Question by chezzam: Ex-drug addict clean 20yrs now needs morphine for pain?
My friend is an ex-heroin addict who has been clean for 20yrs. She now runs a drug rehab facility with her husband. They have always believed that they can never use any type of pain-killer again because it could lead back to addiction. They also stay away from alcohol and anything else potentially addictive. However she has recently fractured her spine and the dr is saying she needs disk replacement surgery and morphine. She is refusing both because of her fears that morphine will send her backwards. I’ve tried to convince her that it would only be for a short time and would be monitored closely to ensure she doesn’t get hooked but she is adamant. She is in agony and finding it hard to function and I wonder how long she can keep it up.
Can anyone share experiences of ex-drug addicts in this position?
What about alternative pain methods? Has anyone had surgery or similar, that would normally require the use of opiates, but successfully used some other form of pain relief?

Best answer:

Answer by Jess Hellmich
Chezzam-

What an unfortunate and tough situation. Hopefully I can add some helpful insight.

Heroin is chemically different from morphine because it contains two acetyl groups, the inactive 3-monoacetylmorphine and the active 6-monoacetylmorphine (6-MAM), that make it more fat soluble. In conjunction with that, when administered intravenously, heroin bypasses first-pass metabolism. First-pass metabolism helps dilute the chemical resulting in less of that chemical entering your system. While bypassing first-pass metabolism, the two acetyl groups making it more fat soluble also allows it to pass through the blood-brain barrier much more easily and rapidly, again, resulting in more of the chemical entering your brain which bind to ?-opioid receptors, resulting in the drug’s euphoric, analgesic (pain relief), and anxiolytic (anti-anxiety) effects. Once in the brain, the two acetyl groups break off and dissolve and it basically becomes a very large, very potent amount of morphine in the brain. Because morphine does not have those two acetyl groups it is less potent. Morphine does not pass through the blood brain barrier as easily which results in the chemical being broken down more before entering the brain.

It is possible that taking morphine could trigger cravings for narcotic drugs and potentially relapse. However, if she works very carefully with her doctor and possibly a drug counselor, she may be able to take the medication for a short period of time following the surgery. All of the opiate based drugs will have similar effects and other pain killers (e.g. acetaminophen, naproxen, ibuprofen) are not strong enough on their own to combat the pain associated with the surgery but she could try them. Since morphine does not have the acetyl groups like those of heroin and will most likely be administered orally after surgery and in a precise dosage, I would venture to say the risk is there but manageable.

In oral administration only about 75% of the drug is absorbed into the brain over the course of 2-3 hours minimizing the intense euphoric feelings of injecting heroin. Orally administered medications also have to pass through first-pass metabolism diluting some of its potency. This combined with close supervision and communication with your friend’s doctor should result in a low risk situation. There are also anti-withdrawal and anti-craving medications such as Vivitrol, Buprenophine, or Suboxone used to help minimize the risk of dependency.

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