Diving on Morphine. Please read!

[Justarius]

Hey everyone, I have a question which I'm afraid no one can answer but I'm hoping someone has experience with.

I'll give you a little background (hopefully not too lengthy).

I'm 29 and I've been through 2 back surgeries on a ruptured L5 disc. I've had a pretty rough time over the past few years, with on and off severe pain. After my 2nd surgery I was feeling pretty good and I got PADI Open Water certified. I can't even begin to tell you the effect that had on me mentally. Battling chronic pain means battling depression and being able to Scuba Dive (a life-long ambition) was such an incredible boost. I didn't have any problems with my back since I did boat dives to limit carrying heavy equipment and I have no problems whatsoever once in the water.

However, my back took a turn for the worse about 6 months later. After another MRI I found out I have scar tissue from my last surgery causing chronic pain and it could be a lifelong thing. The good news is my back is actually fine! I can Scuba, I can weight train, I can do whatever I want as long as I can handle the pain. Enter the topic of this message...

My doctor got me going on 2 drugs for chronic pain and both have been successful enough that I'm back to work and living a relatively normal life. The 1st is time-release morphine pills. A relatively low dose. 45mg at night and 30mg in the day. The 2nd is a drug designed to block scar tissue pain (Neurontin). I believe it also has applications for blocking seizures but that has nothing to do with me.

I'm taking a Caribbean cruise in 2 weeks for a friend's wedding and I can't even begin to tell you what it would mean to me if I was able to dive.

I consulted my doctor but he wasn't much help and admitted he knows little when it comes to diving. His concern is that morphine affects blood pressure (lowers it) and so does diving. I believe he incorrectly thinks diving also lowers it (when in actuality it raises it slightly). He did not think the Neurontin would pose any problems. I suggested going off the morphine in order to dive but he pointed out that even if I wanted to go off it, I would need something like a month to go off it properly. Right now that isn't an option.

I called DAN to ask about the morphine but they couldn't really say. The big concern seems to be experiencing the surface side effects that SOME people have (drowsiness, dizziness, etc.) while diving. Since I don't experience any surface side effects, I was hoping diving wouldn't be a problem. The DAN rep basically said no studies have been done and individual results may vary. His one piece of advise would be to stay below 100 feet (I think PADI Open Water is only 60 feet anyway).

Does anyone know anything about this issue? Has anyone dove while on Morphine or knows someone who has?

I was totally crestfallen when I got the news I may not be able to dive so I'm pursuing every possible angle. Thanks for your time and sorry about the novel!

Anthony

 

[sharpenu]

Before giving specific advice, let's look at the effects of Morphine:

an opioid agonist (narcotic): side effects include: respiratory depression, dizziness, hypotension, sedation, euphoria. The depressant effects of morphine are potentiated by the presence of other CNS depressants such as alcohol, sedatives, antihistaminics, or psychotropic drugs. Use of neuroleptics in conjunction with oral morphine may increase the risk of respiratory depression, hypotension and profound sedation or coma.

Stopping the morphine abruptly in order to dive is inadvisable, as abstinance syndrome and associated withdrawals may occur. Diving with morphine, I would think would possibly make Nitrogen narcosis more pronounced or would increase the likelyhood of respiratory depression.

 

[cornfed]

Anthony,

Isn't morphine a narcotic? I don't care if only some people exeperience side effects from it. I wouldn't be comfortable with a buddy that was taking a controlled substance. Sorry.

 

[saf_25]

Diving with morphine alone just doesn't sound like it would be a good idea, but I also wouldn't write off the effects of Neurontin, either. I'm not a doctor, but I know that my grandmother had been on low doses of that, and it made her extremely sleepy and disoriented (very confused and unable to think clearly). When we discussed this with the doctor, he said that these were normal side effects that most people on the drug experience to some degree. Now, I know you say that you don't experience these effects on land, but from my understanding, the pressure can make your body absorb and respond to medications differently, so you're really not sure how you will respond in that situation.
Maybe you should try calling DAN again and having them put you in touch with a local dive doc who can discuss your specific case and other possible solutions with you? At the very least, make sure you have a good buddy who knows your situation and is competent to respond if you should have a bad reaction in the water.
I know it sucks to think about having to postpone a dive trip, so hopefully it will work out for you, but I personally feel that it's better to play it safe and not dive this trip (maybe by the next one you'll have more time to plan out a strategy to work off the drugs) than to risk it and end up putting your own and others lives in danger.

 

[Diver0001]

cornfed once bubbled...
Anthony,

Isn't morphine a narcotic? I don't care if only some people exeperience side effects from it. I wouldn't be comfortable with a buddy that was taking a controlled substance. Sorry.

From what he said it doesn't sound like there's much evidence to make the call one way or the other. It kind of reminds me of being lost in the forest and wondering what to eat. I was taught to first take small bites of unknown "foods" and wait to see how you feel. If you're ok, take bigger bites.

Anthony, why don't you look for a non-narcotic way to control your pain? Apart from the unknown possible effects of this drug under pressure, morphine isn't a very good long-term solution for pain control, but I'm sure you know that. IIRC it has an addictiveness on the same order as heroin. Meanwhile, what about snorkelling to be on the safe side?

R..

 

[pipedope]

Best is if you can find a really good Dr who dives and knows both the bone/muscle aspects and the neurological.

The surgeon who did my back disk job and fusion (L5-S1, L4-L5) was excellent. His name is Curtis Spencer III and he practices in the Sports Medicine Clinic in Long Beach California. At least he did some 15 years ago.

If you were on a boat with me and seemed to be a responsible diver I would dive with you. That said, it would be easy dives, far from NDL limits. I suspect that both the aftereffects of the back injury and surgery along with the drugs would complicate diagnosis and treatment of any DCI (decompression illness).

Your mission is to find that one great Dr who can undersatnd your situation and is a diver and is well versed in diving medicine.

Good Luck!

 

[cdiver2]

I know its a long shot and a L/distance call but this guy was recomended to me by DAN after I had been diagnosed with a stroke. After seeing him it turned out it was not a stroke but a major vertebra problem in the neck. Dr Paul Buza, D.O. , A.M.E. he is the medical director for (and runs) Sami Spacecoast Aeromedical Institute. Hope he can help.

 

[bridgediver]

for a definitive answer you need to consult a doc that specializes in diving medicine.

Having said that my feeling is similar to sharpenu's. Morphine is a very potent drug and it is also combined with your neurontin. Probably the biggest effect of morphine is respiratory depression more so than hypotension and probably your biggest concern when related to diving.
Codeine is not even recommended to be taken prior to diving. Morphine is about 10X stronger than demerol which is significantly stronger than codeine so the fact that your morphine dose is low is only comparative to other morphine doses.
I understand that you want to get back diving again but is it worth the risk?

 

[Frank O]

I'm not even remotely qualified to answer your questions, but just as a data point, I know someone (actually a non-diver) who is on the same medications you are for chronic pain -- time-release morphine (oramorph) and neurontin.

My impression from observing my friend is that the morphine doesn't seem to make an appreciable difference in alertness (constipation seems to be a major drawback of being on painkillers). However, the neurontin can cause drowsiness. As someone else suggested, I wouldn't dismiss the neurontin but would check it out at least as carefully as the morphine. Good luck!

 

[smrtblnddiver]

cornfed once bubbled...
Anthony,

Isn't morphine a narcotic? I don't care if only some people exeperience side effects from it. I wouldn't be comfortable with a buddy that was taking a controlled substance. Sorry.

I would have to agree on this one.