morphine / morhpia

[Robert Dunlop]

Diamorphine is short for diacetyl morphine. It has two acetyl groups attached to the 3' and 6' positions on the morphine molecule. This makes the morphine molecule extremely soluble in water. Large amounts can be dissolved in small volumes, which makes it ideal for injections and continuous infusions into the tissues just under the skin.

Morphine has two sulphate groups, which is why it is often prescribed as morphine sulphate. It is less water soluble but well absorbed when taken in tablet or liquid form.

Both types of morphine are metabolised to morphine-3-glucuronide (M3G), and lesser amounts of M6G (plus a smattering of other metabolites). M3G is inactive and can be eliminated from the body via the kidneys. M6G, however, is very potent and is one of the major reasons for the pain-killing effect of morphine/diamorphine.

Increasing doses are often required if the cause of the pain increases. This is not always the case, even with cancer-related pain, and many people use the same dose for long periods of time.

Pain is not inevitable with cancer, and not all cancer pains require morphine or equivalent. Morphine used for pain control does not accelerate death.

Robert

[Frank_East]

Diamorphine produces better pain relief with less severe side effects when given intravenously.Most patients taking diamorphine for pain relief over a brief period of time do not become dependent and are able to stop taking the drug.The abuse of diamorphine for its euphoric effects,especially by injection is very likely to lead to addiction.

Wolfgang Paul in his "Hermann Goring. Hitler Paladin or Puppet" records that Goering first took morphine to counter wounds he received in the air in November 1915."The engagement occurred during an interception patrol with two fellow officers when attacking a large HP twin engined bomber.Goering attacked one of these lumbering bombers with his machine gun and forced it to go down.Attacked by six British fighters,his own aircraft took hits in the fuel tank and lost a wing.He managed to land behind the German line,but had sustained a serious hip wound.Metal splinters had to be removed from the deep gash, and without immediate medical attention he would have bled to death.Sixty bullet holes were discovered in his aircraft .He was in for a long stay in hospital".

When the Geschwader "Richthofen" was disbanded at Aschaffenburg November 1918 (the aircraft had been flown to Darmstadt and destroyed),Paul records that Goering "suffered greatly from the wound in his thigh,for which he had to take morphine to ease the pain"

Goering was further wounded in the failed putsch on November 9 1923 and by 13 November, his wound,high on the thigh was critical,it was infected, causing pus, fever and pain.To alleviate Goering's suffering, the doctors authorised (and by this time he was sheltering in Austria) two morphine injections a day which continued for a month.Despite this, the pain did not diminish and while the continuing morphine injections were later to ease the pain in his groin and leg,he became addicted to the drug.(Something the Wehrmacht were to become aware of and resulted in a policy of morphine injections being discontinued after a short time, as Wolfgang Paul experienced himself in the Second World War Russian campaign)

In the spring of 1925, Goering fled to Sweden from Italy and arrived there with a large supply of morphine but his intake had increased from two to six injections per day over the previous year.

It is recorded that there was an attempt by Goering to forsake morphine but the lack of painkillers led to him purchasing the much dearer morphine.

According to the Paracelsus quote "All substances are poisons: there is none which is not a poison.The right dose differentiates a poison and remedy"

[centurion]

According to the Paracelsus quote "All substances are poisons: there is none which is not a poison.The right dose differentiates a poison and remedy"

Well you can certainly kill yourself by drinking too much pure water!

[Desdichado]

Just out of curiosity, where did the Germans obtain their morphine supplies during the war? For the British, I presume that the army was supplied from India which could easily its needs but I would think that Germany would find it very difficult to obtain it, unless it came from Turkey.

[Robert Dunlop]

Diamorphine produces better pain relief with less severe side effects when given intravenously.Most patients taking diamorphine for pain relief over a brief period of time do not become dependent and are able to stop taking the drug.

When used properly, intravenous diamorphine (and morphine) will produce faster onset pain relief but not better quality relief of pain compared with the oral route. By 'properly', I am referring to an initial loading dose followed by small increments at relatively frequent intervals until the pain is relieved. Too small a dose of IV diamorphine does not produce pain relief. Many side-effects, especially drowsiness, nausea and vomiting, are more frequent with injections.

People with cancer pain can take morphine/diamorphine for many months, even years, and then come off it if the pain is relieved by some other means.

Robert

[MACRAE]

I recall a few years back when i had foot surgery the nurse asked me if i was in pain, i said yes and of she went returned about 20 mins later a quick jab and bingo i was sleeping with sister morphine and i can assure you a gang could have battered me with base ball bats and i would not have felt a thing. I can understand why people become addicts you have no worries at all for a few short hours. It can become addictive if not administered properly i dare say. well that is my limited knowledge of morphine .

Dan

[Robert Dunlop]

Goering was further wounded in the failed putsch on November 9 1923 and by 13 November, his wound,high on the thigh was critical,it was infected, causing pus, fever and pain.To alleviate Goering's suffering, the doctors authorised (and by this time he was sheltering in Austria) two morphine injections a day which continued for a month.Despite this, the pain did not diminish and while the continuing morphine injections were later to ease the pain in his groin and leg,he became addicted to the drug.

Thank you very much for the extra details. There is no question that a major soft tissue injury with deep infection could cause severe pain. Two injections of morphine per day would not have been sufficient to control the pain. Morphine by injection has a pain-relieving effect that lasts for around 4-6 hours. If pain is not properly controlled, and persists as a result of the type of injury, then the requirement for pain killer will increase. This is not addiction. This relates to the physiology of chronic pain and the changes that pain can induce in the central nervous system. Higher doses of morphine are needed to control pain that has not been properly controlled from the outset. If a major nerve was damaged, then the requirements for morphine would also increase over time. Nerve pain is only partially responsive to morphine. FWIIW, Goering does not appear to have had a major nerve palsy in the either leg from what I have seen in film clips, but this does not exclude nerve pain from damage to a sensory rather than a motor or mixed nerve.

It is entirely possible that Goering had chronic pain. Chronic pain needs chronic pain killers. Chronic use of morphine for chronic pain does not imply that Goering was dependent psychologically, ie a drug addict in the pejorative sense of the term. It is also possible that the cause of the pain gradually healed. If he had tried to stop the morphine as the pain began to decline, then he would have experienced the physical symptoms of withdrawal - sweating, abdominal pains, anxiety, vomiting, etc. Any residual pain would have flared up. So it is not surprising that he became a chronic user of morphine, but was able to reduce his requirements to weak opioid alternatives later.

Robert

[evolution]

All morphine based painkillers come from opium, diamorphine is the strongest. When they cook the opium you get the strongest at the bottom, or the purest, ie:heroin-diamorphine, and then it gradualy gets weaker, untill you get its weakest form, paracetamol.

The Germans quickly ran out of morphine in WW1 because of the British blockade, so they vertualy invented a new form of painkillers that were as strong as morpine, the first was, I cant remember its name but they prescribe it to heroin addicts today. You have many of these now, pethadene is one which they give to woman in child birth, these are made by using chemicals. A picture of a WW1 morphia vial with 2 cartridge case's I found during my last visit, they were all laying together, tell a story huh.

[evolution]

yhere is the picture, did,nt realise this was a old thread duh

[Robert Dunlop]

Not all opioids come from opium. Some are man-made. Paracetamol is not an opioid

Robert

[Piorun]

You are right, Paracetamol is not an opioid, it is a phenol. Most common trade name today is Tylenol.