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