The Other Heroin

Maybe it’s first prescribed to you for a bad back. Or maybe your friend had wisdom tooth surgery and had a couple pills left over, giving you one to help you relax. At first, you’re fine with just a pill or two, taking them occasionally on the weekend to celebrate or to help you unwind. Then it becomes a regular thing in the evening after work – just like a glass of wine, right?

But then one isn’t quite doing it for you, you’re starting to lose that blissful initial buzz as your tolerance starts to kick in. So you up it to two. Just two, that’s not bad, right? And then someone tells you – you’re not sure who, or maybe you read it on the internet – that if you crush them up and snort them you can get that quick burst back like you used to have.

But this is starting to get expensive. You try to cut back, going a day or two without, but you feel awful. It’s like the flu, but worse. The flu mixed with crippling depression and anxiety and insomnia. You take one so you can get some sleep, and then so you can get out of bed the next morning. And then it’s just so easy, providing you that blissful daze to get you through the day, staving off the morose and despair that are lurking around the corner, waiting to envelope you when it’s been too long.

But this is getting expensive. I mean these pills are $80 a pop on the street! You’ve long since burned through your savings, but you can’t stop now – that would make you face the darkness, and nothing is worse than that. So you suck it up and make the switch; something you swore you’d never do. And now you can’t live without it, though soon you may not be able to live with it.

Last Sunday, we lost one of the best actors of our generation.

And while Hoffman technically died of a heroin overdose – the heartbreaking, embarrassing and ghastly details on view for all to see in the same newspapers andmagazines that so touchingly eulogized him in preceding and succeeding articles – it isprescription painkillers that reportedly triggered his relapse and led to his eventual demise.

This story, sadly, is not a new one. Not the tale of the movie or rock star dying in a blaze of drug-fueled glory, but the sad, lonely, accidental opiate overdose. And despite the panic over potentially laced bags of heroin leading to a rash of deaths, the majority of these overdoses are actually from legal prescription drugs, like Oxycontin or Vicodin.

Because these drugs are technically legal, intended to be prescribed by a doctor to help you heal, there is a misconception that they are safer than street drugs. And while it’s true that they may be cleaner than heroin — unadulterated by additives ranging from the relatively mundane, like laxatives, baking powder and lactose, to the potentially deadlyfentanyl, methamphetamine and desomorphine, or Krokodil – prescription pills are not innocuous.

The effect of opiate drugs like morphine, heroin, Vicodin and Oxycontin are identical in the brain. All of these substances are derived from the opium poppy plant, and once in the brain, our receptors don’t care if they were bought in a pharmacy or on the street. Opiates are depressants, meaning they suppress cell functioning by attaching themselves to opioid receptors scattered throughout the brain, preventing them from firing. However, these drugs don’t work selectively, and while they can stop us from feeling pain, they can also stop us from breathing.

Imagine if you had to concentrate on every breath you took – every inhale and exhale. While advocates of mindfulness meditation would be pleased, most of us would be unable to function. Fortunately, our brainstem takes care of this for us, automatically contracting our diaphragm and expanding our lungs. Death from overdose occurs when this system stops running. These brainstem cells become overwhelmed by opioids inhibiting their functioning, telling them to stop firing. When this happens, we stop breathing. We begin to suffocate. Our lips and nails turn blue; we might start seizing or spasming. Eventually, our heart stops beating.

In 2010, 16,651 people died this way from a prescription medication. Deaths caused by prescription drug abuse now make up more overdose deaths than those from heroin, cocaine and methamphetamine combined.

From Portland, Maine to Portland, Oregon, prescription drug abuse has become a raging epidemic. The governor of Vermont recently spent his entire State of the State addressdiscussing the problem, and President Obama and the White House have raised similar concerns, trotting out such staggering statistics as the fact that drug overdoses are now the leading cause of death of America, comprising more fatalities than car accidents. In Ohio, one of the states hardest hit by the epidemic, deaths from drug overdose increased by 440% since 1999, up to a staggering 1,765 in 2011. That’s five people dying every day from an overdose.

But an addiction to painkillers is not a sustainable one, with pills costing anywhere from$60 – $100, depending on their strength. So more and more people are making the switch to heroin, a $10 drug potentially laced with dangerous additives and laden with connotations. New York has seen an 84% rise in heroin overdoses in the past two years, coinciding with a 67% increase in heroin seized, supply following demand.

All told, there are over 38,000 deaths by drug overdose every year in the U.S., more than 50% of which are from prescription-based drugs, 75% of these opiate-based. And these numbers are rising.

Hoffman’s death is no doubt a tragedy, but odds are, Hoffman wasn’t the only one who died last Sunday.

Dana Smith

PhD student in Experimental Psychology at the University of Cambridge