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.

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.

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
diamorphine. "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.