The deadly toll of drug prohibition

CELEBRITY DEATHS from drug overdoses always garner heavy mainstream media coverage. Last year, it was the death of Cory Monteith, a star of the popular TV show Glee--a lethal combination of heroin and alcohol killed him. This month, it was the gifted actor Philip Seymour Hoffman, who died of an apparent overdose of heroin.

A giant in both film and theater, Hoffman belonged to the world. His acting was nothing short of astonishing, and the creepy and eccentric characters he inhabited from Scotty in Boogie Nights to Truman Capote in Capote were virtuosity in an acting world full of mediocrity. It is profoundly depressing to think that audiences will never see him act again.

Hoffman defies the stereotype about who uses the drug. Brilliant, award-winning actors who live in apartments in Greenwich Village don't--heroin is thought to be a drug used by poor Black people in the "ghetto."

This racialized stereotype of heroin users has been around for decades. Heroin is the most demonized illegal drug--those who inject it face enormous stigma and discrimination. There is little empathy or attention paid to poor people of color who shoot heroin and overdose. But for Hoffman, there was an outpouring of grief, compassion and attempts at understanding in the media.

The actor's death was pronounced a preventable tragedy, and an urgent call went out to address heroin overdose deaths. The NYPD immediately launched an investigation to find Hoffman's dealers. Three people were arrested. In most overdose fatalities, there is no investigation, much less arrests.

Hoffman's death has temporarily opened up a space to talk about how drug prohibition, the "war on drugs" and social stigma combine to kill heroin users.

ONE FACTOR directly responsible for the surge in heroin use and overdose fatalities is the Drug Enforcement Administration (DEA) crackdown on prescription narcotics like Vicodin and Oxycontin.

The DEA tracks every prescription that physicians write for narcotics. Doctors who prescribe pain medication are under increased surveillance. They are harassed by DEA agents for prescribing "excessive quantities" of narcotics and are routinely investigated. In SWAT-style raids on clinics, doctors have been arrested and had their license to practice medicine suspended. The DEA has created a climate of fear and panic that has led doctors to refuse to prescribe pain medication to patients.

As it became more difficult to get narcotic pain relievers and more costly to buy them illegally–an 80-milligram Oxycontin pill sells for about $30--$10 bags of heroin hit the streets. Pill users switched to cheaper, powdered heroin. Hoffman himself reportedly first took prescribed opiates before injecting heroin.

Prescribed medications are safer to use because the potency is known, but street heroin is not. Heroin is cut with a variety of substances to increase profits in an illegal industry. In recent months, 22 people in the Pittsburgh area and 37 in Maryland died from fentanyl-cut heroin that is nicknamed "Theraflu." Fentanyl is a powerful, synthetic narcotic that is used to treat chronic pain; in combination with heroin, it has a dangerous synergistic effect. It's not the first time this drug mixture has killed heroin users. From 2005 to 2006, 1,000 people died from heroin laced with fentanyl.

Despite pleas from public health officials, no high-profile campaign was launched to prevent overdose deaths by providing naloxone to heroin users. Naloxone is a medication that quickly and safely reverses overdose.

Proponents of "Just say no" to drugs believe in abstinence-only policies toward drug treatment and have attempted to block widespread access to naloxone. Drug warriors claim that naloxone will increase use of opiates and "enable" more frequent and riskier drug consumption. Never mind that dozens of studies have disproven this notion. Moreover, naloxone opponents argue that because opiate users know that naloxone can save their lives, they will lose their fear of overdose and death.

The message: Die.

Tragically, opiate users are. Every day, 105 people die from an overdose involving heroin or pharmaceutical opioids. With more than 30,000 deaths annually, accidental overdose has overtaken auto accidents as America's leading cause of accidental death for people 25 to 64.

In New York City, heroin-related deaths increased 84 percent from 2010 to 2012 and occur at a higher rate--52 percent--than overdose deaths involving any other substance.

SINCE HOFFMAN'S passing, though, there has been a sea change in attitudes to naloxone use, and there is an acknowledgment that something must be done now to decrease overdoses from licit and illicit opiates. Nationally, there is a call to make naloxone widely available and over-the-counter.

Major media outlets frontloaded stories about the importance of training and providing naloxone kits to opiate users and their loved ones. In a New York Times op-ed article titled "How to Stop Heroin Deaths," Dr. Robert S. Hoffman wrote:

The most frustrating part is that each of these deaths is preventable, because there is an antidote to heroin overdose that is nearly universally effective. Naloxone, an opioid antidote, is a simple compound that has been in clinical use for more than 30 years. It can be administered via needle or as a nasal spray, and it works by displacing heroin from its receptors in the brain and rapidly restoring the overdose victim to consciousness and normal breathing.

Another harm reduction measure that reduces overdose is safe injection facilities (SIF). In Canada and Europe, heroin users can inject in a safe, clean place under the observation of health care providers. The fatal overdose rate in Vancouver's downtown Eastside decreased by 35 percent after the opening of the SIF called "Insite."

There isn't one SIF in the United States. All attempts to open safe injection facilities have been met with vociferous opposition by the drug warriors, who use the same old twisted and deadly logic that any drug policy that reduces the harm of drug use will lead to more drug use.

Naloxone and safe injection sites, although vitally important, are not enough. As long as heroin use is illegal, and the people who use it are criminalized and stigmatized, overdose deaths are inevitable.

Drug prohibition leads to heroin users consuming tainted drugs in unsafe conditions, under the constant threat of arrest and in shame and secrecy. That is why Philip Seymour Hoffman was using heroin alone in his bathroom--he had to keep his heroin use a secret. And like everyone who buys drugs on the black market, Hoffman didn't know the purity or potency of the heroin he injected--there is no quality control or FDA approval of illicit drugs.

If heroin were available by prescription, as it is in a dozen countries in Europe, overdose deaths would decrease dramatically. In these countries, addiction to opiates is treated as a health problem, not a crime. Heroin-assisted treatment (HAT) is administered in clinics. And studies that have evaluated HAT have shown consistently positive outcomes, from major reductions in illicit drug use, crime, disease and overdose, to the lessening of stigma and social isolation.

When the price of a bag of heroin is just $10 and is widely available, it's clear that the 40-year "war on drugs," which promised a "drug-free" America, has failed. Drug prohibition doesn't stop people from using drugs; it only ensures that some of them will die.