The Pharmacokinetics of Heroin in Patients with Chronic Pain

Charles E. Inturrisi, Mitchell B. Max, Kathleen M. Foley, Michael Schultz, Seung Uon Shin, Raymond W. Houde

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Abstract

We measured blood concentrations of heroin and its active metabolites, 6-acetylmorphine and morphine, serially in 11 patients with chronic pain (9 of whom had cancer) after intravenous injection, intravenous infusion, intramuscular injection, and an oral dose of heroin hydrochloride. Parenteral heroin provided measurable blood levels of heroin, 6-acetylmorphine, and morphine. Blood levels of heroin and 6-acetylmorphine reached their maximal concentrations within minutes and were cleared rapidly. The mean half-life of heroin (±S.D.) after intravenous injection or infusion was only 3.0±1.3 minutes, and the mean clearance of heroin from the blood at apparent steady state was 30.8±2.1 ml per kilogram of body weight per minute. Morphine levels rose more gradually, and morphine was cleared much more slowly. Oral administration of heroin resulted in measurable blood levels of morphine but not of heroin or 6-acetylmorphine. The amount of circulating morphine provided by an oral dose of heroin was only 79 per cent of that available from an equal amount of morphine. We conclude that heroin is a pro-drug that serves to determine the distribution of its active metabolites. Parenteral heroin is rapidly converted to 6-acetylmorphine, which contributes to rapid pain relief. Oral heroin is converted to morphine and appears to be an inefficient means of providing morphine to the systemic circulation. (N Engl J Med 1984; 310:1213–7.).

Original languageEnglish (US)
Pages (from-to)1213-1217
Number of pages5
JournalNew England Journal of Medicine
Volume310
Issue number19
DOIs
StatePublished - May 10 1984
Externally publishedYes

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ASJC Scopus subject areas

  • Medicine(all)

Cite this

Inturrisi, C. E., Max, M. B., Foley, K. M., Schultz, M., Shin, S. U., & Houde, R. W. (1984). The Pharmacokinetics of Heroin in Patients with Chronic Pain. New England Journal of Medicine, 310(19), 1213-1217. https://doi.org/10.1056/NEJM198405103101902