Prescription heroin

[TheLoneWolf]

Was listening to NPR on the way home today, interview of a journalist for vox who claims prescribing heroin TID on taxpayer dollars to curb the opioid epidemic has worked well on a small scale in one Vancouver clinic and advocated attempting this in the US. Sounded ridiculous hearing this but the online articles are there. Also had made multiple unsubstantiated statements such as placing patients on methadone or suboxone reduced the risk of death by more than 50% compared to other opiates. Was always mentioning that he had 'consulted the experts' and 'read the research' though never named any of these on air.

Health Canada to allow more access to prescription heroin to curb opioid crisis

The case for prescription heroin

Cites a few opinions and some biased data in his article

My primary concern in reading this is that a small number of patients will point to this experiment at one clinic and believe that medically directed IV diacetylmorphine administration is a legitimate treatment or (potentially long) transition to oral medication for longstanding addiction or chronic pain. Surprising to read that the UK, Germany, and the Netherlands have been doing this for some time.

Was wondering if anyone had heard of this guy, German Lopez, or their thoughts on the matter.

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[Aether2000]

It has been used in Switzerland as far back as 2004. There are some trials demonstrating efficacy: Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - TIME.com

 

[mid|ine]

Other than the impurity of street heroin there really isnt a difference between heroin and other mu agonists. In most countries around the world heroin (diamorph) is used in the same way that morphine or dilaudid are used. Not a proponent, just pointing out that its basically the same as other narcotics we use.

 

[Aether2000]

Well, sort of...... heroin enters the brain twice as fast as morphine due to its lipid solubility, but concentrations of 6MAM far exceed the concentrations of heroin in the brain within seconds. This suggests that peripheral blood metabolism is occurring very rapidly, creating 6MAM that then crosses the BBB much more rapidly than heroin. The 6MAM then slowly degrades to morphine. It is the rapid uptake of the 6MAM through the BBB that gives heroin (a prodrug) such a punch. The partition coefficient for morphine is around 1 whereas that of heroin and MAM are around 40. Compare that to fentanyl at 813 and carfentanil that is slightly less, and you can see why lacing heroin with fentanyl or carfentanil is desirable to drug addicts. Of course fentanyl is bound to RBCs so the pharmacokinetics get a bit messy. Levels of heroin and its metabolites in blood and brain extracellular fluid after i.v. heroin administration to freely moving rats