Morphine is a potent opioid painkiller derived from the opium poppy, and it is primarily prescribed to manage moderate to severe pain. The drug acts on the central nervous system to reduce the body’s perception of pain, but it also carries a significant risk of physical dependence and addiction. Despite its intended medical use as a tablet or injection, people do abuse morphine by crushing the pill form and snorting the resulting powder, a practice known as insufflation. This method of misuse is extremely dangerous because it bypasses the drug’s built-in safety mechanisms and dramatically increases the risk of a fatal overdose.
Morphine’s Intended Function and Mechanism
As an analgesic, morphine works by binding to and activating mu-opioid receptors, which are specialized G-protein coupled receptors found throughout the brain, spinal cord, and gastrointestinal tract. Activation of these receptors blocks the transmission of pain signals and also suppresses the central nervous system, leading to effects such as euphoria, sedation, and a decreased rate of respiration. The pharmaceutical design of many morphine products, particularly controlled-release (CR) formulations, relies on a slow, steady dissolution to provide pain relief over many hours.
An oral CR tablet is specifically manufactured to release the active ingredient gradually as it moves through the digestive system. This slow release is a safety feature that keeps the concentration of morphine in the bloodstream below the level that would cause dangerous respiratory depression. When taken orally, a large portion of the morphine is metabolized by the liver before it reaches the bloodstream, a process called first-pass metabolism, which results in an absolute bioavailability of only about 20 to 25% for oral solutions. This system is engineered for a slow onset and prolonged effect, which crushing the pill completely disrupts.
How Insufflation Changes Drug Delivery
Crushing a controlled-release morphine tablet defeats the time-release mechanism, turning it into a fine powder that is rapidly absorbed through the delicate mucous membranes lining the nasal cavity. When the drug is snorted, it bypasses the first-pass metabolism in the liver that normally filters and breaks down a significant amount of the drug, allowing a much greater percentage of the morphine to enter the bloodstream directly and quickly.
The resulting effect is a much faster time to maximum concentration (\(T_{max}\)) and a significantly higher peak concentration (\(C_{max}\)) in the blood compared to taking the pill as intended. For example, studies have shown that crushed extended-release morphine delivered intranasally can achieve a \(C_{max}\) of around \(49.5 \text{ ng/mL}\) in approximately \(1.1 \text{ hours}\), which is a rapid, intense surge that users seek. This rapid delivery creates an intense euphoric rush but simultaneously floods the mu-opioid receptors, profoundly increasing the risk of acute central nervous system and respiratory depression.
Direct Physical Harm to Nasal Tissues
Beyond the systemic danger of overdose, snorting morphine causes direct, localized damage to the nasal passages and respiratory tract. The crushed powder, which contains harsh, insoluble binders and polymers from the pill’s original formulation, acts as a physical irritant and corrosive agent. This constant irritation causes inflammation of the nasal mucosa, leading to chronic issues like persistent nosebleeds, a constant runny nose, and severe sinusitis.
With continued use, this corrosive action can cause tissue death and ulceration within the nasal cavity. A severe long-term complication is the perforation of the nasal septum, which is the cartilage wall separating the two nostrils. Damage can also extend to the cilia, the tiny hairs that line the respiratory tract and are responsible for filtering inhaled air. This damage impairs the natural defense mechanism against pathogens, which can lead to frequent respiratory infections and, in rare cases, bone loss or the collapse of nasal passages.
Recognizing Opioid Overdose and Response
The rapid and high concentration of morphine from insufflation makes recognizing the signs of an opioid overdose a time-sensitive matter. A person experiencing an overdose will show signs of severe central nervous system depression, including blue or grayish skin, lips, or fingernails from lack of oxygen. Breathing will become extremely slow, shallow, or may stop entirely, sometimes accompanied by a gurgling or snoring sound.
A key indicator of an opioid overdose is a state of unresponsiveness, where the person cannot be woken up even with a sternum rub or loud shouting. The pupils will constrict to a tiny size, described as “pinpoint” pupils. If an overdose is suspected, the immediate response is to call emergency services, such as 911, and to administer Naloxone (Narcan) if available. Naloxone is a medication that temporarily reverses the effects of an opioid overdose by rapidly blocking the effects of the opioid on the mu-opioid receptors, which can restore normal breathing within minutes. Rescue breaths should be provided after administering Naloxone while waiting for medical help to arrive.