Drink and Drugs News DDN February 2020 | Page 14

TREATMENT WE NEED TO TALK ABOUT DIAMORPHINE The new diamorphine programmes may not be the holy grail that some think, says Nick Goldstein A 14 • DRINK AND DRUGS NEWS • FEBRUARY 2020 s I’m sure many of you have noticed, diamorphine programmes have been in the news – both Durham (DDN, March 2017 page 4), and Glasgow (DDN, December/January, page 4) have announced they will start diamorphine programmes in the near future. But before we go any further it’s only right that I declare a very personal interest – I spent the best part of 20 years in a diamorphine programme and without it I’m convinced I’d be dead or in a cell, and they’re both too dark and claustrophobic for my taste. Certainly the fate of many of my peer group suggests diamorphine saved me. So, to use the modern parlance, diamorphine provision is a game I have ‘skin’ in. Diamorphine hydrochloride is a full opiate agonist in its salt form, making it injectable. It’s used as an analgesic for severe pain, especially in end-of-life care for cancer sufferers. Diamorphine was first synthesised by C.R. Alder-Wright in 1874 by acetylating morphine, but only went into mass production after it was rediscovered by Bayer pharmaceuticals 20 years later. Bayer gave diamorphine a trade name that we’re all familiar with – heroin. However diamorphine has found another role over the years, as a maintenance tool for treating heroin addiction. There is nothing new in prescribing diamorphine for addiction. Diamorphine was the mainstay of prescribing for decades under the ‘British system’ and was a successful frontline treatment until Dole and Nyswander’s methadone model arrived in the UK and became the treatment ‘norm’ in the early 1970s. From then until now diamorphine programmes have withered on the vine for lack of political interest – by the time I left the programme around 2005 there were less than 500 diamorphine prescriptions in the UK, and although it’s virtually impossible to guess current prescription numbers I’d bet they’ve fallen further. So, these new diamorphine programmes are a boon, yes? Well, maybe and maybe not. As ever the devil will be in the detail, and there’s enough detail regarding the future direction of diamorphine programmes already in the public domain to worry WWW.DRINKANDDRUGSNEWS.COM