Death
By Heroin
Philip
Seymour Hoffman died last week, his death apparently heroin-related. He was a popular Oscar-winning film actor,
and since his death closely followed substantial outcroppings of opiate-related
deaths around the country, the news media have gone wild with the story. But was his death a consequence of heroin use
or of the laws against heroin? Answering
that question involves looking at three issues: the safety of opiates,
including heroin, themselves; the kinds of deaths suffered by opiate users; and
the effects of the drug Prohibition laws on those deaths.
The
opiates are incredibly safe drugs. Their
use goes back at least 4,000 years. In
the last fifty years before their Prohibition (c. 1860 – 1914) opiate use –
primarily opium but also morphine and heroin – was widespread and compulsive
use was viewed as a significant social problem, but overdose deaths were
extremely rare. These opiate-related
deaths started becoming common only after the major maintenance clinics were
closed in 1925. Even now, pure heroin overdose
deaths are rare. Experienced users can
build remarkable tolerances. One addict
at the Lexington Narcotics Farm was recorded as using over 1,600 mg. a day –
about ten times the lethal dose; and Fentanyl, a synthetic opioid up to one
hundred times stronger than heroin, is routinely administered for several
chronic pain in doses equivalent to 3,000 mg of heroin daily. The only side effects of opiates are
constipation and the risk of withdrawal symptoms roughly equivalent to the flu
if use is stopped. An addict maintained
on pure heroin can lead a long, normal life.
The lives of three men are illustrative of what a heroin addict’s life
can be. Dr. William Halsted became
addicted to heroin and morphine before age thirty and used them daily until his
death in his seventies. In that time he
became “The Father of American Surgery”, helping form n Hopkins, served as
chief of staff, instituted the use of rubber gloves, and developed the
techniques still used for hernia repair and mastectomy. William Burroughs used
heroin regularly from his thirties until his death in his seventies. His novels written during that time included Junky and Naked Lunch, and he is viewed as a major influence on modern
American literature. Philip Hoffman
serves as a bridge between the ability to function as an addict and the dangers
imposed by suppressing heroin into an underground market. He was a heroin addict before age twenty-two,
and before his death at forty-six, had appeared in over fifty movies, been
nominated for Tony awards, and won an Oscar.
His death with a needle still dangling in his arm raises the issues in
the next section.
Many
heroin users die from opiate-related causes, but few of them die heroin-caused
deaths. Many become homeless because of
the pressures of living in a black market and paying Prohibition-fueled premiums
for a cheap commodity. They die from
malnutrition, exposure, or violence endemic to life on the streets. Most of the other deaths are caused by
impurity, adulteration, or substitution common in unregulated drugs or from the
consequences of unsterile injection techniques.
Almost all of the recently reported deaths involve mixtures of heroin
and Fentanyl, a hundred times stronger than heroin as noted above. These are probably overdose deaths – but overdoses
of Fentanyl, not heroin. A heroin user unknowingly
injecting Fentanyl is trying to take a sip of water from a fire hose. For several decades heroin users have died
when their suppliers substituted Fentanyl for the heroin they expected. As an illegal market, heroin’s supply has wavered
from drought to flood, and when it is scarce Fentanyl steps in and death
results. Other
adulterants or substitutions can also be fatal.
A large number of Dallas teenagers died after injecting a heroin mix
called “cheese”, which was a combination of heroin and Tylenol RM that contains
diphenhydramine
(Benadryl). The required label for
diphenhydramine lists death in adolescents as a possible side effect and warns
that combination with opiates can strengthen the actions of the drug. Autopsies showed low or moderate levels of
heroin and high levels of diphenhydramine.
Another episode near Houston resulted in the deaths of about twenty
men. They bought and injected what they
thought were usual doses of cocaine, but the drug was actually 60% pure heroin:
what would have been their expected high if were cocaine was a fatal amount of
heroin. Poor injection technique can
also be deadly. Injection of air bubbles
or solid contaminants can cause embolisms or thromboses, either of which can
cause instant deaths. When the body is
found with the needle still imbedded, that is usually the marker of this kind
of flawed injection. Overdose, which
takes over an hour at the least, allows plenty of time for the user to remove
the needle.
If this analysis is
correct, countries with legal heroin available should have much lower
opiate-related deaths than those that Prohibit the drugs. Four examples support this assumption, and,
to the best of my knowledge, none show contrary results. As mentioned previously, opiates were freely
available In the U. S. before 1914 and habitual use was recognized as a
problem, but opiate-related deaths were virtually unknown. Incidentally, before the Harrison Act heroin
was generally snorted, smoked, or taken orally; injection only became common
after tight regulation made pure drugs hard to obtain. Switzerland has distributed free heroin to
addicts for almost two decades and the Netherlands has recently joined them. Deaths have virtually disappeared, related
property crimes have gone down, and the rate of use has not increased. The best example is England, which started
allowing doctors to distribute heroin to addicts in 1914. They continued to do so until the Thatcherite
regime stopped the process in the 1980s.
Both the number of deaths and the rate of drug-trafficking crimes shot
up. The English resumed supplying
opiates to addicts and the death and crime rates dropped. In comparison, Scotland continued strict
Prohibition and continues to have death and crime problems.
This year marks one
hundred years since the passage of both the Harrison Narcotics Tax Act and the
first Hague Convention on narcotics.
They have created a century of Death By Heroin. If a society can learn from its history, the
world should have realized by now that Prohibition does not stop drug use, but
it does impose an unconscionable toll of death, misery, and crime. One hundred years is enough. Stop this failed experiment and end
Prohibition now.
