Medicine: Heroin, a Doctors' Dilemma

Dear Committee:

Please do whatever you can to get heroin legalized for easing pain. As a nurse, I hear so many brave but torture-ridden people cry for relief from pain. So many patients just don't respond to morphine. Why must they scream and beg for relief?"

To Whom It May Concern:

My husband has been in constant pain with cancer of the lung, which has spread to the bones, the spinal column and the brain. Perhaps some of the people who are opposed to giving heroin should have to watch a person suffering day after day. I have watched my husband die by inches.

The letters pour into the Washington office of Judith Quattlebaum, 49. Again and again they tell a story that is all too familiar: the unremitting agony endured by a cancer patient, the frustrating sense of impotence felt by the family, and the apparent indifference of doctors seemingly more concerned about the latest advance in chemotherapy than about the comfort and dignity of their patient. Quattlebaum has been through it, having watched her grandmother slowly succumb to cancer. Seven years ago, she decided to act. Working out of her home, she organized the National Committee on the Treatment of Intractable Pain, now 6,000 members strong. Its mission: to win congressional approval for the use of heroin to relieve the pain of terminal-cancer patients.

Over the years, Quattlebaum's efforts have won considerable support in Congress, but several attempts to pass a heroin bill have been defeated. This year she is closer than ever. The Compassionate Pain Relief Act would authorize the use of heroin over a four-year evaluation period for hospitalized terminal cancer patients. It has been approved at the committee level in the House, and a companion bill has been introduced in the Senate. The bills have the support of such diverse political leaders as conservative Republican Barry Goldwater of Arizona and liberal Democrat Henry Waxman of California.

By and large, supporters have been persuaded by Quattlebaum's argument that heroin, which has been prohibited for use by U.S. doctors since 1956, is in many ways superior to morphine, the injectable narcotic most widely prescribed for cancer pain. According to Quattlebaum, heroin is faster acting because it is more soluble: "You can use half a cc of heroin, when you may have to use 20 times as much morphine." This is especially important in treating patients who are so emaciated that there is little muscle left in which to inject a drug, making a large shot extremely painful. Quattlebaum also suggests that heroin might prove helpful to those who are bothered by the side effects of morphine, which include night mares, nausea, constipation and hallucinations. Finally, Quattlebaum points to the experience in countries like Britain, where heroin is available as an analgesic. "Where doctors have a choice," she insists, "both patients and doctors prefer heroin."

But many authorities disagree with Quattlebaum's views.