Saturday, June 02, 2007

Smack Shoot Smash

As far as I know, I have never had morphine. Maybe way back when my tonsils were taken out, but that's just a guess. Certainly in my years of nursing I've administered probably a few metric tons of the stuff.

Well, maybe not quite that much.

Morphine has developed a pretty good track record. After all, it's been in use for about six thousand years.

[Snip] "It is unknown exactly who, when, or where opium was first used or discovered, but the date can be narrowed to around 4000 BC. It was used to relieve anxiety and pain. It was also used to induce sleep and give a feeling of well being and peace. The first recorded use of opium for medical purposes was in 200 BC.

In the 16th century, a Swiss physician name Paracelcus experimented with the medical value of opium. He decided that its medical value was of such magnitude, that he called it Laudanum. Laudanum comes from the Latin word "laudare". Laudare means "to praise". He did not know of its addictive properties.

1803 can be seen as the true "birth date" or discovery date of Morphine. In 1803, Serturner, a German pharmacist, identified and isolated the main ingredient of opium, Morphine. He called this alkaloid "Morphia" after Morpheus, the Greek God of Dreams. The name "Morphine" is now used instead of Morphia because of the standard that all alkaloids end in "-ine".

It's basically very cheap, especially when compared to newer drugs (and they're all newer drugs!). Morphine can be manufactured for a penny per milligram or two. Contrast this with the antibiotic Zyvox, which could run you about $70 per tablet.

It also basically "burns clean," in the sense that morphine is unlike, say, Demerol, in that it does not leave a boatload of harmful metabolites in the body. Of course it's a little more complex than that, and you can read here and here if you want to start down that long and difficult road. What it means to me is that a chronic user of morphine, like a cancer patient, can just take more as they develop tolerance to the drug. Under a doctor's supervision, of course.

Though presently named after the ancient Greek god Morpheus, the drug itself predates the mythology by many centuries.

It's also a rather potent venous vasodilator, which is why realtively small doses of 2 to 4 milligrams are typically used for chest pain, and it slows the heart down a little. Too much can adversely affect breathing, but that can be pharmacologically reversed if absolutely necessary.

We usually keep some Narcan close at hand for patients who are using patient-controlled analgesia pumps, just in case they get too much.

Anyways, I did not intend to be a bore by going on and on about this. I just wanted to give you some idea of what I tell people when I'm smashing them up with powerful opioid drugs.

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