Among the remedies which it has pleased Almighty God to give to man to relieve his suffering, none is so universal and so efficacious as opium
— Thomas Sydenham, English physician (1624-1689)
Morphine, the principal derivative of opium, is the most widely used medicine to date for the relief of severe pain. It is sometimes known as ‘God’s own Medicine’, having stood the test of time with its consistent efficacy. It was used extensively in soldiers of war, who would sometimes become crazed due to excruciating pain, a situation that tragically exists even today, where patients continue to suffer from unbearable pain both due to a lack of knowledge, and misconceptions among professionals about this unique drug.
History and evolution
Morphine, although isolated from opium by Friedrich Serturner in 1805, came into widespread medical use only in the mid-19th century following the development of the syringe and needle. As opium caused a high incidence of addiction, Serturner modified its chemistry, isolated a compound that was less addictive and gave 10 times better pain relief than opium. It was named ‘Morphine’ after the Greek God of dreams, ‘Morpheus’. It is extracted from the opium poppy plant, Papaver somniferum: in Latin, papavar means poppy, somni is sleep and ferre means to bring.
Since then, morphine has been widely used to relieve both chronic pain caused by diseases such as cancer, and acute pain caused by conditions such as myocardial infarction and surgery.
Unfortunately, the injectable form, used liberally, led to a high incidence of addiction as well. Therefore, in the early 20th century, governing bodies worldwide, made stringent rules to prevent the abuse of morphine.
The Indian government enacted the Narcotic Drugs and Psychotropic Substances (NDPS) Act in 1985, making it near-illegal to procure morphine. The outcome was unfortunate. The enactment of the Act delayed the availability of the tablet morphine for cancer pain relief. Over the next 13 years, morphine consumption fell by 92%, with India ranking the lowest in the world in morphine consumption, leaving millions to suffer unnecessarily.
Mr. R. is one such example. An employee of the Chennai Corporation, the 36-year-old would lie on the hospital bed on all fours – the only position that was somewhat bearable with the excruciating pain he was experiencing due to advanced stomach cancer. Soon after taking morphine tablets and being relieved of pain, he lay on his back and asked, “Why didn’t anybody give me this pain medicine in the beginning? I have been suffering for so long”. His case denotes the urgent need for education in pain relief and palliative care in the country.
Developments in law
Taking note of the situation, the World Health Organization asked all governments to amend their narcotic laws to make the tablet form of morphine easily available to patients. In January 2001, the Union Health Ministry announced a relaxation of regulations regarding the sale of morphine tablets. These revised rules would allow States and Union Territories to replace the multiple agencies that originally had to be gone through, with a single agency, the State Drug Control Office. The yearly renewal of licences to be obtained by hospitals/dispensaries was replaced by a three-yearly renewal of a ‘Registered Medical Institution’ (RMI) status, to enable the stocking and dispensing of morphine tablets by doctors trained in palliative care. Kerala and Tamil Nadu were the first two States to amend their policies.
Implementation of this relaxation of the rules, however, has been time-consuming and uneven across the country.
Amendments in 2014 and 2015 to the NDPS Act then helped create a body of drugs, ‘ENDs’ (Essential Narcotic Drugs) that include morphine and other opiates. These rules, applicable to the whole country allowed for the State Drug Controller alone to approve of RMIs to stock ENDs.
Since then, India has made steady progress in accessing morphine and developing palliative care as a specialty of medicine. The Indian Association of Palliative Care (IAPC) was formed in 1994, and State-wise opioid availability workshops were held to help revise their narcotic rules.
Current status
The tablet form of morphine is effective, user-friendly, inexpensive, safe and easily available in most States in India. The tablet form is only one-third active compared to the injectable form, and can be increased without a dose limit until pain is relieved. Side effects such as constipation and nausea can easily be treated.
The 1986 WHO ‘Step Ladder’ guidelines, which advise tablet morphine at the third step (severe pain), hold good till date. Morphine is not to be reserved for the terminal stage: it is used even for treatment-related pain, as it helps patients get back to their regular lives, preventing them from discontinuing treatment and losing the chance of a cure.
The story of 17-year-old Michael, who was diagnosed with lymphoma, a type of cancer, is a classic example. He came in with severe pain caused by the chemotherapy. Since he had not received adequate pain relief elsewhere, he said, “If you can’t relieve my pain, kill me,” and also expressed suicidal thoughts. Michael’s cancer was curable. He was counselled and assured of pain relief. He took morphine tablets for a whole year, through the entire course of his treatment, during which time he did part-time jobs. The morphine was tapered off towards the end of his treatment. Michael is now married, has a child, and is back in social circulation. Without pain relief, Micheal may have ended his life or lost the chance of a cure. His case illustrates the need to start pain relief and palliative care early in the course of a disease.
Busting misconceptions
The long-held and pervasive misconception that morphine leads to addiction has to be dispelled. In order to be addictive, a drug needs to reach the brain quickly, either through injection or inhalation, to be able to give users a ‘high’. However, the tablet form of morphine is slow to get absorbed as it first passes through the liver and is most unpleasant when taken by mouth.
Morphine still remains the gold standard by which other opiate analgesics are measured. Morphine and morphine-like opioids are used world-wide to treat severe continuous (‘wound-like’) cancer pain and for selected, non-cancer pain. It is not helpful for other kinds of pain such as muscle spasms or nerve pain.
It is only with complete knowledge of its pharmacology, indications and precautions in certain patients can doctors use this drug effectively to help relieve suffering.
The fact that millions of patients have experienced pain relief and an improved quality of life, stands testimony to the fact that oral morphine does not produce addiction. Morphine consumption is, in fact, used as an index of improvement in pain management by individual countries.
(Dr. Mallika Tiruvadanan is a consultant in palliative medicine and managing trustee, Lakshmi Pain and Palliative Care Trust, Chennai.)
(This article was first published in The Hindu’s e-book, Pain and Relief: Demystifying the Science of Suffering)
Published – June 30, 2026 11:02 am IST