Morphine
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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