose Or Am Pregnant?
If you miss a dose of methadone, the procedure for what to do depends on why you are taking the drug. If you are taking methadone for pain, take it as soon as you remember, then resume your schedule as normal. However, if you are taking methadone for addiction, take your missed dose the following day at your regular time.
If you miss your dose for more than three days in a row, you should call your doctor for instructions and may have to restart at a lower dose. The worst thing you can do is take extra medicine to make up for a missed dose, as it may lead to increased cravings and a relapse into addiction.
Women who are pregnant or breastfeeding are able to safely take methadone because it actually helps them avoid withdrawal symptoms from abused drugs. Methadone will help them avoid withdrawal and the potential health risks it could cause to their baby while also managing their addiction. Taking methadone while pregnant does not cause birth defects, but may cause some babies to go through withdrawal after birth. Pregnant women who are taking methadone should consult their doctors before making any decision on continuing or discontinuing use of the drug.
Why Isn’t Methadone Used More Often To Treat Pain?
It makes you wonder – Why isn’t methadone used more to treat pain if it might be a better option? Part of the reason is because of the stigma surrounding methadone. Patients only think of methadone as a drug used to help people with addiction, so prescribing it to them may make them uncomfortable.
This stigma will slowly go away as more education comes out about the potential benefits of methadone, and more doctors begin to use the drug with good reviews of pain relief from patients.
Another reason is how long it takes methadone to work. Because of its extended half-life, methadone will slowly build up in the body and may take 5 to 7 days for its levels to stabilize. Patients will need to be monitored closely for signs of toxicity during this time, which isn’t often an option, unless the patient is already under palliative or hospice care, with 24/7 access to nurses and doctors.
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