Medical use
Under the chemical name diamorphine, diacetylmorphine is prescribed as a strong analgesicin the United Kingdom, where it is given via subcutaneous, intramuscular, intrathecal orintravenous route. Its use includes treatment for acute pain, such as in severe physical trauma, myocardial infarction, post-surgical pain, and chronic pain, including end-stagecancer 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 diacetylmorphine for post-operative pain relief.[14]

In 2005, there was a shortage of diacetylmorphine in the UK, because of a problem at the main UK manufacturers.[15] Because of this, many hospitals changed to using morphine instead of diacetylmorphine. Although there is no longer a problem with the manufacturing of diacetylmorphine in the UK, some hospitals there have continued to use morphine (the majority, however, continue to use diacetylmorphine, and diacetylmorphine tablets are supplied for pain management).

Diacetylmorphine continues to be widely used in palliative care in the United Kingdom, where it is commonly given by the subcutaneous route, often via a syringe driver, if patients cannot easily swallow oral morphine solution. The advantage of diacetylmorphine over morphine is that diacetylmorphine is more fat soluble and therefore more potent (by injection only), so smaller doses of it are needed for the same analgesic effect. Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary in palliative care.

The medical use of diacetylmorphine (in common with other strong opioids such as morphine,fentanyl and