About 5,000 years ago, poppy fruit was called "happy plant" by the Sumerians, and in the 3rd century BC, the Greeks called it "the flower of divine dreams", and in the "Compendium of Materia Medica" written by Li Shizhen in the Ming Dynasty, it is recorded that poppy can "cure diarrhea, moisturizing and pain relief".
In 1804, the 21-year-old German pharmacist Zeltina first isolated a monomer compound from the poppy, and he tried to mix a small spoonful of dog food, only to fall asleep on the floor after a few minutes, beating it with a stick and not waking up. In order to explore the mystery, he ate a little himself, and as a result, he fell asleep and even almost died. He was very happy to find that the compound had an analgesic effect that made people think of it like a dream. So he borrowed the name of Morpheus, the god of dreams and sleep in Greek mythology, and called this compound morphine, creating a precedent for finding active ingredients from natural products. This great achievement is not only a sign that human beings began to use pure monomer compounds as drugs, but also a sign that the initial stage of natural medicinal chemistry began to take shape.
The important role of morphine is analgesia, especially the advent of morphine controlled-release tablets, which increases the safety of drugs, enables the continuous release of drugs, prolongs the analgesia time, and avoids drug dependence, which is conducive to long-term administration, more in line with the needs of chronic pain or cancer pain patients, it should be said that "merit is immeasurable".
Morphine comes in tablets, oral patches, injections, sustained-release and controlled-release formulations. As a natural anesthetic and a powerful analgesic, morphine injection and common pills are suitable for acute sharp pain that is ineffective with other analgesics, such as severe trauma, war wounds, burns, advanced cancer and other pains; for myocardial infarction and normal blood pressure, it can calm patients and reduce the burden on patients; for cardiogenic asthma can temporarily alleviate the symptoms of pulmonary edema; anesthesia and preoperative administration can keep patients calm into drowsiness; can not be used alone for visceral colic, should be combined with effective antispasmodic drugs such as atropine; morphine retardation, Controlled-release tablets are mainly used for analgesia in patients with severe cancer pain.
When applying morphine, attention should be paid to:
(1) Patients known to be allergic to morphine, infants, newborns, pregnant and lactating women, maternal, respiratory depression has shown cyanosis, increased intracranial pressure and head injury, bronchial asthma, pulmonary heart disease, hypothyroidism, cortical insufficiency, prostate enlargement, dysuria and severe liver dysfunction, shock has not been corrected, paralytic intestinal obstruction and other patients are banned;
(2) Morphine can affect the ability to drive and operate machinery, and drivers of vehicles and boats should avoid driving or operating machinery after taking it;
(3) Slow and controlled release tablets must be swallowed in their entirety;
(4) Abuse of oral drugs without gastrointestinal route can cause serious adverse reactions and even death;
(5) For patients with severe cancer pain, the dosage should not be too strictly limited, resulting in insufficient medication, and should be used according to the actual pain of the patient;
(6) For patients with a history of epilepsy, morphine can lower the seizure threshold and induce seizures.
At present, the Chinese government and health administrative departments at all levels adhere to the people-oriented concept, give unprecedented care to cancer patients, issue documents for cancer pain problems many times, organize various seminars and academic exchanges, and promote the popularization of cancer pain relief principles in China. More than 20 years of practice have proved that true addiction does not occur when treated strictly according to the "three-step pain relief principle".
In the past 30 years, the use of morphine in China has increased rapidly from less than 2 kilograms in 1980 to nearly 300 kilograms per year, but it is still far from the actual demand. So far, there have been no medical reports of psychological dependence on cancer patients due to the use of morphine, and the rational application of morphine is still "a long way to go".
Article Source:
The Fourth Clinical Medical College of Peking University; Beijing Jishuitan Hospital Zhang Shige