I'm not in the UK but Oz, and I'm aware the UK has permitted the medical use of heroin since 1926. It's some years since I learned of the matter so I've forgotten the specifics but as a signatory to drug treaties the UK struck heroin off its schedule of banned substances (unlike many other countries, the UK has always considered the medical use of heroin too important to have it withdrawn from its pharmacopoeia). My other half trained as a nurse at Barts and she was initially surprised that heroin wasn't used here especially for relief of intractable pain such as in terminal cancer cases (likewise Brompton cocktail/mixture—heroin, cocaine and sometimes other compounds).

Contrary to what may look like my alarm that heroin was ever discovered (or rediscovered by Bayer), my actual view is like that of the UK, that is, in cases of intractable pain heroin ought to be used more widely elsewhere. It's understandable why a substantial number of countries limited their use of opioids to morphine, pethidine etc. but as I see it as heroin is actually better at suppressing pain than morphine irrespective of dose then it should be available to those who actually need it on humanitarian grounds.

Banning the medical use of heroin because it's difficult to manage given the risk of diversion etc. I think is an unacceptable excuse, especially so nowadays. Perhaps that policy may have been acceptable when heroin was the strongest narcotic on the block, but it's highly questionable now given the widespread use of fentanyl which is almost two orders of magnitude more potent.

What I find so objectionable about Bayer is that I just do not believe that when Hoffmann and others at Bayer named the drug 'heroin' it was because, unlike morphine, they believed that it was free of addictive side effects; more likely it was 'heroic' because of its enormous commercial potential. By the time Bayer named heroin the addictive effects of opiates were well known. Laudanum had its critics at least 150 years earlier, and with the adoption of the hypodermic needle in the mid 19th Century and its widespread use in the US Civil War to administer opiates to wounded soldiers (many of whom became addicted) it's almost inconceivable that those at Bayer actually believed that heroin was non-addictive (especially given how little the molecules† differ from each other). Either that or they were irresponsible for not at least suspecting it so and testing the drug to that effect before they released it for public consumption.

Not that things are much better nowadays! As we've seen with the recent opioid crisis—Purdue Pharma, the despicable and greedy Sacklers and oxycodone/Oxycontin—it's much more about money and profit than for concern about consumers of the drug. I still find it astonishing that the opioid crisis happened. How was it possible that this crisis ever have happened?

Why were the regulators—the FDA—and the medical and pharmaceutical professions so gullible and or so asleep at the wheel that they could let this disaster happen, especially given the high profile nature of drug addiction, international narcotics treaties and the illicit trafficking of narcotics? Similarly, why did it happen given that just about every pharmaceutical text written in the last 100 or more years has very explicit references about narcotic drugs and their potential for addiction—same goes for medical training, where information about narcotic drugs and addiction is essential learning?

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† Even back when Bayer introduced heroin to the market, Hoffmann et al would have been sufficiently familiar with the morphine molecule to know that its acetylation would have changed more the way it reacted than its intrinsic characteristics, that is, an opioid is an opioid and behaves like one irrespective of potency.

Incidentally, I use the name diacetylmorphine in preference to the more common diamorphine as it's more descriptive of the chemistry. The acetylation of morphine is a really nice example of the process because of the shape of both molecules makes it dead easy to understand what's happened. Even if one has little chemistry, an examination of the skeletal diagrams shows the basic morphine molecule remains essentially the same and with heroin the only change is that the two hydroxyl groups at one end get substituted for two acetyl ones.