"IT'S TOO BAD," a congressional staffer recently remarked, "that Congress doesn't care as much about terminal cancer patients as it does about tobacco price supports." He was referring to the fact that Congress hasn't managed to find time this year to consider legislation allowing the carefully controlled use of heroin as a last-resort painkiller for terminal cancer patients.
Last year similar legislation, with strong support from members from every part of the political spectrum, seemed headed for easy passage. At the last minute, however, many members got cold feet. They were scared off by opponents -- including the Health and Human Services Department which launched a grass-roots lobbying campaign -- claiming falsely that the measure would "legalize heroin" and promote addiction. So inaccurate were these charges that one supporter of the bill wondered during the House floor debate whether opponents were even talking about the same measure.
Rep. Claude Pepper recently recalled the defeat of the measure in bitter terms. "I told them about my wife's suffering (as a terminal cancer patient) . . . about that killing, terrible pain, but they were afraid they'd be accused of voting for drugs, the bunch of weak, spineless bastards." Congress' courage, of course, reaches a biennial low in the fall before an election. But elections are not in the immediate offing, and Congress ought to be grown-up enough to deal with the fact that there is no special evil involved in including small quantities of heroin in well-guarded hospital pharmacies along with all the other potentially addictive drugs already there.
The irrational element in the debate is made evident by the fact that opponents of medicinal heroin tout the virtues of another drug, Dilaudid, as an alternative. Dilaudid, despite its clinical sounding name, is simply another opium derivative. Like heroin it is used and abused by street addicts. The drug has been available for many years. But, as Dr. Allen Mondzac, clinical professor of medicine at George Washington University observes, where the option exists as in Great Britain, heroin has been generally preferred because of its effectiveness, quick action and anti-depressive properties.
Dilaudid proponents claim that a more concentrated version of the drug makes the use of heroin unnecessary. But the only relevant research supports heroin superiority in treating chronic pain. New research is scheduled to be started next year, but two of the physicians involved in the research have already announced their opposition to heroin use, and the results probably will not be available for years.
In any case, as Dr. Mondzac points out, individuals react differently to drugs so that the wise physician will want to hae as many options as possible. For this and other reasons the American Nurses Assn., representing the people who deal most continuously with patients in severe pain, supports the use of heroin. The ever-cautious American Medical Assn., however, does not. In Canada, by contrast, the medical profession recently helped to persuade the government to allow heroin use in hospitals. Unfortunately in this country it appears that most doctors, like most congressmen, are more afraid of name-calling than they are concerned about the suffering of thousands of people.