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by Haemmig RB and Tschacher W. Int. J. Psychoactive Drugs 33(2):105-109, 2001 (April-June)
Although this website is intended primarily for physicians interested in office-based treatment of heroin users, this article is considered important - notwithstanding the low probability that either heroin or morphine will be available to such practitioners in the near future. Thirty-nine long-term heroin users were randomly assigned to two groups - one received injectable morphine and the other heroin, with dosages determined primarily by the patients themselves. After 2-3 weeks there was a double-blind change to the other drug, in equivalent dosage. Total period of observation in this trial was six weeks.
Heroin and morphine were associated with very different outcomes — an observation "that was not expected since the profiles or action of both substances are very similar, and morphine is a main active metabolite of heroin." And yet, only morphine was associated with histamine-type reactions (studies of the two medications employed for analgesia have reported no such differences). "Most particularly, the switch-over from full-dose heroin to full-dose equipotent morphine proved to be highly problematic." For both medications, there was no difficulty in achieving a dose considered by patients to be "satisfactory," a finding that might be explained by the inverse relationship between dosage and euphoria reported by the subjects. The latter experience lead the author to observe recently that in this respect heroin is different from money: people rarely can have enough of the latter!
The authors conclude that there appears to be significant superiority of heroin over morphine in treatment of drug dependence, and suggest that this finding might have relevance to the treatment of pain as well.
The purpose of this study is to evaluate the effects of high doses of injected opiates as prescribed maintenance in intravenous drugs users. This was accomplished via a randomised double-blind study with crossover at an outpatient clinic in Bern, Switzerland. The subjects were 39 patients with a long history of intravenous opioid use and persistent abuse despite treatment; they were randomly allocated to two groups. Group A was started on controlled injection of graduated doses of morphine up to a satisfying individual dose and was then switched as a double blind to heroin at a randomly determined day between week three and four. Subsequently this group was given heroin for the remaining two to three weeks of the study. Group B was started on heroin and was then switched to morphine in the same manner. Equipotent solutions of 3% morphine and 2% heroin were administered. The main outcome measures were clinical observations, structural interviews and self report of subjective experiences to assess the effects of the drugs. In 16 cases, the study had to be discontinued owing to severe morphine-induced histamine reactions. Thirteen participants in Group B presented these adverse reactions on the day of the switch-over. Full data were thus only obtainable for 17 participants. Average daily doses were 491 mg for heroin and 597 mg for morphine. The findings indicate that heroin significantly produced a lower grade of itching, flushing, urticaria and pain/nausea. A negative correlation between dose and euphoria was observed for both heroin and morphine. The authors concluded that as heroin produces fewer side effects it is the preferred high-dose maintenance prescription to morphine. The perceived euphoric effects are limited in both substances.