Why can we give dying patients Morphine and not Heroin?

Of course I know that Heroion is a Schedule I (or is it C) narcotic and not approved for any legal use. But my question has to do with exactly why this is the case. IF Heroin is more effective at controlling certain types of pain (and I don’t believe that this has been established in part because I doubt there have been too many clinical studies on this narcotic) then shouldn’t it be utilized especially for terminal patients with uncontrolled pain? By the way what is the chemical difference between heroin and morphine and how does this relate to their physiological effects?

Morphine is a synthesized opiate made in a LAB.
Heroin is a natural opiate made from opium grown by guys in afghanistan.

The safer, more dependable option is the morphine. I’m sure you’d have all kinds of problems with dosage and safety if you used a natural opiate.

Oh, and by the way. THere is no pain that morphine will not take away, the problem is it also knocks you out. There’s no difference between the pain reducing effects of heroin and morphine.

Sorry, Cat but that’s not really very correct.

Heroin is di-acetyl morphine. It is made in a lab. It is produced by chemically treating morphine. Morphine is the main active molecule in opium.

And there’s plenty of pain reducing difference between the two. Heroin binds much more tightly to the opiate receptors than does morphine, and it crosses the blood-brain barrier much much better and faster. As a result, the euphoric side-effects are more intense than with most other opiates, which is what earned it the Schedule I status.

And there’s tons of pain morphine won’t take away, or any other opiates, frankly. Visceral pain often responds poorly to opiates, unless it’s due to colonic spasm. Neuropathic pain doesn’t really get much better than opiates.

As for treating terminal pain with Heroin, frankly between things like immediate-release morphine, fentanyl patches, methadone cocktails, etc. I’m not sure that Heroin would be any better than those sort of properly prepared mixes.


I beg to differ. One time, directly post-surgery, I got a blood infection, spiked a very high fever which caused uncontrollable shivering. The shivering made the incision hurt worse than you can possibly imagine. The doctor gave me so much morphine that it suppressed my breathing and lowered my blood pressure to a dangerous level; if they had given me more morphine, it would have killed me, but I was still in a good deal of pain.

Morphine is a natural opioid, made from the opium poppy.
Heroin is a semi-synthetic opioid, made from morphine.

See Frequently Asked Questions About the Opioids.

Like when I saw Godfather III? I think it gave me both.

Well, I’m not saying that Heroin necessarily should be used or that it offers any unique benefits (one can imagine that lesser doses than morphine might be utilized if it binds better, possibly although not necessarily reducing deliterious side effects such as respiratory depression). What I am suggesting is that any such decision should be based upon clinical studies and objective evidence rather than knee jerk reactions conditioned by decades of societal struggle against drug addiction.

Ideally, yeah. Do you see that happening with Heroin in today’s political climate?

Besides, who’d invest the time or money to do the study? Heroin is off patent, noone’s gonna make a ton of money off it except illegal narcotic dealers. We’ve already got effective meds approved which seem to do the trick. Kind of a moot point, I fear.

One question, and it isn’t rhetorical—I really am asking a question. Is heroin commercially available for human clinical use? If the answer to this question is no, then that provides the simplest answer to the OP yet offered.

Washoe, that would answer the question from a practical, but not philisophical standpoint. What I am suggesting is that such research should be conducted and decisions should be based upon observations. If the drug is not patentable (and therefore less profitable) perhaps an entity such as the NIH could fund the studies. Furthermore, perhaps the molecule could be slightly modified (even if only to effect it’s release or half-life rather than action) so as to make it patentable. My point is that we should evaluate it from the standpoint of a useful molecule (if indeed it is).

Qadgop: You’ve already covered the main reason why morphine can be used medically (in North America) and heroin cannot: heroin crosses the blood-brain barrier and causes euphoria along with profound analgesia, while morphine does not cross the BBB as effectively and causes less euphoria. Heroin is simply the diacetyl ester of morphine; both hydroxyl (OH) groups in morphine (the ‘claws’ of the morphine molecule – I’ve always thought morphine looks like a mouse or something) have an acetyl group added, so you have R-O(C=O)CH[sub]3[/sub] instead of R-OH. Replacing the polar hydroxyl groups with non-polar acetyl esters makes heroin much less polar than morphine. Thus, heroin is less soluble in water and more soluble in fat than morphine, and consequently heroin is more able to pass through the blood-brain barrier.

The drugs are made water-soluble by treatment with hydrochloric acid to make a hydrochloride salt, which has the effect of making the drug more polar and thus more soluble in water in the injectable solution or in the digestive system. (The latter only applies to morphine; heroin can’t be administered orally because it is deacetylated in the liver. It probably still functions as morphine, but in order to reach the brain as heroin it must be injected.) Most likely, the drugs in the bloodstream consist of a mixture of protonated and deprotonated molecules – I’m not sure about this, but maybe only the deprotonated ones pass through the BBB, though of course the equilibrium would maintain a constant amount of deprotonated drug in the bloodstream as the drug is taken up by neurons.

Apparently heroin is still available by prescription in the UK, but I don’t know how up-to-date this information is or how often it would be prescribed. You might’ve heard of the Brompton cocktail (which as far as I can tell is no longer used) – a mixture of morphine or heroin, cocaine, alcohol, chloroform, water and flavoring given to terminally ill patients to alleviate their suffering. While I think few people would be opposed to giving a dying person a very powerful analgesic (even if it does make them euphoric and is highly addictive), there would probably be issues with illegitimate prescriptions, diversion and theft if heroin were available medicinally. I’m not sure how much illegal use of medicinal heroin occur(s/ed) in the UK, though.

Washoe: As far as I know, it’s not available in the US for routine clinical use, but I should mention that it is possible to purchase heroin legally if you have a license to possess Schedule 1 controlled substances for research or law enforcement purposes. For example, a research scientist might need heroin to test its effects on animals or see if a new drug might be helpful in treating heroin addiction, a police forensics lab would need small amounts of absolutely pure heroin to determine whether a suspected substance was heroin, and a medical toxicology lab might need it to determine the amount of heroin in an possible overdose victim’s bloodstream.

Heroin and other controlled substances are included in the Sigma-Aldrich catalog (the standard catalog for ordering fine chemicals). As with most chemicals, there are ranges of qualities depending on the intended use (samples for analytical purposes must be more pure than samples for animal testing, for example). As I mentioned, you need a special license to order them, though the prices are fairly similar to chemicals of similar complexity and rarity.

Gee, welcome to “our side” of the Drug War.

Here’s a question: are there any studies showing that opiate euphoria, in and of itself, can further reduce pain or the perception thereof? I just read an article about how VR scenarios can be used to alleviate the pain severe burn patients experience, by distracting them during exceptionally painful procedures like changing dressings. It makes me wonder if the euphoric effects of a heroin-like drug, aside from the sheer pain-reducing effects, could further decrease a patient’s perception of pain.

Heroin has been studied.
Various cancer research centers in the US and England tested a number of alternative drugs as treatment of side effects from irradiation and chemotherapy. They were done in the mid '70s.
The study I’m most familar with, measured the level of pain relief compared to the side effects. Example: Comparing morphine and heroin, the same level of relief Heroin caused significant respiratory depression and severe disorientation, where morphine caused mild to moderated respiratory depression and moderate sleepiness, without disorientation.
I’m sorry I can’t give a site. I never actually saw the published results, I just collected data. I did see an early draft.
There are analgesics that relieve pain better than morphine, depending on the cause. Fentanyl, Tramadol As QtM said, visceral pain, bone pain, and kidney pain are very difficult to control.
In the critical care setting, pain control is a big priority. The way the drug is delivered is as important as which drug is used.

Here is a site that gives extensive information on drug research. The site is layman-friendly, but comes from a healthcare provider webring.

Euphoria can certainly reduce the perception of pain, whether it comes from an opiate or other medicine – many palliative patients do take antidepressants. Morphine, fentanyl, etc. do a good job of controlling some types of pain. Nausea and vomiting is also a severe problem in many palliative patients and the drugs vary in terms of how much nausea they cause; this is independent of euphoria, and also needs to be considered. I can’t see the NIH studying heroin, and I think any benefits of heroin over morphine may well be modest.

Could you state that in more technical terms, Roche? I think I understtod a few words. :wink:

I’m not familar with any studies specific to drug euphoria, but distraction & visualization have been studied. Many procedures need the patient to be alert, and/or are of such short duration that pain meds weren’t used.
Distraction techniques can be as simple as having some one talk to the patient, to having the patient inflict localized pain on themselves. (Don’t gasp, it works.) Pinching the webbing between the thumb and first finger is very effective for spinal taps.
Visualization can be as simple as listening to soothing music, to self-hypnosis.

From personal observation, drug euphoria has a narrow line between pleasant euphoria to paranoia.
One of the other drugs in the study I mentioned the my previous post, was THC. I believed than and still do that the FDA wanted the study to fail. The dose range we were mandated to give was much too high. The situation in which it was to be used (Total Body Irradiation) was enough to cause paranoia, in itself.
The patient signed a consent that stated “I understand that, without a successful bone marrow transplant, the irradiation dose I will receive is fatal.”
The patient had to write out “I understand” then sign the form.
A couple hours later they were taken to the radiation therapy unit. Their gurney placed between two huge pillars. Everyone else hustles out of the room, like its on fire, as the towers open, exposing the irradiators, painted yellow and black, with “DANGER!” signs in 4 places on each.
So, having been given a pill with 3 times the amount of THC that would be in a joint, 20 minutes earlier… Can you say, psychotic break?
Of course the “rare” patient that had experience with the more “natural” form did a little better than first timers.

I can’t see any reason not to give whatever it takes to fer-sure terminal cases. When my father was dying of cancer we gave him Demerol according to a schedule that we had been given early on in the treatment. I noticed a few facial twitches and mentioned to the doctor that he seemed to be having a little pain when he came out of the Demeral haze. The answer was, “I wouldn’t let him come out.” So we poured on the Demerol, he lay essentially inert and died of pneumonia in about 3 days.