Diamorphine

Morphine is the principal alkaloid of opium. It acts both as a base and as a phenol and reacts to form methylmorphine (codeine ) and diacetylmorphine (diamorphine or heroin). 

The processes used in the manufacture of morphine are believed to be still based on that described by the Scottish chemist Gregory,in 1833, with improvements devised by Anderson. A description has been published by Schwyzer, who also deals with the manufactme of codeine, narcotine, cotarnine, and the commercially important morphine derivatives, diamorphine (diacetylmorphine), and ethylmorphine (morphine ethyl ether). More recently Barbier has given an account of processes, based on long experience in the preparation of alkaloids from opium. Kanewskaja has described a process for morphine, narcotine, codeine, thebaine and papaverine, and the same bases are dealt with by Chemnitius, with the addition of narceine, by Busse and Busse, and by Dott. It is of interest to note that a number of processes for the extraction and separation of opium alkaloids have been protected by patent in Soviet Russia. ... 

Morphine Diamorphine Codeine Pethidine Fentanyl Alfentanil Remifentanil... 

Morphine is an opioid analgesic that may be used for pain relief in myocardial infarction. However, diamorphine is usually preferred because it causes a lower risk of nausea and hypotension than morphine. 

Only medical practitioners who hold a special licence issued by the Home Secretary may prescribe diamorphine, dipipanone or cocaine for addicts other practitioners must refer the addict to a treatment centre. This stipulation only applies to addicts and does not preclude the prescription of diamorphine or cocaine for the relief of pain due to organic disease or injury (see also page 531 Chapter 17.15.3). 

The most known narcotics are the opium alkaloids such as morphine, codeine, thebaine, papaverine, noscapine and their derivatives and modified compounds such as nalmorphine, apomorphine, apomopholcodine, dihydrocodeine, hydro-morphone and heroine, also known as diamorphine. Synthetic narcotics share the structural skeleton of morphine and include dextromethorphan, pentazocine, phenazocine meperidine (pethidine), phentanyl, anfentaitil, remifentalin, methadone, dextropropoxyphene, levoproxyphene, dipipanone, dextromoramide, meptazinol and tramadol. Thebaine derivatives are also modified narcotics and include oxycodone, oxymorphone, etorphine, buprenorphine, nalbuphine, naloxone or naltrexone. Narcotics can be semi-synthesized or totally synthesized from the morphine and thebaine model. The compounds serve various purposes in clinical practise. 

Opioids such as diamorphine, pethidine, and pentazocine strongly inhibit gastric emptying and greatly reduce the absorption rate of paracetamol. Codeine, however, has no significant effect on paracetamol absorption. Morphine and diamorphine have been shown to reduce the absorption of antiarrhyth-mics such as mexiletine in patients with myocardial infarction. 

Amanda is a 33-year-old woman whose case we inherited after she had been prescribed diamorphine in controversial circumstances. She had previously been a patient of the methadone clinic but her progress had generally been unsatisfactory, and eventually she had obtained treatment with diamorphine from a doctor in private practice. Unfortunately the doctor did not have the licence required to prescribe the drug, but by the time the situation was discovered treatment had been established for several months. It was agreed that we would take her back into our service, where diamorphine could be prescribed on a legal footing while her case was being reassessed. 

Because diamorphine is converted to morphine in the body, prescribing the two drugs may be considered broadly similar. However, the initial subjective effects of diamorphine are crucial, and morphine is often a less attractive proposition. In the early major trial of injectable drugs in Switzerland (Uchtenhagen et al. 1996), in which the morphine protocol was based on previous experience in the Netherlands, two of the morphine-prescribing groups were curtailed because of poor acceptability by participants. Of side-effects, histamine-like reactions on intravenous injection were most frequently reported. 

The process of controlled withdrawal from a drug (Palfium) Opioid medication, frequently abused by injection Heroin - the chemical term diamorphine may be used to refer to the pharmaceutical preparation... 

Metrebian N, Mott J, Carnwath Z, Carnwath T, Stimson GV Sell L (2007). Pathways into receiving a prescription for diamorphine (heroin) for the treatment of opiate dependence in the United Kingdom. European Addiction Research, 13, 144-7... 

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