Medicinal

The pharmacology of heroin is virtually identical to that of morphine. This probably reflects its rapid conversion to 6-acetylmorphine and morphine. De-

Mexican brown heroin and Southeast Asian heroin. Although pure heroin is a white powder, most heroin that is sold on the street varies in color from white to dark brown, with an average purity of 35 percent. (Drug Enforcement Administration)

tailed studies comparing the actions of heroin and morphine in cancer patients with severe pain have shown very little difference between the two agents, other than simple potency. Heroin may have a slightly more rapid onset of action than morphine and it is certainly two to three times as potent (presumably due to its greater facility in crossing the blood-brain barrier). This difference in potency is lost with oral administration. The pain relief (analgesia) from both agents is comparable when the doses are adjusted appropriately. At equally effective ANALGESIC doses, even the euphoria seen with heroin is virtually identical to that of morphine. From the clinical point of view, there is little difference between one drug and the other. Both are effective analgesics and can be used beneficially in the treatment of severe pain. Heroin is more soluble, which makes it somewhat easier to give large doses by injection, with smaller volumes needed. Many of the similar semisynthetic agents, such as Hy-DROMORPHONE, however, are many times more potent than heroin and offer even greater advantages.

One widespread use of heroin in the United Kingdom was in the early formulations of Brompton's Cocktail, a mixture of drugs designed to relieve severe pain in terminal cancer patients. The heroin employed in the original formula is now typically replaced with morphine without any loss in effectiveness. For many years, some groups have maintained that heroin is more effective in the relief of cancer pain than morphine is. Careful clinical studies show that this is not true, but the most important issue is using an appropriate dose. Thus, heroin offers no major advantage over morphine from the medical perspective.

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