Death By Heroin

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.