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March 2, 1979

Should Heroin Be Available for Pain?-Reply

Author Affiliations

American Medical Association Chicago

JAMA. 1979;241(9):882-883. doi:10.1001/jama.1979.03290350012006

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Dr Farr's favorable comments about my recent article on heroin are appreciated, and his point concerning the relative solubilities of heroin and morphine is acknowledged.

Because most of the putative advantages of heroin reported in the literature have been related to its pharmacologic actions, my COMMENTARY was limited to a consideration of these; the physical properties were not discussed. As Dr Farr pointed out, and as reported by Twycross, the greater solubility of heroin permits the injection of an analgesic dose smaller in volume than that of an equianalgesic dose of morphine. However, heroin is not the only alternative to morphine with a greater solubility; other available analgesics, namely, hydromorphone hydrochloride and oxymorphone hydrochloride, are not only more soluble than morphine but are more potent on a milligram basis than heroin. (Incidentally, the solubility of morphine is greater than the 15 mg/mL concentration cited by Dr Farr. According