Analgesic and Mood Effects of Heroin and Morphine in Cancer Patients with Postoperative Pain

We designed a study to determine the relative analgesic potency of intramuscular heroin and morphine and to compare mood and side effects in 166 cancer patients with postoperative pain. Heroin was about twice as potent as morphine (95 per cent confidence limits, 1.6 to 2.6 times) in graded-dose, twin-crossover assays. Heroin provided an analgesic peak effect earlier than morphine (1.2±0.08 and 1.5±0.10 hours, respectively [mean ±S.E.M.]). Doses with equal analgesic effects provided comparable improvements in various elements of mood, particularly feelings of peacefulness. Peak mood improvement occurred earlier after heroin than after morphine (1.2±0.10 and 1.8±0.13 hours, respectively). Both analgesia and mood improvement were less sustained after heroin at doses providing equal peak analgesic effects. The drugs shared the most common side effects, with no marked differences in their occurrence; sleepiness was the most frequent side effect after both drugs (46 per cent with each). Heroin has no apparent unique advantages or disadvantages for the relief of pain in patients with cancer. (N Engl J Med. 1981; 304:1501–5.) FEW drugs have provoked as much controversy as heroin (diacetylmorphine; 7,8-didehydro-4,5 alpha-epoxy-17-methylmorphinan-3,6 alpha-diol diacetate ester). Heroin has been judged to produce more euphoria than morphine does 1 2 3 — an attribute that has been considered a reason for its being the preferred drug of narcotic addicts and for its having virtues in the management of intractable pain in terminal illness. 4 , 5 Although it is proscribed in the United States, heroin is used in some countries in controlling the pain of advanced cancer. Apart from differences in action over time, 6 however, heroin and morphine have been shown to be similar in most respects, so . . .