Should heroin be legal?

I mean legal as a painkiller used by doctors in a medical setting

Photo credit: www.horizon-health.org

Heroin is a brilliant invention. It was first synthesized in a laboratory in the late 19th century by scientists who started out with morphine from the opium poppy, but found a way to make it even stronger. The turn of the 20th century was a time when industrial chemistry was growing rapidly. Scientists within the nascent pharmaceutical industry took all kinds of natural substances and chemically manipulated their active ingredients to make drugs that were stronger, faster-acting, or with fewer side-effects. Compared to morphine, heroin is much stronger and enters the brain much more rapidly. Scientists found its opioid effects on the brain so heroic that they name it “heroin.”

In chemistry, heroin is called “di-acetyl-morphine.”

• “di” means two,

• “acetyl” (u-see-tl) is a small tail of organic molecule two-carbons long,

• and “di-acetyl morphine” means a morphine molecule with two acetyl’s pinned onto it, like two extra tails pinned on the donkey. It is sometimes abbreviated as “diamorphine.”

Many pharmaceuticals that have since taken over the medical profession were born in the same way. Aspirin was made by attaching the same acetyl tail to an ingredient from willow bark. There are many other examples.

Today heroin is illegal in the US, even when prescribed by a doctor for medical reasons. And it is so laden with social and cultural baggage that it is hard to imagine that this will ever change. The word “heroin” calls to mind the depraved extreme of addiction, ruined lives and overdose deaths.

But there is no good reason that heroin should be unavailable to doctors, when doctors like me commonly give patients IV drugs like morphine, or hydromorphone (brand name Dilaudid) which is 5 times as strong as morphine. Or fentanyl, which is 100 times as strong. If addicts were shooting up street-bought Dilaudid on their home couches, I think we’d still have an equivalent problem. And fentanyl these days seems to kills more people than any other opiate, including heroin. Hell, even oxycodone seemed like a plague on humanity for a while there, and that is everpresent in medicine.

The truth is that there is no good medical or scientific reason that heroin should be banned from medical use while these other IV drugs are not. Heroin can be prescribed in many European countries. True, we do not need it, since we have these other drugs. And there are certainly historical and social (and perhaps economic) reasons that it remains Schedule 1, meaning it has no accepted medical use. But it’s still good to acknowledge, when you look at the situation from a purely pharmacological and physiological perspective, that the law makes no sense.