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<p dir="ltr">Morphine is a pain relieving drug which is the main psychoactive chemical in opium. It is an opioid analgesic which is used for killing intense pain. Just like other opioid drugs such as oxycodone and hydromorphone, morphine has a direct effect on the central nervous system. The name morphine originates from the name given to the Greek god of sleep and dreams “morpheus” for its ability to make the ailing patients fall asleep.</p> <p dir="ltr">Nowadays, morphine is widely used to relieve pain of patients with terminal illnesses. Terminal illness is a medical term that is used to refer to health conditions that are likely to result in death of the patient irrespective of the nature of treatment and care accorded. The patients who suffer from such conditions are referred to as terminal patients, or terminals. In most cases, physicians begin to consider patients as terminal if their estimated life expectancy is six months or less. The majority of the recorded terminal cases in the current medical field are associated with cancer.</p> <p dir="ltr">Introduction of Morphine to the Public</p> <p dir="ltr">Morphine was invented in 1804 by Friedrich Serturner. He was the first person to extract the drug from the natural plant known as alkaloid. The official use of the drug began in 1817 and by 1827 it was commercially sold in chemists and hospitals. The drug gained more popularity after the discovery of the hypodermic needle in 1857.</p> <p dir="ltr">Indication of the Medication</p> <p dir="ltr">Morphine is mainly used for treatment of both acute and chronic severe pains. It is useful for managing labor pain in women as well as other patients with myocardial infraction. The medication is also currently used to relieve pain of terminally ill cancer patients. This medication is not recommended for patients with breathing problems or lung diseases. Patients with a history of brain tumor, liver or kidney diseases, head injury or seizures are also discouraged from taking the drug. In addition, those with mental illness, alcohol addicts, patients with problems with the pancreas, gall bladder or thyroid and those with urination problems should not use the drug. Although the drug may be administered to children under well monitored conditions and dosage, expectant mothers should avoid the usage of drug as it may affect the newborn.</p> <p dir="ltr">Pharmacokinetics of Morphine</p> <p dir="ltr">Pharmacokinetics generally refers to the process of changing of drugs within the body. It entails the process of absorption, distribution, metabolism and excretion of medical products. Morphine can be taken in an oral, buccal, sublingual, intranasal, intrathecal or epidural way. However, the higher effectiveness of the drug is achieved through intravenous injection.</p> <p dir="ltr">Once introduced into the body, morphine goes through the first-pass metabolism where it is broken down in the liver. If administered through IM or SC injections, only 40-50% of the chemical content reaches the nervous system and the morphine plasma levels peak in approximately 20 minutes. In cases of oral administration, the morphine levels peak after 30 minutes. After the drug is metabolized in the liver, 87% of the content is excreted through the urine <a href="https://essaysprofessor.com/blog/over-100-best-medical-research-paper-topics.html">medical research topics</a> within a time span of 72 hours of administration. The rate of metabolism is also determined by age, gender, diet, genetic makeup, disease state and other medications. The concentration of the contents of the drug can be detected through the body fluids such as urine, blood and plasma.</p> <p dir="ltr">Drug Dosage</p> <p dir="ltr">Doctors prescribe the doses of morphine depending on the conditions of the patients. The dosage also depends on the drug strength, the number of times it is taken per day, the duration between the doses and the length of treatment. For instance, a start dose for patients who are not taking narcotic medicines is 30 mg once a day. For moderate to severe pains, the dosage may be 15-30 mg every four hours. Children dosage should be administered with strict instruction of a doctor. The physician should take into account the size, age and condition of the child and should avoid giving too much of the drug.</p> <p dir="ltr">Monitoring the Conditions</p> <p dir="ltr">A patient who is on morphine medication must make sure he/she takes the same brand and the same type of the drug. It should not be taken alongside other narcotic pain relievers. In oral administration, the drug should not be broken, crushed or chewed. The drug must also be taken at the same time every day and the patient should not stop taking or withdraw the drug suddenly. The drug should be stored at room temperature, away from heat, moisture and light. Overdose should be avoided and any unused drug should be disposed by being flushed down the toilet to avoid the danger of accidental abuse.</p> <p dir="ltr">Side Effects of the Drug</p> <p dir="ltr">At times, morphine can cause allergic reactions in patients. Such include difficulty in breathing, swelling of the face, throat, or tongue. The drug can also cause slow hear beat, shallow breathing, chest pain, first or pounding heart beats. Other side effects also include drowsiness, dizziness, constipation, headache, stomach pain, nausea and vomiting. In other cases, anxiety and mild itching can also be realized.</p> <p dir="ltr">Cost and Affordability of Morphine</p> <p dir="ltr">The cost of this medication varies from one country to another and is also affected by proliferation of certain generic drugs on the world market. In reaction to the high prevalence of cancer in many societies, the need to access medication that leads to freedom from pain has been perceived as part of human rights. Despite the fact that morphine has been recently included in the World Health Organization’s list of essential drug, its high cost in hospitals and pharmacies challenges its affordability. As a result, many people, especially low and middle income earners, cannot buy it. For instance, there was the case where a cancer patient who was taking morphine 100 mg for 2 years reported that he had to spend around $700 per month. Morphine ER 100 mg also costs $190 for a day’s dosage. Despite the existence of drug discounts, it has been generally observed that the price of this drug keeps on going up as its demand increases.</p> <p dir="ltr">Clinical Practice Guidelines on the Use of Morphine in Terminal Patients</p> <p dir="ltr">The Scottish Intercollegiate Guidelines Network (SIGN) is one of the clinical professional associations that gave a guideline on the use of morphine in terminally ill patients as well as other opioids. In these guidelines, it is indicated that taking the history of pain, locating the specific site, duration and character should be considered before administering the medication. In addition, the impact of the drug on social, emotional and psychological life of the patient should be considered. It was also indicated that the drug must be administered in relation to full view of the level of pain as indicated in the pain scale.</p> <p dir="ltr">Controversies Associated with the Use Morphine in Terminally Ill Patients</p> <p dir="ltr">The use of morphine has led to a number of controversies raised by various medical practitioners. For instance, Dr. Shaver has raised a number of ethical concerns with respect to this medication. He argues that it is difficult to establish that symptoms are factionary to treatment. He also states that psychosocial and spiritual suffering often exists outside the setting of imminent death hence making it less clear whether death is hastened by the sedation or not. He further added that the whole concept of terminal patient is controversial since doctors may consider a case as terminal yet the patient does not die as soon as expected. The assumption that the cases are truly terminal makes the medication more controversial.</p> <p dir="ltr">According to Dr. Shaver, the use of strong sedations deprives the patient of spiritual importance of such condition and may only delay the process that is certain and expected. Besides these, there are also controversies that relate to vast negative side effects and the high cost of the drug which challenges the concept of affordability to all needy patients.</p> <p dir="ltr">Alternative Medication</p> <p dir="ltr">Apart from morphine, there are other forms of medication that are used to relieve pain of terminal patients. These include pethidine, tramadol, buprenorphine and alfentanil. Despite the controversies associated with morphine, it still remains the most widely used opioid drug especially in terminal cancer patients.</p> <p dir="ltr">Morphine is a pain relieving drug which is extracted from opium. It is mainly used as a sedation that relieves pain of terminal patients. The drug has been in use since its invention in early 19th century and its dosage varies from patient to patient depending on age, weight, gender and the condition of illness. Despite its wide range of usage, it has numerous side effects which include drowsiness, dizziness, constipation, headache, stomach pain, nausea and vomiting. The drug is also associated with a number of ethical controversies. Hence recommendation for alternative medications is given.</p> <p> </p>
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