Sir.—Cole and colleagues'1 recommendation of the use of intravenous narcotics in sickle cell vaso-occlusive crises is of concern to me for the following reasons:
1. Publicizing this mode of therapy might lead to its overuse by practicing physicians. Pain perception and pain threshold differ not only from one patient to another but also from one physician to another; patients will be able to affect many physicians' decisions.
2. The authors refer to postoperative pain relief and relief of pain accompanying malignant neoplasms. Although comparing the efficacy of pain relief might be appropriate, it is inappropriate to compare the indications for therapy. In the first situation, the medication is given perhaps once in a lifetime; in the second, the patient is usually terminal, and the least of his or her physician's concerns is drug addiction.
3. The authors quote textbooks and imply that they recommend narcotics use; however, it