Updated: November 12, 2014 · 4 min read
#2 Morphine
Basic Characteristics
Morphine is an opioid pain medication made from the opium poppy. It is used to treat moderate to severe pain and is one of the world's oldest known analgesics (pain relievers). Morphine is also classified as a narcotic drug and works by changing the way the body senses pain. Morphine can be taken orally by pill or by capsule, or by methods other than through the mouth, such as by injection.Common Medication Errors Involving Morphine
According to patient safety research, wrong dosages account for a significant proportion of morphine-related medication errors, and many of these incidents result in serious harm. Misinterpreting a written order is a common cause of error. The pharmacists may read 7.5 mg. (milligrams) instead of 1.5 mg. and dispense a 7-fold overdose. Or, he or she may mistake 0.5 mg. for 5 mg. and dispense a dose ten times stronger than what was ordered. In one case, a 9 month-old baby recovering from surgery was mistakenly given 5 mg. of morphine instead of 0.5 mg. She suffered cardiac arrest and died. Medication errors in general are all too common on children's hospital wards. Studies show that medication errors — including wrong drug, wrong dosage, and wrong frequency — occur at rates up to three times higher in pediatric patients than in adults.Morphine Oral Solution
The use of morphine oral solution has caused numerous adverse drug events and deaths. The solution is available in three strengths: 10 mg/5 ml (10 milligrams per 5 milliliters of fluid), 20 mg. /5 ml. and 100 mg. /5 ml. (20 mg/1 ml.) The last and highest concentration is intended for relief of moderate to severe pain and only in patients who can tolerate opioids. A number of unintentional overdoses have occurred due to mistakes in reading milliliters for milligrams. An error of this type regarding the high concentration solution causes a 20-fold overdose. In response to these dangers, the manufacturer of morphine oral solutions has changed the color and design of the packaging; using bright labels to differentiate the strength and type of the solution and highlighting patient warnings.Morphine vs. Hydromorphone
Some patients cannot tolerate morphine or may have a kidney or liver condition that affects the use of the drug. A common alternative for treating pain is hydromorphone (Dilaudid). Oral hydromorphone is 4 times more potent than oral morphine. Non-oral (parenteral) hydromorphone is approximately 5 to 8 times more potent than non-oral morphine. The similarities in the names of the two drugs have led to inadvertent mix-ups. In addition, pharmacists may substitute hydromorphone for morphine in the mistaken belief that it is a generic replacement for morphine. Mix-ups between these two drugs outnumber those for all other drug pairs. Recently, a 69 year-old patient was mistakenly given 10 mg. of non-oral hydromorphone instead of 10 mg. of non-oral morphine and was then sent home from the hospital. The dosage was 6 to 7 times higher than what was appropriate. By the time the hospital discovered its mistake, the patient had experienced cardiac arrest and could not be revived.Preventing Morphine/Hydromorphone Errors
It is extremely important that morphine and hydromorphone be clearly marked and stored separately in medical facilities. In particular, pre-filled syringes of each drug should never be stocked together in the same strength. Pharmacy and hospital staff must be carefully instructed as to the difference between the two drugs. Before administering any narcotic, medical staff should speak to the patient and say the name of the drug out loud. This helps to ensure that the drug being administered is the one that was ordered.Sources
- FDA — Morphine Sulfate Oral Solution Prescribing Information
- ISMP — Risk Control Strategies for Reducing Patient Harm with HYDROmorphone
- NIH/PMC — Morphine and Hydromorphone: An Omnipresent Risk of Mix-ups
- PA Patient Safety Authority — Inadvertent Mix-Up of Morphine and Hydromorphone
- AHRQ PSNet — Morphine Sulfate Oral Solution Medication Use Error
- DEA — Drug Scheduling (Morphine: Schedule II)
- NIH/PMC — Opioid Medication Errors in Pediatric Practice
Contact The Orlow Firm Today
If you or a loved one has suffered harm due to a medication error involving morphine or other opioid pain relievers, The Orlow Firm can guide you as to the proper legal action. Contact the New York prescription error attorneys at The Orlow Firm for a caring and knowledgeable legal consultation.
Call (646) 647-3398 or contact us online.
The Following People Contributed to This Page
Written byParalegal & Office ManagerB.A.Sc., Political Science & Government, John Jay College of Criminal Justice (CUNY), 22+ years at The Orlow Firm, Bilingual: English and Spanish
