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As others have mentioned, high addiction potential. That alone makes me wary of giving it. I don't think addicts are inherently bad people, I think genetically there are many people who have genetic predispositions for addiction. Given that, I'd rather not expose people to addictive substances if I have a choice. I'm sure that there are many cocaine users, meth heads etc who wish they had never tried the stuff. That being said it seems to work very well on sickle cell pain. Also for some reason maybe some better effect than morphine in those with high morphine tolerances. Had a burn patient the other night who was on methadone at home, morphine wasn't really touching her pain but 2mg dilauded x 2 over 3 hours did well.