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
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