Embeda: Uses, Side Effects, Abuse and More

Embeda is a discontinued combination drug of long-acting morphine and naltrexone. If you or a loved one were ever prescribed Embeda before its discontinuation in 2020, you may have questions about the drug, especially if you still have a supply at home. It is important to understand the risks and benefits of Embeda.

What Is Embeda (Morphine and Naltrexone)?

Embeda was a brand-name drug that combined the opioid pain reliever morphine and naltrexone. The FDA approved Embeda in 2009, the only extended-release morphine drug of its kind. Embeda was prescribed to manage long-term, severe and around-the-clock pain. Embeda was used when non-opioid or immediate-release opioids weren’t providing enough pain relief to patients, or they couldn’t handle these medications. Embeda wasn’t intended for acute or as-needed pain management. The naltrexone was included in the Embeda formulation as a misuse-deterrent, although this inclusion doesn’t eliminate the risk of misuse. Naltrexone was believed to reduce or eliminate the euphoric effects of Embeda if it was misused. Naltrexone can also trigger sudden withdrawal symptoms in someone addicted to opioids. Naltrexone is classified as an opioid antagonist, meaning it works in the brain to prevent opioid effects. It can also reduce cravings for opioids in people going through withdrawal.

The naltrexone in Embeda is called sequestered naltrexone. When used as directed and prescribed, the morphine in Embeda was released into the individual’s system, and the naltrexone went through the gastrointestinal tract but wasn’t absorbed. Theoretically, when used as prescribed, the naltrexone would not affect the individual. However, if someone were to crush or chew the capsules, the naltrexone could reverse the effects of the morphine. The naltrexone in Embeda was encased in a specialized film that wasn’t digested. However, it broke open when there was a physical disruption to the morphine pellets. The effects of Embeda may be less appealing than other opioid drugs, but that appeal may not disappear altogether.

The primary difference between Embeda and other extended-release versions of morphine was the misuse-deterrent naltrexone. Other extended-release versions of morphine that don’t contain naltrexone include Avinza and MS Contin. Embeda was available in 8–100 mg and usually taken every 24 hours for continual pain treatment. Embeda was usually taken every 24 hours for continual pain treatment. Despite the inclusion of misuse-deterring naltrexone, risks were associated with using Embeda. This medication shouldn’t have been prescribed to people with a history of drug misuse or mental health disorders. There was also a risk of overdose associated with the use of Embeda. Common possible side effects of Embeda included: 

• Nausea
• Vomiting
• Constipation
• Dizziness
• Drowsiness 
• Abdominal pain

What Does Embeda Look Like?

Embeda came in capsule form, like many controlled-release and extended-release drugs. The capsules were different colors based on the dosage. The following were the available Embeda doses and a description of what they look like:

• Embeda 20 mg: This capsule was yellow and was printed with Embeda 20.
• Embeda 30 mg: This purple capsule was printed with Embeda 30.
• Embeda 50 mg: The 50 mg Embeda capsule was blue and printed with Embeda 50.
• Embeda 60 mg: This red capsule was printed with Embeda and 60.
• Embeda 80 mg: The 80 mg dosage was two-toned and peach-colored.
• Embeda 100 mg: A 100 mg dose of Embeda was green. 

The amount of naltrexone in each dosage differed depending on the morphine strength.

How Was Embeda Used?

Embeda was reserved for people in a very specific category of pain. Not everyone with pain was a candidate for Embeda, and doctors had to choose Embeda patients carefully. Those who may have been considered for Embeda included:

• Those seeing a doctor familiar with chronic pain management
• At higher doses, those already used to taking opioids
• Those who could swallow the capsules intact

How Embeda Worked

The morphine component of Embeda worked similarly to other opioids. The opioid component activated mu opioid receptors in the central nervous system, blocking pain perception. This gave Embeda its analgesic effect.

The naltrexone component of Embeda worked as a deterrent for those who would otherwise have tried abusing the drug by dissolving it and injecting it. The naltrexone would not activate unless the morphine pellets in the Embeda capsules were disturbed. When activated, they would block morphine’s effects, preventing someone from getting high off the medication.

Drug Interactions With Embeda

Embeda’s drug interactions were similar to those of other opioids and included:

• Antidepressants and other drugs that could increase serotonin, including MAOIs, which can cause serotonin syndrome
• Other opioids which could worsen Embeda’s side effects or stop the drug from working
• Alcohol, which can increase morphine levels in the body
• Benzodiazepines and other central nervous system depressants which intensified Embeda’s side effects
• Muscle relaxants, which worsened Embeda’s side effects
• Cimetidine, which worsened Embeda’s side effects
• Diuretics, which may not have worked as well if you took Embeda
• Anticholinergic drugs, which could worsen constipation or urinary retention on Embeda
• Drugs that inhibited a chemical called P-glycoprotein, which could lead to higher than expected amounts of morphine in your body

Pharmacology of Embeda

Embeda contained extended-release morphine pellets that slowly released morphine compared to short-acting morphine alternatives. For example, after taking short-acting morphine, about half would reach the bloodstream within 30 minutes, compared to eight hours for Embeda. 

In most people who took the drug by mouth as directed, little to no naltrexone was released into the body. However, around 2% of people showed low naltrexone levels in their bloodstream. For those who took the drug other than prescribed — including crushing or chewing the capsules — up to 100% of the naltrexone could be released into the body.

Embeda Dosage and Administration

Embeda was taken once or twice daily, depending on the person’s need. The drug was available in the following strengths:

• 20 mg
• 30 mg
• 50 mg
• 60 mg 
• 80 mg
• 100 mg

Only people tolerant to opioids were prescribed Embeda 100 mg/4 mg capsules, a dose higher than 60 mg/2.4 mg or more than 120 mg/5 mg.

Embeda Side Effects

Embeda’s side effects were very similar to other opioids and included:

• Constipation
• Nausea and vomiting
• Drowsiness
• Dizziness
• Itchy skin
• Dry mouth
• Headache
• Fatigue
• Insomnia
• Diarrhea
• Upper abdominal pain
• Flushed skin

As an opioid, Embeda also carried a risk for abuse, dependence, addiction and overdose.

Precautions for Embeda Use

Although most people could take Embeda without a problem if they took the drug as prescribed, some needed to avoid Embeda entirely or only take it with close monitoring. This was because Embeda might have been riskier in particular people.

When Not To Use Embeda

Experts advised avoiding Embeda if a person fit certain criteria. These criteria made the drug riskier and increased the risk of complications or side effects. They included:

• Significantly slowed breathing
• Severe asthma or current asthma attack
• Using an MAOI within the past 14 days
• An intestinal or bowel obstruction
• Allergy to morphine or naltrexone

Considerations Prior To Use

Some people needed closer monitoring while taking Embeda. Specifically, experts advised avoiding or using the drug with caution in those with:

• Chronic lung disease
• Elderly, frail or debilitated patients
• Adrenal insufficiency
• Severely low blood pressure
• Increased intracranial pressure
• Brain tumors
• Head injury 
• Impaired consciousness or coma

Embeda Addiction

Embeda carried a high risk of abuse, addiction and dependence as a Schedule II controlled substance. If you or a loved one were prescribed the drug, it was important to take it as prescribed and no differently than your doctor ordered

Is Embeda Addictive?

Morphine is a powerful opioid pain reliever. Opioids are highly addictive drugs. The opioid drug class includes prescription pain medications and heroin. These drugs bind to specific receptors and can create a sense of euphoria. That then creates a pleasure and reward response and a reinforcement response in the brain. These effects lead to addiction. On its own, morphine is very addictive due to how it affects the brain. The theory is that since Embeda contains naltrexone and is designed to lower the risk of intranasal, injectable and oral misuse, the potential to become addicted is lower. However, despite the misuse-deterrent properties of Embeda, the risk of addiction isn’t altogether gone. Any opioid product, including anything with morphine, has the potential for misuse and addiction.

Reach out to our team at The Recovery Village. There’s no better day than today to make the first step, and we’re available.

Symptoms of Embeda Addiction 

Misuse of Embeda can include emptying the medicine from the extended-release capsules and snorting or dissolving and injecting it. This causes a rapid delivery of the morphine in the drug all at once. Other symptoms of Embeda misuse include:

• Using it without a prescription
• Taking a dose other than what was prescribed
• Experiencing withdrawal symptoms if they are addicted to opioids
• Trying to stop Embeda unsuccessfully
• Secrecy and withdrawing from friends and family
• Mood swings or changes in behavior
• Loss of interest and a decline in performance at school or work
• Changes in appearance
• Risk-taking behavior

Effects of Embeda Addiction

One of the main side effects of Embeda misuse is immediate withdrawal when stopping drug use. Additional side effects of Embeda addiction may look like more severe versions of the side effects an individual experiences when taking the drug as prescribed. These include:

• Drowsiness
• Dizziness
• Nausea
• Vomiting

Long-term use of Embeda and other opioids can lead to:

• Reduced pain tolerance
• Depression
• Anxiety
• Damage to the respiratory system
• Brain damage (from lack of oxygen)
• Liver damage (from naltrexone)

Embeda Overdose

Embeda is a potent opioid drug that can cause respiratory depression and death, even when taken as prescribed. Morphine is very potent, and despite the naltrexone, an opioid antagonist, it is still possible to overdose. The risk of overdose is higher in people who:

• Have no previous experience using opioids.
• Take a larger dose or take Embeda more often than prescribed.
• Use Embeda in any way other than prescribed, such as crushing, breaking, chewing, snorting or injecting it.
• Use Embeda with alcohol or other central nervous system depressants, such as benzodiazepines or prescription sleep aids.
• Have stopped using opioids and then use Embeda again, as they may have a decreased tolerance to the drug.

Embeda Withdrawal and Detox

Embeda withdrawal can occur in two ways:

• Sudden withdrawal: If someone dependent on opioids takes Embeda, the naltrexone in the drug can block the effects of the opioids and cause sudden withdrawal symptoms. This can be very dangerous, and it is important to seek medical attention if it occurs.
• Gradual withdrawal: If someone has been taking Embeda for a long time and becomes dependent on the morphine in the drug, they may experience withdrawal symptoms if they stop taking it. These symptoms are usually not as severe as sudden withdrawal, but they can still be uncomfortable.

Possible Embeda withdrawal symptoms include:

• Restlessness or irritability
• Watery eyes
• Runny nose
• Chills
• Sweating
• Muscle aches and pains
• Dilated pupils
• Anxiety
• Joint and bone pain
• Weakness
• Abdominal cramping
• Insomnia
• Nausea and vomiting
• Diarrhea

Embeda Withdrawal Timeline

Embeda is an extended-release variation of morphine, so withdrawal symptoms can take up to 30 hours to begin. They may last longer than symptoms would last with an immediate-release opioid. For most people, the worst withdrawal symptoms will occur in the first week after the last drug dose is taken. However, with Embeda, it could be more than a week before symptoms start to subside. Ongoing withdrawal symptoms may last several weeks or even months in some cases. These longer-lasting withdrawal symptoms tend to be psychological, such as depression or anxiety.

Embeda Detox

Embeda detox is the process of safely and comfortably withdrawing from the drug Embeda. Several different FDA-approved medications can be used to help with medical Embeda detox. Experts recommend methadone or buprenorphine-based products as medication-assisted treatment (MAT) when medically appropriate.

The time it takes to complete medical Embeda detox will vary depending on the individual. However, most people will need to stay in a medical detox facility for at least a few days. After medical detox, the patient can move on to other forms of addiction treatment, such as therapy or counseling.

Treatment for Embeda Addiction

There are many different rehabilitation programs available for people struggling with Embeda addiction. While each program may have its unique approach, some core concepts should be consistent across all programs that you will want to look for:

• Individualized treatment plans: The program should account for the person’s history of addiction, mental and physical health and personal goals for recovery.
• Licensed and accredited: This ensures the program meets certain quality and safety standards.
• Dual diagnosis treatment: The program will address the addiction and accompanying issues like mental health disorders. 
• Addiction as a chronic disease: The program views addiction as requiring long-term treatment and management.
• Whole-person approach: The program should address the entire person’s needs, not merely what can be relegated to “the addiction.”

The Recovery Village is proud to offer services with these. 

Inpatient Embeda Rehab

Inpatient rehab can be a good option for people with severe Embeda addiction. These programs offer a safe, supportive and supervised environment where participants can focus on their recovery without distractions. Inpatient rehab can also address mental and physical health needs, and therapy is offered in individual and group settings. After completing an inpatient program, participants may move into outpatient care or a sober living facility.

Outpatient Embeda Rehab

Outpatient rehab is a less intensive form of addiction treatment than inpatient rehab. Participants can stay home and continue their daily routines while attending treatment or therapy sessions. Outpatient rehab can include drug education, intensive group or individual therapy, family or couples counseling or participation in a 12-step program. The amount of time required for outpatient rehab varies, but it can be as little as one hour per week or as much as several sessions throughout the week.

Outpatient rehab is a good option for people with a supportive home environment who can maintain their jobs while in treatment. It is also a good option for people who prefer treatment in a less structured environment.

How Long Does Embeda Stay In Your System?

The half-life of a drug is the time it takes for half of the drug to be eliminated from the body. The half-life of morphine in Embeda is 29 hours, which means it takes about 145 hours for a dose of Embeda to be fully eliminated from the body. However, many factors can affect how long Embeda stays in your system, including:

• Age: Older people tend to have longer drug elimination times than younger people.
• Metabolism: People with a fast metabolism usually excrete drugs from their systems faster than people with a slower metabolism.
• Health and hepatic function: A person’s overall health and hepatic function can also affect how long a drug stays in their system.
• Hydration: Drugs like Embeda are excreted in urine, so staying hydrated can help speed up the elimination process.
• Dosage: The amount of Embeda taken can also affect how long it stays in the body.
• Other substances: If Embeda is taken with other substances, this can also affect how long it stays in the body.
• Body weight and body fat percentage: Body weight and body fat percentage can also play a role in how long a drug stays in the body.

If you are concerned about how long Embeda will stay in your system, you should talk to your doctor. They can help you understand the factors that may affect your elimination time and answer any other questions.

Mixing Embeda and Alcohol

Embeda should never be mixed with alcohol. Ingesting both substances can lead to serious, life-threatening or deadly respiratory depression.

Alcohol is also a central nervous system (CNS) depressant. When combined with Embeda, the slowdown of the respiratory system can become so profound that a person can suffer brain damage, go into a coma or die. Additionally, alcohol can affect how Embeda is metabolized, which can increase the concentrations of the drug in the bloodstream. All of these risks are more likely when someone misuses Embeda by crushing or breaking the capsule and releasing all of the morphine into their system at one time.

If you take Embeda, it is important to avoid alcohol and other CNS depressants. Talk to your doctor if you have any questions or concerns about taking Embeda.

Embeda and Pain Management

Although Embeda is no longer manufactured, drugs like Embeda, which are abuse-deterrent, are the new frontier for pain management. By helping people avoid the temptation of abusing the opioid, doctors can instead focus on helping people treat their chronic pain.
Nonetheless, Embeda addiction was possible. If you or a loved one are concerned you may be addicted to Embeda or another opioid, help is available. Contact The Recovery Village today to see how we can help you overcome your opioid addiction for good.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more