Research Note — Prescribing Diamorphine for Medical Conditions: A Very British Practice

Abstract

Diamorphine, with a 129-year history, is one of the longest established medications. In British medicine, diamorphine is sometimes used as a maintenance treatment for opiate addiction but is also routinely used in clinical practice to treat a number of general medical conditions. These ways of using diamorphine are very different but are often confused by observers of the British system. Although the routine clinical use of diamorphine in medicine is unique to the United Kingdom (UK), in other countries there is little awareness of this very British practice. Diamorphine is used in hospitals, primary care settings, and hospices. It may be administered by different routes, including oral, intramuscular, intravenous, subcutaneous, inhaled, epidural, and intrathecal routes. Among its most important medicinal uses is the treatment of severe and/or intractable pain. Discussion of the medical uses of diamorphine is often confused by entanglement of medical practice and illicit drug abuse problems. This article summarizes the history, regulation, and uses of diamorphine in the UK.