On the day Philip Seymour Hoffman died of an apparent heroin overdose, so did roughly 100 other Americans -- 100 lives claimed by heroin or some other drug.
"Everyone's talking about him, and we want to know whose phone numbers were in his cellphone," says Steve Pasierb, president and CEO of The Partnership at Drugfree.org. "All of that's important, but in Washington, in San Diego, in Chicago and in Vermont, people died. And that's the nature of this. People say he was a smart guy, that he should have known it was bad. Of course he knew it was bad -- the problem is, his brain was constantly telling him that some heroin would be a very good idea."
Hoffman's death highlights a steep increase in drug overdoses. Consider that in 2010, there were 38,329 such deaths in the United States, according to the Centers for Disease Control and Prevention. That's more than double the 16,849 fatal overdoses recorded in 1999. Overdosing is now the leading cause of accidental death in the U.S., ahead of traffic fatalities and gun homicides. And health officials warn that we're in the midst of a new heroin epidemic that will only get worse before it gets better.
"It's not that Hoffman overdosed on heroin -- it's that he was using heroin in the first place," Pasierb says. "Like there's some safe level. Like if only he would have taken less, then somehow this would have been OK."
Aside from the obvious truth that no amount is safe, here's what you need to know about the drug:
It's a depressant. Heroin -- a white to dark brown powder or tar-like substance -- is a highly-addictive opioid drug extracted from poppy plants and synthesized from morphine. It's a downer, which means it's a depressant that slows messages traveling between the brain and body. When it enters the body, it's converted back into morphine, and users feel a rush of euphoria. "You have an extraordinary sense of well-being," says Nora Volkow, director of the National Institute on Drug Abuse. "It's bliss. It removes any sense of discomfort." Once the brain discovers that effect -- that powerful high -- it begins to crave it again and again. "And if you don't have that drug onboard, you feel awful," Volkow says. "Things that in the past would produce pleasure no longer do."
It's linked with prescription drug abuse. The No. 1 sign that someone will use heroin, Pasierb says, is that he or she abused prescription painkillers like Vicodin and oxycodone. "Where I am in NYC, I'm looking out at Madison Square Park," he says. "I can probably go out there and find an oxycodone for about $40. I could go down to Washington Square Park and get five envelopes of heroin for $40." Those are the "economics of what's driving the increase in heroin use," Pasierb says.
There are signs that someone is using. When someone is abusing heroin, he or she may suffer from shortness of breath, dry mouth, a droopy appearance and cycles of hyper alertness followed by sudden drowsiness. Their pupils will likely appear small. Users may also show sudden changes in behavior or actions. "At one moment, they may be extremely friendly and sociable and very happy, and then they may be the opposite -- very aggressive," Volkow says. She adds that as heroin starts to leave the body, a person's heart rate will spike, he or she will begin to sweat and the user might even experience seizures. "It's a very severe withdrawal," she says.
There are multiple ways to use it. Twenty or 30 years ago, heroin was 6 to 10 percent pure, Pasierb says -- so if people wanted to get high, the only choice they had was to inject it. These days, heroin is 50 to 60 percent pure, so most users start by snorting it, then gradually progress to smoking and injecting it. "Maybe you've taken a couple oxycodones, and you're now dependent on them, and you say you're never going to put a needle in your arm," Pasierb says. "So you grind up some heroin and snort it, and that actually works for a little while." But then you build up a tolerance, so in pursuit of a better high, you decide to smoke it. That works for a while, too, until you again become tolerant. "And lo and behold, the only way to capture that high is to inject it into your arm," Pasierb says.
There's such thing as "bad heroin." A batch of so-called "bad heroin" has been making headlines across the East Coast, reportedly killing 22 people in western Pennsylvania over the course of a week. It's mixed with the prescription narcotic Fentanyl, which is up to 100 times more potent than morphine. Dealers use fentanyl to spike heroin as a "product marketing" tactic, Pasierb says -- it provides a more powerful high than standard batches. "The problem is, these guys mixing it into some of the heroin they're selling aren't mixing the right amount, and they're killing their customers." Fentanyl-laced or not, he cautions: "The key thing about heroin is you don't know what you're getting. Buying a bag on the street is Russian roulette -- open the chamber and see what you get."
Withdrawal is brutal. Imagine that you haven't eaten for three or four days, and then food is withheld for another three days. You'll become psychologically and physically distraught. "You're in agony," Pasierb says. "Your body is craving the thing you're refusing to give it. It's a very tough, hard thing, and your body goes into a full-out revolt." That's why, even when people are determined to kick their habit, they often fail to do so without strong professional help.
It makes your body forget to breathe. Every time someone injects heroin, they're risking an overdose. Most often, "it kills you because you stop breathing," Volkow says. We typically don't need to think about breathing, because it's an automatic behavior driven by centers in the deep parts of our brain, and regulated by multiple neurotransmitters. But heroin inhibits the brain centers that control breathing, and after making someone feel calm and sleepy, the respiratory drive will simply shut down. Short of death, heroin can cause an array of serious health conditions, including hepatitis and HIV. Chronic users may suffer from collapsed veins, infections of the heart lining and valves, liver or kidney disease, and pulmonary complications like pneumonia.
No one is immune. Heroin affects all demographics and professions; men and women of all ages in all parts of the world. "It reaches everybody," Volkow says. "That's the case for addiction in general -- you can have it in very rich people, in very poor people, in people who are 20 and people who are 64. It doesn't discriminate."