Balance, Pain

Heroin and Morphine; Almost the same?



I was watching CNN on Sunday night, a program about babies in Florida being born to mothers misusing/abusing oxycodone.  Yes the new “crack babies.” In fact the program was showing a graph of the number of “crack babies” decreasing as “oxy babies” increased, when they interrupted the program to announce a resolution to the “debt ceiling.”

The story was attempting to expose both the problems with the “pill mills” in Florida as well as the impact on these innocent victims of  “Drug dependency syndrome” (a.k.a, addiction).  One comment that struck me forced me back to my pharmacology texts.

“Oxycodone is almost identical to heroin.” (or words to that effect).

This struck me as somewhat strange. It is close to oxycodone but fact Heroin is closer to morphine than it is to oxycodone! While these structures may seem complicated, heroin is a prodrug that in fact the body breaks down to morphine.  Heroin is very commonly used in palliative care settings in the United Kingdom under the proper chemical name, diacetylmorphine.

Why don’t we hear the reporter telling us the similarities of heroin to morphine.  They are in fact all opioids and therefore very similar in structure, if that is in fact important. Heroin is in fact more similar to morphine than it is to oxycodone.

So our perception of these differences is very important.

Would people perceive the story differently if told that oxycodone is very similar to morphine?

Is there such a stigma with morphine that viewers would not perceive “abusers” in the same way?

Is morphine an important part of the current problem of opioid overdoses and deaths?

This final question is particularly important to me, as the work of PPSG started when the question of using heroin for the treatment of cancer pain was raised in Wisconsin.  Rather than heroin, the focus moved to the use of oral morphine. So the discussion of balance was initially being considered in the context of morphine, a context we continue to encourage in low and middle income countries.

As we all evidence, lets be clear and use all of the evidence before us.

jfclearywisc.


About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide

Discussion

2 thoughts on “Heroin and Morphine; Almost the same?

  1. True, true Jim- the structure of heroin more closely resembles morphine than oxycodone. But I think you’re missing the reporter’s point.

    What she probably meant to indicate is that oxycodone’s abuse liability is comparable to heroin. Which is probably true. Sandy Comer @ Columbia University did an interesting study a few years ago in which she compared the abuse liability of a few opioid analgesics to heroin and found that they were very similar. See: http://www.nature.com/npp/journal/v33/n5/full/1301479a.html

    I think this brings us back to the question of balance… on one hand a reporter getting a message out to the public that oxycodone is as dangerous and addictive as heroin could be seen as a constructive. Especially when we have evidence that teenage non-medical users are often unaware that they’re playing with fire. If they were informed that mom’s pills are similar to heroin that could be a good thing. And if mom were made aware, maybe she would put a lock on her medicine chest.

    On the other hand, a palliative care pain patient might become afraid of taking their pain medicine after hearing a reporter compare it to heroin.

    There’s no easy answer here except to strive for balance.

    Posted by Andrew Kolodny | August 3, 2011, 10:02 PM
  2. INteresting study to point out; From the abstract;
    “In general, the order of potency in producing these effects, from most to least potent, was fentanyl>buprenorphine ≥heroin >morphine=oxycodone. In contrast, buprenorphine was the only drug that produced statistically significant increases in ratings of ‘I feel a bad drug effect’ and it was the only drug that was not self-administered above placebo levels at any dose tested. These data suggest that the abuse liability of buprenorphine in heroin-dependent individuals may be low, despite the fact that it produces increases in positive subjective ratings. The abuse liabilities of fentanyl, morphine, oxycodone, and heroin, however, appear to be similar under these experimental conditions.”

    Brings me back to my questions about morphine if in fact the abuse liability of morphine and oxycodone are the same (admittedly under experimental conditions).

    Just trying to understand all of the evidence.

    Posted by Pain policy & palliative care | August 3, 2011, 10:14 PM

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