| Abstrakt: |
To the Editor.—Recently there has been new interest, particularly in the lay press, regarding the use of heroin to relieve pain in patients with terminal cancer. However, John R. Lewis, PhD (240:1601, 1978), reviewed several clinical studies and concluded that there was no scientific evidence to indicate superiority of heroin over morphine. Recent reports by Twycross1 and William C. Farr, MD, PhD (241:882, 1979), regarding pain treatment in patients with cancer generally support this conclusion. However, these authors mention that heroin was preferred in a small number of patients (1% to 8%) that required high intramuscularly given doses. In these instances, Farr noted that the large volumes of morphine produced irritation and discomfort. Morphine sulfate is at least 12-fold less soluble than heroin hydrochloride (1:20 vs 1:1.6).2 Since morphine sulfate is usually available only as a prepared sterile solution of ≤15 mg/mL, the solubility difference is actually greater. |
