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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.
In 1964 the Brain Committee recommended that only selected approved doctors working at approved specialised centres be allowed to prescribe diamorphine and benzoylmethylecgonine (cocaine) to users. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone; currently only a small number of users in the UK are prescribed diamorphine.
In 1994, Switzerland began a trial diamorphine maintenance program for users that had failed multiple withdrawal programs.
By analyzing a community in San Francisco, they demonstrated that heroin use was caused in part by internal and external factors such as violent homes and parental neglect.
This lack of emotional, social, and financial support causes strain and influences individuals to engage in deviant acts, including heroin usage.
Since January 2009, Denmark has prescribed diamorphine to a few addicts that have tried methadone and subutex without success.
Beginning in February 2010, addicts in Copenhagen and Odense became eligible to receive free diamorphine.
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.
The advantage of diamorphine over morphine is that diamorphine is more fat soluble and therefore more potent by injection, so smaller doses of it are needed for the same effect on pain.
Both of these factors are advantageous if giving high doses of opioids via the subcutaneous route, which is often necessary in palliative care.
Some researchers have attempted to explain heroin use and the culture that surrounds it through the use of sociological theories.
In Righteous Dopefiend, Philippe Bourgois and Jeff Schonberg use anomie theory to explain why people begin using heroin.