RT Journal
A1 Farr WC
T1 SHould heroin be available for pain?
JF JAMA
JO JAMA
YR 1979
FD March 2
VO 241
IS 9
SP 882
OP 882
DO 10.1001/jama.1979.03290350012005
UL http://dx.doi.org/10.1001/jama.1979.03290350012005
AB To the Editor.— 
    I could not agree more with most of the recent COMMENTARY by John R. Lewis, PhD, "Should Heroin Be Available To Treat Severe Pain?" (240:1601, 1978). However, I believe he missed the point with respect to one specific advantage of heroin over morphine in the treatment of severe pain in patients with terminal cancer. Saunders1 and Twycross2 at St Christopher's Hospice in London have consistently shown that there is a distinct advantage to the use of heroin over morphine in a small, select group of patients. They are those patients who require large doses of injectable narcotics.Heroin's use is more advantageous than morphine's in that it is extremely soluble and therefore permits using a smaller injected volume (heroin, 100 mg/0.2 mL, vs morphine, 15 mg/1.0 mL). Heroin is not a more effective analgesic. In my experience with the treatment of more than 280 terminally