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Some believe that heroin produces more euphoria than other opioids; one possible explanation is the presence of 6-monoacetylmorphine, a metabolite unique to heroin – although a more likely explanation is the rapidity of onset.

While other opioids of recreational use produce only morphine, heroin also leaves 6-MAM, also a psycho-active metabolite. these subjects showed no preference for one drug over the other.

Equipotent injected doses had comparable action courses, with no difference in subjects’ self-rated feelings of euphoria, ambition, nervousness, relaxation, drowsiness, or sleepiness.

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[20] Short-term addiction studies by the same researchers demonstrated that tolerance developed at a similar rate to both heroin and morphine.

When compared to the opioids hydromorphone, fentanyl, oxycodone, and pethidine (meperidine), former addicts showed a strong preference for heroin and morphine, suggesting that heroin and morphine are particularly susceptible to abuse and addiction. Morphine and heroin were also much more likely to produce euphoria and other positive subjective effects when compared to these other opioids.

Its use includes treatment for acute pain, such as in severe physical trauma, myocardial infarction, post-surgical pain, and chronic pain, including end-stage cancer and other terminal illnesses. In other countries, it is more common to use morphine or other strong opioids in these situations.

In 2004 the National Institute for Health and Clinical Excellence produced guidance on the management of caesarian section, which recommended the use of intrathecal or epidural diamorphine for post-operative pain relief.

Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary for the palliative care.

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