Ban to stay on heroin for patients

The Minister for Health, Mr Martin, is expected to continue a ban on the use of heroin for cancer patients in the Republic.

The Minister for Health, Mr Martin, is expected to continue a ban on the use of heroin for cancer patients in the Republic.

In a report due to be published at the end of March, the expert group set up by the previous Minister, Mr Cowen, is set to reject a proposal to legalise the use of heroin, also known as diamorphine, for the medical treatment of severe pain.

The Irish Times understands representations were made to the Department asking for diamorphine to be legalised on the basis that patients living in the North of Ireland who come to the Republic on holiday or to live were at a disadvantage.

It is also understood there were concerns about patients from Border areas of the Republic receiving treatment in the North which they would be unable to continue on their return home.

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The National Advisory Committee on Palliative Care has informed the Minister that there is no medical need to have diamorphine available in the State. The experts consider morphine and hydromorphone, the two opiates used here, are better and safer drugs.

Dr Liam O Siorin, consultant in palliative medicine at Our Lady's Hospice and St James's Hospital, says there was never a medical need to have diamorhine. "While in the past the extra solubility of diamorphine may have been an advantage, we have always used hydromorphone in accordance with best international practice. It is widely used in the United States where diamorphine has been banned since the 1920s" he added.

The World Health Organisation has asked member-states to ban diamorphine because of its higher level of addiction compared to other opiate drugs. Britain and Canada are the only countries still using heroin for medical purposes.

Asked about the difficulties that might face patients receiving cross-Border care, both Dr O Siorin and Dr Tony O'Brien, a consultant in palliative care at Marymount Hospice, Cork, said there was no problem switching a patient from diamorphine to hydromorphone.

"In any case, surely it makes more sense to prescribe the opiate which is available in the State where the patient lives" Dr O'Brien said.

With only seven palliative care consultants in the State, the report from the National Advisory Committee on Palliative Care will also call for up to 20 additional posts so palliative care services will be accessible on a more equitable basis. The integration of hospice services with the acute hospital sector is another key recommendation.