Pubdate: Monday 01 November 1999 Source: Calgary Herald (CN AB) Copyright: 1999 Calgary Herald Contact: P.O. Box 2400, Stn. M, Calgary, Alberta T2P 0W8 Fax: (403) 235-7379 Website: http://www.calgaryherald.com/ Forum: http://forums.canada.com/~calgary Author: Robert Walker, Calgary Herald MD TOUTS HEROIN TO RELIEVE SEVERE PAIN Calgary and other Canadian doctors are being asked to think again about using heroin for cancer and other pain. The plea is by Dr. Kenneth Walker, the Toronto obstetrician who successfully campaigned through the early 1980s to get heroin legalized. Although heroin was made legal 15 years ago, most Canadians know of it only as the illegal street drug over which society fights a never-ending battle to keep at bay. "They have to reconsider their decision," he said. "I spent six years of my life and hundreds of hours on this." Despite his success, Calgary doctors and many other physicians gave thumbs down to adding the powerful narcotic to their arsenal of weapons to fight pain. In Britain, heroin has been widely used for many years to treat pain in cancer and other serious conditions. Dr. Neil Hagan, medical leader of Foothills Hospital palliative-care service and head of the cancer pain clinic at the Tom Baker Centre, said doctors here don't use heroin, because there's plenty of alternatives such as morphine, Dilaudid (hydromorphone) and Fentanyl to effectively treat pain, making heroin unnecessary. "Heroin has very few advantages over morphine," he said and denied any prejudice against heroin. Others agree, warning that stocking heroin in hospital pharmacies would tempt abusers to try to break in and steal supplies But Walker said doctors are so prejudiced against the drug that at least one drug company hasn't imported heroin into Canada for the past year. . "If you had a patient with terminal cancer now, you couldn't even get it," Walker said "It was a hell of a battle won and hell of a war lost." . He suggested patients consider suing their doctors and hospitals for not using heroin if they consider they're getting poor care. Calgary architect and cancer survivor Martin Cohos agreed that patients need all the help they can get to deal with pain. "If it helps people it should be used. For doctors in Calgary not to use this powerful painkiller I think is silly, especially in cancer patients, where some of the pains are just dreadful," said Cohos, who is in remission from cancer of the marrow and of the lymph glands. "If you are nearing death it is not going to do any harm." Cohos, who was wracked with pain from cancer, said he had no idea heroin was a legal drug. "It is one of the myriad of tools that doctors should have at their disposal." Carol Langlois from the office of controlled substances at Health Canada said demand peaked at 1.668 kilograms in 1996, but it rapidly trailed off to a meagre 0.032 kilograms last year. One kilogram supplies about 30,000 smaller doses or about 10,000 larger doses. Walker said hospitals have set up administrative road blocks to its ready use that many doctors have been deterred from trying it "Doctors, because of the lack of humanity to their patients and education, didn't use it," Walker said. "It's a good drug, and it's been treated in a terrible fashion by the medical profession here." After his father died a painful death from cancer in 1981, Walker mounted a successful nationwide campaign to legalize the medicinal use of heroin, collecting 30,000 letters of support for the cause. David Cook, professor of pharmacology at the University of Alberta, said that most Canadian doctors have had no experience in using heroin. Because Britain has been more successful in keeping heroin off the streets, doctors there are not as terrified of it, he said "It is a cultural thing to a point. These drugs spook people," Cook added. Steve Long, Calgary Regional Health Authority administrative leader for acute-care pharmacy services, said he hasn't had a request for heroin in the past four years and regards it as obsolete. He wouldn't know where to get heroin if it was requested. At the same time heroin was legalized, Dilaudid became available and is more potent, more soluble and cheaper. Dilaudid works for longer periods, too, Long said. Other alternatives such as morphine can be taken orally,which is more convenient than injection. Heroin is more of an attraction for thieves, Long said. "You could become a target for break-ins." It is more important for patients to get treatment from doctors experienced in pain management than for heroin to be available, Long said When heroin was legalized in the 1980s, Foothills Hospital decided "heroin is not the answer to the management of chronic pain or the treatment answer to the management of chronic pain or the treatment of terminal illness," a statement from the facility said at the time. . Heroin in hospitals Medicinal use in Canada since 1984 Year Kilograms 1998 0.032 1997 0.091 1996 1.668 1995 0.423 1994 0.819 1993 0.484 1992 0.792 1991 0.497 1990 1.590 1989 0.982 1988 0.687 1987 0.522 1986 0.274 1985 0.082 - --- MAP posted-by: Keith Brilhart