The Unique Role of Diamorphine in British Medical Practice: A Survey of General Practitioners and Hospital Doctors

Abstract

Aims: Diamorphine (heroin) is one of the longest established medications with a 130-year history. In British medicine diamorphine is sometimes used as a maintenance treatment for opiate addiction but is also routinely used in clinical practice to treat a number of general medical conditions. These uses are very different but are often confused by observers of the British system. The routine clinical use of diamorphine in medicine is unique to the UK, but this is not well known outside the UK. The present study investigates the use of diamorphine to treat medical conditions by general practitioners and by hospital doctors. Method: In a survey of 141 medical practitioners who had prescribed diamorphine for the treatment of a medical condition, data were collected on conditions prescribed for, numbers of patients, dosage, routes of administration, duration of treatment, worries about prescribing diamorphine and observed adverse effects. Findings: Many doctors had prescribed diamorphine to a large number of patients. The four main conditions for which diamorphine had been prescribed in the previous year were myocardial infarction, palliative care, pulmonary oedema, and post-operative pain. More than half of the sample (57%) reported no reservations about prescribing diamorphine. Of the doctors (n = 60, 43%) who expressed worries, this was most often about possible problems of respiratory depression or respiratory arrest. Respiratory arrest/failure was also the most frequent observed adverse effect. Relatively few doctors reported worries about addiction. Conclusions: Although diamorphine was widely used and most doctors regarded it as a useful medication, there remains insufficient research information about current clinical practice. At a time when diamorphine may be coming under increased scrutiny, more detailed information is required of its uses and applications.

Pain Syndromes in Sickle Cell Disease: An Update

“…It remains the drug of choice to achieve a prompt analgesia in patients with SCD [6,74]. Diamorphine (heroin), being highly soluble, produces rapid analgesia and has been successfully employed in the setting of SCD pain [75], although the routine clinical use is unique to the United Kingdom [76]. Among full µ‐agonists, strong opioids, hydromorphone [77], and oxycodone [78] have been reported as effective in the setting of acute SCD pain [79].…”

Wieder ein „War on Drugs“

“…Medizinisch darf Heroin weltweit nicht mehr eingesetzt werden, allerdings mit einer Ausnahme: Im UK wird es bis heute medizinisch mit offenbar geringen Risiken und guter Wirksamkeit genutzt -unfassbar für den Rest der Welt -und zwar überwiegend für postoperative Schmerzen von Kindern (!) oder Schwangeren sowie in der Palliativmedizin [8,14,38,42]. Vermutlich würde demnach die Freigabe von Heroin für medizinische Zwecke zu keinen nennenswerten neuen Risiken führen, allerdings wäre der Nutzen wohl nur gering.…”

Regulating Global Drug Problems

“…If we take heroin, for instance, in many respects this is clearly traded within a Type 1 illegal market and indeed we might view it as an exemplar of an illicit commodity. But in some parts of the world, most notably the UK, heroin (diamorphine) is also a staple of medical practice, used for pain relief and palliative care, particularly with cancer patients (Gossop et al 2005). This means that there is a parallel regulatory regime for its licit production, distribution and consumption for the purpose of legitimate medical care.…”