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Morphine is the
principal constituent of opium and can range in concentration from 4 to 21
percent. Commercial opium is standardized to contain 10-percent morphine. In
the United States, a small percentage of the morphine obtained from opium is
used directly (about 15 tons): the remaining is converted to codeine and other
derivatives (about 120 tons). Morphine is one of the most effective drugs known
for the relief of severe pain and remains the standard against which new
analgesics are measured. Like most narcotics, the use of morphine has increased
significantly in recent years. Since 1990, there has been about a 3-fold
increase in morphine products in the United States.
Morphine is
marketed under generic and brand name products including "MS-Contin®,"
Oramorph SR®," MSIR®," Roxanol®," Kadian®," and RMS®."
Morphine is used parenterally (by injection) for preoperative sedation, as a
supplement to anesthesia, and for analgesia. It is the drug of choice for
relieving pain of myocardial infarction and for its cardiovascular effects in
the treatment of acute pulmonary edema. Traditionally; morphine was almost
exclusively used by injection. Today, morphine is marketed in a variety of
forms, including oral solutions, immediate and sustained-release tablets and
capsules, suppositories, and injectable preparations. In addition, the
availability of high-concentration morphine preparations (i.e., 20-mg/ml oral
solutions, 25-mg/ml injectable solutions, and 200-mg sustained-release tablets)
partially reflects the use of this substance for chronic pain management in
opiate-tolerant patients.
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