heroin and Neoplasms

Topics: Adult; Animals; Bacillus; Bacillus subtilis; Child; DNA, Recombinant; Drug Contamination; Foodborne Diseases; Genetic Engineering; Gram-Positive Bacterial Infections; Heroin; Humans; Immunocompromised Host; Industrial Microbiology; Infant; Mice; Neoplasms; Opportunistic Infections; Retrospective Studies; Safety; Substance Abuse, Intravenous; Virulence

We describe two patients in whom diamorphine was administered into the intraventricular space via an Ommaya reservoir, producing excellent pain relief. The use of this technique for long term administration of analgesia is reviewed.

Topics: Adolescent; Catheters, Indwelling; Female; Heroin; Humans; Injections, Intraventricular; Male; Middle Aged; Neoplasms; Pain, Intractable

Topics: Heroin; Humans; Hydromorphone; Infusion Pumps; Morphine; Narcotics; Neoplasms; Pain

Heroin is currently being advocated by some as a superior therapeutic agent for use in terminal illness. However, a review of the literature on heroin presently available does not support this contention. Administered orally, heroin is approximately 1.5 times more potent than morphine in controlling chronic pain in terminal cancer patients. Its effects on mood and the incidence and nature of side effects do not differ from those of morphine except in males where poorer pain control probably accounts for the worse effect on mood. Given parenterally for acute pain, heroin is 2-4 times more potent than morphine and faster in onset of action. When the potency difference is accounted for, the pharmacological effects of heroin do not differ appreciably from those of morphine. Heroin is metabolized to 6-acetylmorphine and morphine. After oral administration of heroin, morphine but not heroin or 6-acetylmorphine is detected in blood. In this case, heroin is a prodrug for the delivery of systemic morphine. Following acute i.v. administration, heroin appears transiently in blood with a half-life of about 3 min. The half-life of heroin exposed to blood or serum in vitro is 9-22 min, indicating that organ metabolism is involved in blood clearance as well. Direct renal clearance of heroin is less than 1% of the administered dose. In animal studies, heroin and 6-acetylmorphine are both more potent and faster acting than morphine as analgesics, effects attributed to their greater lipid solubility and subsequent penetration of the blood-brain barrier. Given centrally, morphine is more potent than heroin and 6-acetylmorphine in producing analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Analgesia; Animals; Brain; Codeine; Depression; Euphoria; Female; Half-Life; Heroin; Humans; Hydromorphone; Kinetics; Liver; Male; Morphine; Morphine Derivatives; Neoplasms; Pain; Sex Factors; Solubility; Terminal Care; Water

Extensive clinical experience has been obtained in the use of opiates during the last decade in special units devoted to symptom control in advanced cancer. Important contradictions have emerged with the clinical pharmacological literature on opiates calling into question its relevance to the treatment of chronic pain. Specifically in the case of morphine it is clear that: it is a very effective analgesic given orally, dosage must be individualized, parenteral use or exotic analgesic 'cocktails' are usually unnecessary, and tolerance, dependence and respiratory depression are rarely common or serious problems which prevent effective pain control provided morphine is used appropriately in accordance with its pharmacological characteristics. Heroin is a suitable alternative to morphine (particularly for intramuscular administration) if differences in milligram potency are taken into account, but has no advantages in terms of either analgesic efficacy or side effects. This paper summarizes clinical experience in the use of oral morphine for cancer pain at St. Christopher's Hospice, any data from clinical investigations which support this approach, and comments on the areas of controversy which have emerged.

Topics: Administration, Oral; Analgesics; Constipation; Delayed-Action Preparations; Drug Combinations; Heroin; Humans; Morphine; Morphine Dependence; Nausea; Neoplasms; Palliative Care; Respiratory Insufficiency

Oral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed.. To explore the perspectives of healthcare professionals in the UK caring for children with life-limiting conditions concerning the assessment and management of breakthrough pain; prescribing and administration of transmucosal diamorphine compared with oral morphine; and the feasibility of a comparative clinical trial.. Three focus groups, analysed using a Framework approach. Doctors, nurses and pharmacists (. Oral morphine is frequently used for breakthrough pain across all settings; with transmucosal diamorphine largely limited to use in hospices or given by community nurses, predominantly buccally. Perceived advantages of oral morphine included confidence in its use with no requirement for specific training; disadvantages included tolerability issues, slow onset, unpredictable response and unsuitability for patients with gastrointestinal failure. Perceived advantages of transmucosal diamorphine were quick onset and easy administration; barriers included lack of licensed preparations and prescribing guidance with fears over accountability of prescribers, and potential issues with availability, preparation and palatability. Factors potentially affecting recruitment to a trial were patient suitability and onerousness for families, trial design and logistics, staff time and clinician engagement.. There were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome.

Topics: Analgesics, Opioid; Breakthrough Pain; Child; Delivery of Health Care; Feasibility Studies; Fentanyl; Focus Groups; Heroin; Humans; Morphine; Neoplasms

We performed a combined analysis of the results from four controlled single-dose relative-potency studies to assess the impact of inferred pain mechanism on the response to an opioid drug. A total of 168 patients received 474 administrations of either morphine or heroin, and we assessed the analgesic response during a 6-hour period with visual analog scales. We summarized this as a total pain relief (TOTPAR) score. Two experienced pain clinicians reviewed information about pain characteristics and designated each case according to the inferred pain mechanism (neuropathic, nociceptive, or mixed) and the degree of confidence in the inferred mechanism (definite versus probable/possible). They grouped the cases as follows: nociceptive pain only (n = 205), neuropathic pain only (n = 49), and mixed (n = 220). We compared pain relief achieved by patients with different mechanisms, with TOTPAR adjusted for significant covariates (duration of prior opioid administration, doses of opioid administered in the previous 48 hours, pain intensity at the start of the study, BUN:creatinine ratio, and dose of administered opioid). The adjusted mean TOTPAR score of the group with any neuropathic pain was significantly lower than that of the group with nociceptive pain only (26.1 versus 20.4, p = 0.02). The score of the group with definite nociceptive pain alone (adjusted mean TOTPAR = 28.0) was significantly higher than scores of the groups with possible/probable nociceptive pain (TOTPAR = 19.9), mixed mechanisms (TOTPAR = 20.2), definite neuropathic pain alone (TOTPAR = 20.6), and possible/probable neuropathic pain alone (TOTPAR = 22.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Female; Heroin; Humans; Male; Middle Aged; Morphine; Neoplasms; Nervous System Diseases; Nociceptors; Pain; Pain Measurement; Palliative Care

A direct comparison of the analgesic activities of heroin and hydromorphone was carried out in cancer patients with postsurgical pain. Intramuscular doses of 5 and 10 mg of heroin were compared with 1 and 2 mg of hydromorphone in a randomized, double-blind, 4-point parallel group assay. Design innovations in the study provided that about half the patients would receive prior repeated doses of the same drug as the test medication, and half would receive the alternate medication. Both test drugs were found to be potent, relatively short acting analgesics with similar profiles of action. Hydromorphone was about 5 times as potent as heroin on a milligram basis. The comparison of those patients who had repeated doses of the same treatment prior to the test dose and those who had repeated doses of the alternate drug demonstrated no significant effect on the relative potency estimates. Side effect occurrence was similar for both drugs, with sleepiness the most prominent effect. The study supports the view that hydromorphone and heroin produce similar clinical effects, and that either drug may adequately substitute for the other. Covariate analysis indicated that time since last analgesic was positively related to analgesia, and amount of prior opioid had a negative relationship. To a lesser extent, increase in patient age was associated with an increase in analgesic scores. Taking these covariates into account served to increase the sensitivity of the analysis.

Topics: Affect; Analgesics; Female; Heroin; Humans; Hydromorphone; Hypnotics and Sedatives; Male; Neoplasms; Pain Measurement; Pain, Postoperative; Time Factors

Narcotic analgesics are the mainstay of pain control in patients with cancer. A controversy has been raging in the United States and Canada as to the legalization of heroin. We have reviewed the literature in order to determine the relative efficacy of heroin and morphine in cancer pain. We applied the following methodologic criteria: Was the assignment of patients to the different opiates randomized? Were all clinically relevant outcomes reported? Were the patients recognizable? Were both clinical and statistical significance considered? Was the opiate regimen feasible in routine clinical practice? Were all patients who entered the study accounted for at its conclusion? Two trials satisfied our first standard. The first, a double-blind cross-over trial, failed to meet standard 4 (the negative conclusion may represent a type 2 error) and only 21% of patients completed both treatment periods. The second study, which compared intramuscular heroin and morphine among patients with postoperative pain, failed to meet standards 3 (patients not described in sufficient detail and only tangentially related to chronic cancer pain) and 4 (type 2 error). Thus the relative efficacy of heroin and morphine in the relief of chronic cancer pain remains unknown. Randomized trials that meet all six methodologic standards must therefore be carried out for this controversy to be resolved.

Topics: Clinical Trials as Topic; Female; Heroin; Humans; Infant, Newborn; Male; Morphine; Myocardial Infarction; Neoplasms; Palliative Care; Random Allocation

Measurement of pain in cancer patients requires all the procedural safeguards essential for the measurement of subjective responses, including the employment of active and inactive controls, double-blind techniques, randomization, and statistical verification of results. Pain is traditionally measured in analgesic studies by employing verbal descriptors of intensity, but more recently visual analogues of pain intensity have been used and generally provide more sensitive measures of pain intensity. Patients with chronic pain tend to rate the categories representing more intense pain as lower in the visual analogue scale than do patients with postoperative pain. This may well reflect differences in the prior pain experiences of the two groups. Patients with chronic cancer pain have greater positive mood effects after the narcotic, morphine, than after the non-steroidal antiinflammatory analgesic, zomepirac, and this appears to be independent of analgesic activity. It is possible to design crossover analgesic studies in cancer patients so as to minimize carry-over effects, and such studies are more efficient than parallel group assays. Crossover studies also provide the ability to measure carry-over when it occurs.

Topics: Analgesia; Analgesics; Clinical Trials as Topic; Emotions; Heroin; Humans; Methods; Morphine; Neoplasms; Pain; Research Design; Surveys and Questionnaires; Tolmetin

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 plus or minus 0.08 and 1.5 plus or minus 0.10 hours, respectively [mean plus or minus 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 plus or minus 0.10 and 1.8 plus or minus 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 pain in patients with cancer.

Topics: Clinical Trials as Topic; Dose-Response Relationship, Drug; Emotions; Female; Heroin; Humans; Injections, Intramuscular; Male; Morphine; Neoplasms; Pain, Postoperative; Time Factors

Topics: Administration, Oral; Clinical Trials as Topic; Heroin; Humans; Morphine; Neoplasms; Pain, Intractable

Topics: Chemistry, Pharmaceutical; Chlorpromazine; Clinical Trials as Topic; Cocaine; Drug Combinations; Drug Evaluation; Female; Heroin; Humans; London; Male; Morphine; Neoplasms; Pain, Intractable; Palliative Care

The results of this study in postoperative patients have, thus far, revealed little that was not expected from a review of the literature. Heroin hydrochloride appears to be about two to three times more potent than morphine sulfate as an analgesic, to act more promptly and to have a slightly shorter duration of action. There is a suggestion that heroin may have a somewhat different spectrum of side effects and mood effects compared to morphine, but the effects of both drugs on mood were inversely correlated with the patients' feelings at the time of drug administration. Regardless, as a group, patients responded to both drugs with significantly improved moods. A lag time between the peak intensity of analgesic and mood effects of both heroin and morphine suggest a dissociation between these effects. Whether or not these early impressions will be reinforced as this study proceeds, and whether or not the effects of the drugs in patients with chronic pain due to advanced cancer will be any different than in these patients with postoperative pain, remains to be seen.

Topics: Affect; Clinical Trials as Topic; Double-Blind Method; Heroin; Humans; Morphine; Neoplasms; Pain, Postoperative

A controlled trial of diamorphine (diacetylmorphine, heroin) and morphine is reported in which the two drugs were administered regularly by mouth in individually determined effective analgesic doses. Elixirs contained cocaine hydrochloride 10 mg/dose; other drugs were prescribed when indicated clinically. 699 patients entered the trial and, of these, 146 crossed from diamorphine to morphine, or vice versa, after about two weeks using an oral potency ratio of 1.5/1 determined in a pilot trial. Additional medication and survival were closely similar in both treatment groups. In the female crossover patients, no difference was noted in relation either to pain or the other symptoms evaluated. On the other hand, male crossover patients experienced more pain, and were more depressed, while receiving diamorphine. In these, the potency ratio of diamorphine to morphine appeared to be less than 1.5/1. If this is allowed for, then the difference in mood is probably not significant. Compared with male patients, fewer females required a dose of 10 mg or more, but more were prescribed an anxiolytic. The ability to do without a 2 a.m. dose appeared to be related more to the size of the dose than to gender or treatment. It is concluded that, provided allowance is made for the difference in potency, morphine is a satisfactory substitute for orally administered diamorphine. However, when injections are necessary, the greater solubility of its hydrochloride gives diamorphine an important practical advantage over morphine, especially when large doses are required.

Topics: Administration, Oral; Aged; Female; Heroin; Humans; Injections; Male; Middle Aged; Morphine; Neoplasms; Palliative Care; Sex Factors

1. A method is described for comparing narcotic analgesics and adjuvants in patients with terminal cancer. 2. A randomized controlled trial of orally administered diamorphine and morphine is reported to illustrate the method. 3. It is concluded that there is no over-all clinical difference between diamorphine and morphine when administered by mouth every four hours at individually optimized doses in association with cocaine and a phenothiazine. 4. The validity, reliability and sensitivity of the method are discussed.

Topics: Aged; Analgesics, Opioid; Clinical Trials as Topic; Drug Evaluation; Female; Heroin; Humans; Male; Methods; Morphine; Neoplasms; Pain; Palliative Care; Surveys and Questionnaires; Terminal Care

Topics: Administration, Oral; Adult; Aged; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Tolerance; Female; Heroin; Humans; Infusions, Parenteral; Male; Middle Aged; Morphinans; Neoplasms; Pain; Substance-Related Disorders; Terminal Care; Time Factors

Diamorphine is a strong opioid licensed in the UK for many uses, including moderate and severe pain. In the early 2000s, its use in palliative medicine was widespread before a supply disruption led to preferential use of alternative, cheaper opioids. Though these supply issues were resolved, the use of diamorphine in palliative medicine has remained reduced, particularly with another UK supply disruption in 2021. Following anecdotal reports of good results from diamorphine use in younger patients, this piece discusses two cases of young patients with metastatic cancers suffering significant pain and psychological distress. Both patients were approaching end of life and required high doses of opioids, benzodiazepines and co-analgesics, all given to limited benefit. Both patients were rotated to diamorphine giving objective and subjective improvement in symptoms. These cases are presented in the context of newer information and description of the biochemical actions of diamorphine and its metabolites, which exert their own clinical effect before themselves generating active metabolites. Various trials on, and discussion about, diamorphine's unique metabolism and subsequent central nervous system effects help argue for its use in situations where extreme pain and psychological distress overlap.

Topics: Analgesics, Opioid; Heroin; Humans; Neoplasms; Pain

Identify opioids prescribed, preferred routes, and doses among children with incurable cancer.. Prospective survey with monthly questionnaires regarding patients 0 to 19 years old from oncology centers. Data were collected by professionals on each patient for 6 months or until death, and analyzed from patients who died. Impact of tumor was analyzed with Kruskal-Wallis and Mann-Whitney tests. Major opioid dosages are expressed as oral morphine equivalents.. Of 185 children recruited, 164 (88 boys, 76 girls) died. Mean palliative care duration was 67 days. One hundred forty-seven (89.6%) received major opioids. Morphine, diamorphine, and fentanyl were prescribed in 75%, 57.9%, and 11.6%, respectively. Seventy-three (44.5%) received >1 major opioid. Median monthly maximum doses prescribed rose from 2.1 mg/kg/24 h (study entry) to 4.4 mg/kg/24 h (death) (P < .001); overall variable (0.09-1500 mg/kg/24 h, median 3.7 mg/kg/24 h). Opioids were given by the oral (117/164, 71.3%), intravenous (68/164, 41.5%), subcutaneous (40, 28%), rectal (20, 12.2%), and transdermal (18, 11%) routes. There was a shift to intravenous use as death approached. Numbers within each tumor group were too small to show significance. Children with solid tumors outside the central nervous system were likely to receive more opioids, be given multiple different opioids, and receive opioids in the last month.. The study shows the United Kingdom practice of opioid use and provides comparator data for practice in children's palliative medicine.

Topics: Administration, Oral; Administration, Rectal; Adolescent; Adult; Analgesics, Opioid; Child; Child, Preschool; Drug Prescriptions; Female; Fentanyl; Heroin; Humans; Infant; Infusions, Intravenous; Injections, Subcutaneous; Male; Morphine; Neoplasms; Pain; Palliative Care; Prospective Studies; Research Design; Surveys and Questionnaires; Therapeutic Equivalency; United Kingdom

Intraspinal analgesia can be helpful in some patients with intractable pain. Over 15 years palliative care professionals evolved their spinals policy through a repeated series of evaluations, discussions and literature reviews. One hundred intraspinal lines were then reviewed. Notable changes in policy were the switch from epidurals to intrathecals, and the insertion of lines during working hours rather than as emergencies. Our efficacy, and frequency of adverse effects, is equal or better to published studies. Key issues in reducing adverse effects were the improved care of the spinal line exit site, a change from bolus administration to continuous infusions, and modifying line insertion techniques. Current policy is to use continuous infusions of diamorphine and bupivacaine in a 1:5 ratio through externalized intrathecal lines. The lines are effective in approximately two thirds of patients and can be kept in place for up to 18 months. The policy continues to be updated and common documentation is now in place.

Topics: Adult; Aged; Aged, 80 and over; Analgesia; Analgesia, Epidural; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Drug Administration Schedule; Drug Combinations; Heroin; Humans; Injections, Spinal; Middle Aged; Neoplasms; Pain, Intractable; Palliative Care

Topics: Administration, Oral; Analgesics, Opioid; Heroin; Humans; Injections, Subcutaneous; Morphine; Neoplasms; Palliative Care

Topics: Heroin; Humans; Legislation, Drug; Neoplasms; Pain; Program Development; Wisconsin

Topics: Heroin; Humans; Neoplasms; Pain; Palliative Care

Topics: Drug and Narcotic Control; Heroin; Humans; Neoplasms

Topics: Heroin; Humans; Infusions, Parenteral; Neoplasms; Pain

Topics: Heroin; Humans; Neoplasms; Pain

Topics: Heroin; Humans; Meperidine; Neoplasms; Pain

Topics: Canada; Health Occupations; Heroin; Humans; Legislation, Drug; Neoplasms; Pain; Palliative Care

Topics: Heroin; Humans; Morphine; Neoplasms; Palliative Care

Topics: Analgesics; Analgesics, Opioid; Heroin; Humans; Morphine; Neoplasms; Pain

Topics: Heroin; Humans; Neoplasms; Pain; Palliative Care; Risk Assessment; Terminal Care; United Kingdom; United States

The clinical pharmacology of the narcotic-type analgesics is discussed in depth. Relative analgesic potency, peak and duration of analgesia, oral potency, and adverse effects are reviewed, With an emphasis on the clinical application of this knowledge. The differences among psychologic dependence, physical dependence, and tolerance are carefully delineated. Guidelines are provided for using narcotic-type analgesics in the management of patients with cancer.

Topics: Administration, Oral; Analgesics; Drug Therapy; Drug Tolerance; Heroin; Humans; Morphine; Narcotics; Neoplasms; Primary Health Care; Substance-Related Disorders

Topics: Arizona; Drug and Narcotic Control; Heroin; Humans; Neoplasms; Pain, Intractable

Topics: Heroin; Humans; Morphine; Neoplasms; Pain, Intractable

Topics: Heroin; Humans; Legislation, Drug; Neoplasms; Pain, Intractable; Terminal Care; United States

Topics: Heroin; Humans; Legislation, Drug; National Institutes of Health (U.S.); Neoplasms; Pain, Intractable; Terminal Care; United Kingdom; United States; United States Food and Drug Administration; United States Public Health Service

Topics: Heroin; Humans; Legislation, Drug; Neoplasms; Pain, Intractable; Terminal Care; United States

Topics: Administration, Oral; Drug Combinations; Heroin; Humans; Morphine; Neoplasms; Palliative Care

Topics: Heroin; Humans; Neoplasms; Pain, Intractable

Topics: Analgesics; Heroin; Humans; Morphine; Neoplasms

Topics: Attitude; Canada; Government Regulation; Heroin; Humans; Neoplasms; Pain; Physicians; Social Control, Formal; Terminal Care; Terminally Ill

Topics: Analgesics, Opioid; Attitude; Euthanasia, Passive; Heroin; Humans; Life Support Care; Moral Obligations; Neoplasms; Pain; Pharmaceutical Preparations; Physicians; Risk; Risk Assessment; Social Responsibility; Stress, Psychological; Terminal Care; Treatment Refusal

Topics: Heroin; Humans; Morphine; Neoplasms; Pain; Palliative Care

Heroin hydrochloride is approximately twice as potent as morphine sulfate, and acts slightly faster but for a shorter duration than morphine. Although patients with chronic pain due to advanced cancer differ from cancer patients with postoperative pain in terms of their degree of tolerance to the analgesic effects of morphine and heroin and their reports of various elements of mood, there is, thus far, no indication that heroin has any unique advantage over morphine in terms of side effect occurrence or effects on mood at equianalgesic doses. Both drugs improve mood provided they are administered in doses which result in analgesia. While there appears to be some slight difference in the spectrum of side effects observed after heroin as compared to morphine, heroin and morphine share the most common side effects. The incidence of side effects following both drugs appear to be highest among those effects which are primarily somatic and undesirable. The use of visual analog scales concurrent with categorical pain and pain relief scores provides a means for the finer estimation of relative analgesic potency and time action. The results of these studies are in general agreement with those of other investigators. Where apparent differences exist they can usually be explained on the bases of differences in methods and subject populations.

Topics: Adult; Aged; Analgesics; Chronic Disease; Female; Heroin; Humans; Injections, Intramuscular; Levorphanol; Male; Meperidine; Middle Aged; Morphine; Neoplasms; Pain; Postoperative Complications

Topics: Civil Rights; Heroin; Humans; Jurisprudence; Neoplasms; Pain; Pharmaceutical Preparations; Privacy; Risk; Risk Assessment; Supreme Court Decisions; Terminal Care; Terminally Ill; United Kingdom; United States

Topics: Heroin; Humans; Neoplasms; Palliative Care

Topics: Heroin; Humans; Neoplasms; Palliative Care; Terminal Care

Topics: Administration, Oral; Cocaine; Drug Combinations; Ethanol; Heroin; Humans; London; Morphine; Neoplasms; Palliative Care; Terminal Care

Topics: Cognition; Heroin; Humans; Morphine; Neoplasms; Pain, Intractable

1 Venous blood was obtained from patients with far-advanced cancer receiving either diamorphine (diacetylmorphine, heroin) hydrochloride (65 samples) or morphine sulphate (24 samples) regularly by mouth in doses from 2.5 mg to 90 mg every 4 h. 2 Samples were obtained within 30 min of the 09.00 h drug round. 3 Serial samples were also obtained over a 4 h period from three patients receiving diamorphine hydrochloride. 4 Assay of serum 'morphine equivalents' was by radioimmunoassay using an antibody that cross reacts almost equally with diamorphine, 6-0 monoacetylmorphine and morphine. 5 The serum concentration of opiates expressed as 'morphine equivalents' ranged from 11 ng/ml to 1440 ng/ml. 6 A highly significant positive linear correlation exists between the dose administered and the serum concentration (P less than 0.001) with respect to both drugs. 7 There was no difference between the two drugs in relation to the serum concentration achieved per 10 mg of opiate administered. 8 Higher oral doses of both diamorphine and morphine are now being used when indicated rather than, as before, resorting to injections when an oral dose in excess of 40 mg is indicated.

Topics: Adult; Aged; Biotransformation; Female; Heroin; Humans; Intestinal Absorption; Male; Middle Aged; Morphine; Neoplasms; Time Factors

Topics: Heroin; Humans; Morphine; Neoplasms; Pain

Topics: Cannabis; Heroin; Humans; Neoplasms; Pain; Pharmaceutical Preparations; Terminal Care

Topics: Government Regulation; Heroin; Humans; Neoplasms; Organizational Policy; Pain; Pharmaceutical Preparations; Physicians; Politics; Social Control, Formal; Societies; Stress, Psychological; Terminal Care; Terminally Ill; United Kingdom; United States

Topics: Analgesics, Opioid; Attitude; Heroin; Humans; National Institutes of Health (U.S.); Neoplasms; Pain; Palliative Care; Public Opinion; United States

Topics: Administration, Oral; Adolescent; Aged; Antipsychotic Agents; Female; Heroin; Hospitals, Special; Humans; Injections, Intravenous; London; Male; Middle Aged; Neoplasms; Pain, Intractable; Palliative Care; Phenothiazines; Terminal Care

Topics: Administration, Oral; Adult; Aged; Female; Heroin; Humans; Injections, Intravenous; Male; Middle Aged; Neoplasms; Pain, Intractable; Terminal Care

Topics: Chloroform; Cocaine; Ethanol; Heroin; Honey; Humans; Neoplasms; Palliative Care; Pharmaceutical Vehicles; Terminal Care

Topics: Heroin; Humans; Infections; Neoplasms; Substance-Related Disorders

Topics: Adrenalectomy; Androgens; Breast Neoplasms; Busulfan; Chlorambucil; Estrogens; Heroin; Hormones; Humans; Hypophysectomy; Male; Morphine; Neoplasm Metastasis; Neoplasms; Pain; Palliative Care; Prostatic Neoplasms; Surgical Procedures, Operative; Thiotepa; Toxicology