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Dáil Éireann díospóireacht -
Thursday, 16 May 1996

Vol. 465 No. 5

Adjournment Debate. - Use of Diamorphine.

The drug diamorphine should be made available to the medical profession for its various benefits, especially in hospice care. Raising this matter on the Adjournment is, at least, providing an opportunity to debate an issue which should have been dealt with a long time ago.

I raised this matter in October 1995 in a parliamentary question and the written reply I received from the Minister stated:

Following consultations with the Irish Association of Palliative Care, I am satisfied that available drugs for the control of pain in patients suffering from terminal illnesses are satisfactory. I am not aware of any demand that diamorphine, or heroin as it is commonly known, be legalised in this State.

He further stated there are currently arrangements in place whereby patients travelling to this State from Northern Ireland or Great Britain may bring diamorphine with them for their own use.

The final part of the reply brings me to the reason for my request that the drug should be legalised for use here. It is the drug of choice in Northern Ireland and Great Britain. In Donegal I have been closely associated with hospice care since it was set up in association with the Foyle Hospice, which is the flagship of hospice care in this island, with its coordinator, Dr. Tom McGinley. It caters for many patients in Derry, Tyrone and Donegal. Many of my patients who are treated in the Foyle residential hospice are likely to be treated at home by hospice nurses afterwards. Consequently, if they were to continue with the treatment they had commenced in Derry, they would be breaking the law here.

I know the Minister has to rely in these matters in accordance with the professional advice available to him. However, perhaps he would allow me to add the benefit of my experience. For various reasons the use of diamorphine — heroin — has not yet been legalised here and, consequently, in most parts of the State people have not have any experience of its use. Therefore, I am not surprised there has not been widespread demand for its legalisation. However, the situation in the Donegal-Derry area is probably unique. I assure the Minister that once a patient has got used to being treated with this drug, he or she would not generally wish that treatment to be discontinued. To put it in its most simple terms, the facts about the drugs are as follows. Diamorphine is six times more soluble than morphine. It can also be administered subcutaneously that is, underneath the skin — a patient of mine who died last week was literally skin and bone — whereas morphine has to be injected into the muscle. This is virtually impossible in many terminal cases. In cases of extreme pain, large doses are necessary and this can be administered in much smaller volumes. In the patient's home the hospice nurse connects up a syringe driver, which with diamorphine can last for 24 to 36 hours before needing to be removed, whereas the other substance requires removal three times per day.

It is true that another form of morphine, namely hydromorphine, is also available. However, it is only half as soluble as diamorphine. It could also be argued that diamorphine breaks down into morphine but it only breaks down into that eventually.

As the Minister's reply last October stated, patients travelling from Britain or the North to this State can bring diamorphine with them for their own use. This is a highly undesirable practice as far as any drug is concerned, particularly diamorphine. Surely the sensible thing is to allow the medical profession to use its discretion in the matter, rather than have lay people in possession of a drug which is illegal here and which would make a doctor or nurse liable to prosecution if they administered it in this State? I hope the Minister of State will see the logic in this argument.

The Drugs and Therapeutics Bulletin, volume 24 No. 23 of November 1986 commented on heart attacks, the other common cause of distress. It stated with regard to the immediate primary care of a suspected heart attack patient approximately half the patients who suffered from cardiac malfunction died within a month, many within hours, many of them from acute left ventricular failure. It also stated that pain relief is necessary immediately, that a strong analgesic, diamorphine 5.10 mg., preferably by slow intravenous injection, is the drug of choice and that acute left ventricular failure should be treated with diamorphine.

Should the Minister ever require diamorphine, or should I have a heart attack, I hope it will be available to us.

I am pleased to have the opportunity of clarifying the position in regard to this matter and I thank the Deputy for raising the topic. I will refer the issues he has raised to the Chief Medical Officer. This matter has been raised on previous occasions and I am glad to be able to reiterate my Department's position in relation to it.

Ireland is a party to the various UN conventions on narcotic drugs and the various recommendations and resolutions adopted by the competent UN bodies on this question of diamorphine. The current international policy on diamorphine, which has been in place since 1954, urges all governments to prohibit the manufacture, import and export of diamorphine except for such small amounts as may be necessary for scientific purposes only. This international policy is based on the belief that there are sufficient other drugs available for the treatment and control of pain.

My Department held consultations with the Irish Association of Palliative Care on the use of diamorphine. As a result of these consultations, I am satisfied that patients suffering from terminal illnesses have available to them an adequate range of drugs to control pain.

The Deputy will be aware that the Minister for Health has made the development of cancer services, including palliative care for cancer patients a particular priority since taking office. I am not aware of a significant demand for making diamorphine available in this State. I trust this explanation will be sufficient to allay the Deputy's concerns on this issue.

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