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Should heroin be available to treat severe pain?

THE TREATMENT of patients with chronic, severe pain is a major problem. It has been estimated that 70% to 90% of hospitalized cancer patients suffer severe pain, although specific data on this point are not available. Because of reports that many cancer patients do not obtain adequate pain relief, the news media have publicized a proposal that heroin should be made available for these patients. This proposal is based on the belief that heroin has certain advantages over morphine and other available strong analgesics. Its proponents claim that it causes more euphoria and less sedation, nausea, and constipation, and it enhances the appetite. However, none of the supposed benefits have been demonstrated by controlled clinical trial. 1 In summarizing a review of the published literature on heroin prior to 1957, Eddy et al 2 stated: Most reports agree that nausea and vomiting and the milder side-effects occur less frequently after heroin