Nth stage analgesics

Any medicos out there? This one’s for you mostly.

I read somewhere that it’s been found that for patients in the final stage of cancer, heroin is better than morphine to keep them comfortable. The reasoning is that for the dosages needed to fight the pain, heroin will leave the patient more lucid and able to carry on conversations with family members than morphine will.

Any truth to this?

double post

I have never heard this and it sounds like utter BS. To start with (in the US at least) heroin is not legally available and so the purity is unknowable. Perhaps someone has let their junkie friend dose up dying mom, but I think that would be a rare situation.

I’m curious where you heard this.

It is utter BS, according to the National Institute on Drug Abuse

(emphasis added)

Heroin is legal for the terminally ill in Europe, last I heard, so it may be possible to answer the question one way or the other.

I practice hospice medicine, and it is not true. Between morphine, dilaudid, fentanyl and benzos we can tame almost anyone’s pain and maintain lucidity until the disease process runs its course. Dilaudid in particular is on par with heroin for pain relief and anti anxiety effect without excess sedation.

In an admittedly less than exhaustive Google search for “prescribing heroin in Europe” , I find it used for, unsurprisingly, heroin addiction.

Broomstick, I do find a Wikipedia mention of using heroin subcutaneously for palliative care in the UK. Because heroin is both more concentrated and fat soluble than morphine. I can’t find how common such use is.

My fiancé (who had pancreatic cancer) was able to get excellent pain relief without drowsiness with methadone, plus an occasional Percocet for breakthrough pain.

My husband’s bladder cancer metastasized to his bones and spine before the end, but in his case, too, he was maintained pain-free and lucid up until a half an hour before he died. We were able to converse with him to that point and he was able to tell us that his pain was controlled.

We have used those agents too, in select patients with good results. I am glad it helped, and sorry you experienced that.

As heroin is just a concentrated form of morphine – the same active ingredient – I don’t see any pharmacological reason for these drugs to work any differently.

Untrue; heroin is a whole different molecule, it has an extra acetyl group which causes it to cross the blood-brain barrier faster, and its binding affinities to the opioid receptor are also different. The two different drugs have significantly different pharmacokinetics though both are opiates that cause analgesia, somnolence, nausea, constipation, respiratory depression, pruritis, and other classic effects.

That’s fascinating. Adding an extra bunch o’ atomic stuff to a molecule makes it more able to cross the blood-brain Berlin Wall?
I woulda thought that the smaller the molecule, the easier it would be to slip through.

It is still a small molecule, but the addition changes its shape to one more amenable to crossing the barrier.

Anecdotal, but my mother claimed that she was given heroin after her pneumonectomy in the mid 1950s because her pain was not controlled by morphine. She was notoriously resistant to painkillers, I recall after a much later surgery her doctor commenting that they had to give her a way higher dose of morphine than expected given her 4’11”/80lb size. Not relevant to the OP, but if true an indication that heroin could be prescribed in the US at one point.

Thanks as ever to Qadgop the Mercotan, MD.

They used to use something called a Brompton cocktail that had heroin and cocaine to counteract the drowsiness, but I don’t think they do that anymore. Cocaine AFAIK is poorly absorbed from the gastrointestinal system, but what do I know.

They are much better IME at managing pain in terminal cases. When my beloved uncle was dying of cancer his big complaint wasn’t pain, it was constipation. But the idea was to keep him comfortable first, and worry about addiction hardly at all - he wasn’t going to be addicted for long in any case.

No idea if the pendulum swing nowadays back against opiates has affected that - I hope not, at least for terminal cases.


heroin manufacturing by pharmaceutical companies was banned in the US in 1924. Hospitals and physicians were allowed to continue prescribing whatever they had left until it ran out. I doubt any would have lasted into the 1950s in the US.

Physicians began prescribing dilaudid in 1926, and many former heroin users embraced this as a substitute for heroin, due to its more intense euphoria an d relief of acute severe pain compared to morphine.

It’s called diamorphine when prescribed in the UK. I’ve seen a nurse administering it to an elderly patient. Obviously as a controlled drug there are special rules for storage, signing for it, etc.

Makes sense. Maybe they told her “hydromorphone” and she remembered it as “heroin” - in any case something way stronger than morphine. It was a pretty brutal surgery, done in a TB sanatorium.

This exists in Switzerland :
Heroin Prescription Therapy (HeGeBe)
Heroin prescription therapy (also known as HeGeBe, from “HEroinGEstützte BEhandlung”) is aimed at highly heroin addicts who cannot be helped in any other way. Leads a regulated and controlled prescription of diacetylmorphine (pharmaceutical heroin),
a complete psychosocial accompaniment, e
medical treatment.
Heroin prescription therapy was first tested, between 1994 and 1996, as part of a nationwide cohort study. By means of the urgent federal decree of 9 October 1998 (see Art 8. para. 6-8 of the Federal Narcotics Act) and the decision of 8 March 1999 concerning the medical prescription of heroin, then entered a distant part of the so-called “4-pillar policy”. In 2003, the federal decree was extended until the end of 2009…"