Heroin -- much hailed as a miracle drug to ease the pain of the terminally ill -- is proving no more effective than morphine and other familiar drugs in tests so far.
But new attention to pain and the plight of the suffering and dying should lead to effective pain control for millions of patients.
This hopeful assessment was given by panels of experts at a conference on pain and humanitarian care at the National Institutes of Health yesterday.
The final word on heroin is not yet in, said Dr. Seymour Perry, head of a year-old federal Inter-Agency Committee on New Therapies for Pain and Discomfort. "We should have much better information in a year or so," Perry reported.
But in the two main American tests -- at Georgetown University here and at Memorial Sloan-Kettering Cancer Center in New York -- morphine and other drugs are proving highly effective in the vast majority of patients.
Doctors at St. Christopher's Hospice in London -- which became famous for its care of the painfully dying, including the liberal use of a heroin-cocainealcohol cocktail -- has dropped the cocaine because it "added nothing," and switched from heroin to morphine for most patients, Dr. Thomas West of that center said.
There are exceptions, the doctors added, where heroin can more effectively be used in large doses because of its high solubility -- the speed with which it dissolves in the bloodstream.
But the most important element in easing pain, said the doctors, is a change in doctors' own attitudes.
Led by St. Christopher's and other centers, the attitude is changing from one where pain is treated when it becomes severe to one where pain-kill-ers are given in anticipation of suffering.
Another idea is not the use of pain-killers alone, but "skilled symptom control" for many kinds of discomfort, said Dr. William Fisher of Hospice Inc., a New Haven, Conn., organization that gives hospice-type care to the terminally ill in their own homes.
"One of the most exciting developments I've seen," said Dr. West, "is a new 'symptom control team' at St. Luke's Hospital in New York. It's a team of specialized doctors, nurses and a chaplain called in when pain is out of control. They deal not only with physical, but also with social, emotional and spiritual pain. We're adopting this team idea at St. Christopher's."
In the new treatment of pain and the dying, there also has to be "a focus on the family," Dr. Fischer added. "When the patient dies, the family survives."
New Haven's Hospice, Inc., will soon open a $3.5 million, 44-bed unit for terminally ill patients who cannot be cared for at home or need temporary hospital-type care, Fischer said.
NIH officials said they support the establishment of "some" such hospices as research and demonstration centers.
But Fischer said the hospice movement, if it is to remain humane and also cost-effective, should help as many families as possible care for patients at home, with the help of hospice teams.
What is needed, said Dr. Robert Butler, head of the National Institute on Aging, is "a hospice concept," one of giving the terminally ill and the suffering expert, humane care, no matter where they may be, in specially named units or not.
But he warned against establishing too many independent, free-standing hospices, lest they become mere "death houses," cut off from the main-stream of medical care in the same way as the "already disastrous" nursing-home industry.
"If we aren't careful," said the National Cancer Institute's Dr. Diane Fink, "if the patients in hospices don't get good, meticulous medical management, we may miss some who are potentially curable."