The use of narcotic analgesics in terminal illness

Abstract

A group of 500 patients was reviewed. To achieve and maintain pain relief many of the patients received diamorphine (heroin) regularly every four hrs. Almost all the patients received phenothiazine concurrently; other drugs were prescribed when indicated. It was concluded that: Although most patients receive parenteral diamorphine during the last 12 to 24 hrs, the majority can be maintained on oral medication until this time; There is no single optimal dose of diamorphine; Psychological dependence does not occur; Physical dependence may develop but does not prevent the downward adjustment of the dose of diamorphine when considered clinically feasible; Tolerance is not a practical problem; The prescription of diamorphine does not, by itself, lead to impairment of mental faculties. Also discussed are: the psychobiological nature of pain; the rational use of analgesics; the need for further research; the importance of the doctor's attitude.