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Exit is occasionally asked about whether heroin can be obtained from ‘the street’ and used to end life. These questions are often prompted by media reports of people dying from a heroin overdose. In reality, there is little to be gained by using heroin.
As an opioid, heroin suffers from the same problems of tolerance and sensitivity discussed above. In addition, there is the question of the uncertainty of the dose with heroin. When heroin is bought on the streets, there will be uncertainty over its exact composition and dose. Heroin also needs to be injected intravenously. In Exit’s experience, few elderly and seriously ill people have these skills.
Note: If heroin is taken orally, it is converted into morphine as the blood passes the liver, and it is morphine that crosses into the brain. Taking heroin orally offers no advantage over taking prescription tablet morphine, where at least the exact dose is known.
Note: Morphine and the other opioids are useful drugs to reduce the distressing symptom of dyspnea and air-hunger from pneumonia. In the COVID-19 Chapter in this Handbook it is suggested that those who are seeking a peaceful death and are unlucky enough to find themselves with coronavirus, could make good use of morphine (or heroin).