Can you inject morphine 30 mg

Their injection can give rise to several complications such as abscesses, ulcers, granulomas and phlebitis, pulmonary embolism, fibrosis and talcosis [ 8 , 9 , 10 , 11 ].

Filtration can prevent or delay these complications by removing insoluble particles from the suspension prior to injection. Membrane filters, such as the Sterifilt and wheel filters, are more efficient in eliminating particles from a solution than cotton or cigarette filters that are commonly used by PWID [ 12 , 13 , 14 ]. In France, one of the pharmaceuticals commonly diverted by injection is Skenan, a slow release capsule formula of morphine sulphate. The major preparation method for this drug involves heating after adding the active substance to the solution [ 17 , 18 ].

Because of the presence of starch, when heated, the suspension becomes highly viscous. Therefore, the more efficient membrane filters tend to clog up and are not often used. New drug preparation guidelines have also been taken up by PWID in other contexts [ 19 ]. But, despite the promotion, by harm reduction professionals of a cold preparation technique for Skenan, this advice has not been followed up [ 17 ].

It is thus plausible that there is a good reason to heat this drug. Some mention a lack of tingling feelings when they use the cold technique and a membrane filter; others mention an enhanced high when heating [ 20 ]. This might be true. The solubility of morphine is Most PWID in France inject mg or mg capsules; they may heat in order to dissolve the available morphine in a small volume 1-mL and 2-mL syringes are used.

McLean et al. Low solubility may not be a limiting factor under these conditions. According to other sources [ 23 , 24 ], a higher temperature does seem to enhance morphine or morphine sulphate solubility.

Thereafter, the suspension is stirred and filtered through either a small piece of cigarette filter or a cotton filter. Though very rare personal observation in the field , some people use the cold preparation method. Membrane filters can be easily used with this preparation method. This technique seems promising as it is used by a large number of users, and it is compatible with membrane filtration.

First of all, the microbeads contained in the capsule are crushed and put aside. Water is poured into the cooker and heated until the first bubbles appear. Fairly quickly, the crushed powder is added to the lukewarm water and the solution is stirred.

Subsequently, the solution is filtered either through a membrane filter only or through a membrane filter that is positioned on top of a cotton filter, called combined filtration.

Prepared in this fashion, the solution is still a little viscous, but it goes through membrane filters; the presence of a cotton filter underneath prevents the filter from clogging and enhances the filtration speed. Many professionals in the field of harm reduction including the author have been wondering for a long time what would be the best technique for the preparation of this drug. This pushed the fund to write a protocol and to subsequently request Ethypharm to perform the lab work on its product.

The lack of a clear regulation places health professionals and their patients in condition of random treatment success. Morphine as an option of opiate substitution, even for a limited number of patients, deserves to be explored and better supervised for the benefit of all.

For filtration, the following filters were used Fig. Filters used. In the field of harm reduction, they are called "wheel filters" Sartorius, Germany. This is the successor of the Sterifilt described by Scott [ 14 ] and Roux et al.

It is characterized by a larger filtration area, increased filtration speed and decreased risk of clogging during filtration Apothicom, France.

Other materials used are a hot plate to heat the solutions, standard g white paper and a lighter to crush microbeads and a digital microscope Keyence VHX to visualize the insoluble particles in the filtrate. Two preparation practices are thoroughly explored. As the hot method is used most often, it probably results in a reasonable amount of morphine in the solution.

However, this method does not resolve any of the complications related to the injection of insoluble particles because the heat renders the solution incompatible with the use of efficient filters. This preparation method has thus not been explored. We decided to focus on the methods that may result in reduced harm, namely the cold method and the lukewarm method. A mg morphine sulphate capsule was opened, and the microbeads were put on a carefully folded piece of paper. They were crushed using a lighter while inside the paper.

The solution was then either directly taken up through a syringe with a G needle or filtered through one of the four filters. As filtration by suction through wheel filters is facilitated by wetting the membrane, these filters were rinsed with 0. The paper containing the powder was put aside for later use. Two millilitres of water was poured into the cooker, which was then put onto a hot plate until the first bubbles appeared.

The solution was subsequently either taken up through a syringe with a G needle or filtered through one of the four filters. Prior to filtration, wheel filters were rinsed with 0. Rinsing of wheel filters : It is known that wheel filters have a high void volume and retain part of the solution [ 12 , 14 ].

To examine whether more morphine could be extracted by rinsing, one cold and one lukewarm extraction were performed with an additional rinse using 0.

Contact and stirring time : All solutions were stirred for 1 min. Three tests were performed per preparation technique. The following results were collected for each sample: total preparation time, total filtration time, volume retention by the used filter, microscopic particle count digital microscope: Keyence VHX and morphine concentration.

Morphine content refers to the total morphine available in the filtrate, e. To ensure proper particle recognition, dispersions of sole components soluble and insoluble in cold and lukewarm water were evaluated. Starch and talc were easily individually recognisable with no significant difference in size and shape of these compounds between cold and lukewarm suspensions.

To measure the morphine concentration, an ICH validated method using high pressure liquid chromatography with fluorescence detection was used. Overall, filtration time and ease seem acceptable for all filters. Filtration was faster using the lukewarm method; membrane filters were associated with slower filtration than the cotton filter, and wheel filter filtration was slowest overall. Without filtration, a large number of insoluble particles are observed in the morphine sulphate solution, consisting of starch and talc particles.

The latter are mainly present in clusters Fig. The cotton filter eliminates mainly starch particles. Though a large number of particles are eliminated by this filter, talc particles are still present in relatively high numbers after filtration Fig.

Fifty-six percent is recovered without filtration; filtration is thus not necessarily associated to a reduced recovery Table 1. Though the hot method has not been tested, these results show that heating the solution to that point is simply not necessary; all the morphine can be recovered using the lukewarm method.

The final morphine content differs to some extent between filters. With both methods, the wheel filter retains more morphine than the other filters.

To examine whether more morphine can be recovered by rinsing wheel filters after filtration, these were rinsed using 0. Stirring duration is thus an important factor. An enhanced duration might improve extraction in cold water, but will be less acceptable to PWID.

This difference is probably due to a difficulty in recovering all the viscous suspension from the cooker after a hot preparation technique e. As mentioned, the virtually complete extraction by Mclean et al. In our study, a rinse with 0. People who use drugs are resourceful. The reason for their reluctance to use a cold water preparation method has been found, and they were proven right. This method does yield less morphine. To spread information and to convince others to use a particular preparation technique, lab tests can help.

For PWID, it is not easy to try to change a preparation practice for a valuable drug that they cannot miss and do not want to lose, even partially, even once. Evidence-based information on solubility and filtration effectiveness can help people to take just that single step that makes their life easier and their drug less harmful in the long run. When slow release morphine sulphate capsules are diverted by injection, the use of filters is essential to prevent long term complications due to the injection of insoluble drug fillers such as talc and starch.

This practice consists of preheating water, followed by adding beforehand crushed microbeads to the solution, then waiting and stirring for about a minute, followed by filtration through a membrane filter.

The three membrane filters tested were equivalent in number of particle reduction. Additional data and figures that support the findings of this study are available. Restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Costes J-M et al. Les usages de drogues illicites en France depuis Prevalence of opioid analgesic injection among rural opioid analgesic users. Drug Alcohol Depend. Article Google Scholar.

Surveillance des maladies infectieuses chez les utilisateurs de drogue par injection. Paulozzi LJ. Opioid analgesic involvement in drug abuse deaths in American metropolitan areas. Am J Public Health. Prescription opioid abuse among enrollees into methadone maintenance treatment.

The Royal Australasian College of Physicians, Prescription Opioid Policy: improving management of chronic non-malignant pain and prevention of problems associated with prescription opioid use, Sydney; Route of administration for illicit prescription opioids: A comparison of rural and urban drug users. Harm Reduct J.

The health consequences of injecting tablet preparations: foreign body pulmonary embolization and pulmonary hypertension among deceased injecting drug users. Del Giudice P. Cutaneous complications of intravenous drug abuse. Br J Dermatol. Just one dose can cause death in someone using this medicine accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program.

If there is no take-back program, flush the unused medicine down the toilet. Morphine is sometimes taken only once per day, and sometimes 2 or 3 times per day. Since morphine is used for pain, you are not likely to miss a dose. If you do miss a dose, take the medicine as soon as you remember. Then take your next dose as follows:.

Do not take two doses at one time. Do not take more than your prescribed dose in a hour period. Seek emergency medical attention or call the Poison Help line at A morphine overdose can be fatal, especially in a child or other person using the medicine without a prescription.

Overdose symptoms may include slow heart rate, severe drowsiness, muscle weakness, cold and clammy skin, pinpoint pupils, very slow breathing, or coma.

Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Get emergency medical help if you have signs of an allergic reaction : hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up. Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Serious side effects may be more likely in older adults and those who are malnourished or debilitated. Long-term use of opioid medication may affect fertility ability to have children in men or women. It is not known whether opioid effects on fertility are permanent. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. Opioid medication can interact with many other drugs and cause dangerous side effects or death.

Be sure your doctor knows if you also use:. This list is not complete. Other drugs may affect morphine, including prescription and over-the-counter medicines, vitamins, and herbal products.

Not all possible interactions are listed here. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.

Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

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