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Monday, February 3, 2014

With Hoffman’s Death, A Look At Heroin Use

New York City Police Department investigators leave the apartment building of actor Philip Seymour Hoffman after he was reported dead on February 2, 2014 in the Greenwich Village area of New York. (Stan Honda/AFP/Getty Images)

New York City Police Department investigators leave the apartment building of actor Philip Seymour Hoffman after he was reported dead on February 2, 2014 in the Greenwich Village area of New York. (Stan Honda/AFP/Getty Images)

The New York City medical examiner’s office is doing an autopsy today on the body of actor Philip Seymour Hoffman. The actor and father of three was found on Sunday in his Manhattan apartment, dead of an apparent heroin overdose.

Philadelphia social worker and former heroin addict Jeff Deeney writes about Hoffman’s death in a piece in The Atlantic:

Now that Hoffman is gone the one purpose his passing can offer is to bring into sharp focus the fact that overdose deaths are an uncontained, growing epidemic, and to more vigorously continue the discussion about what to do about it.

Deeney joins Here & Now’s Jeremy Hobson to discuss that epidemic, and what should be done about it.

Deeney says that most heroin users start out as prescription drug abusers. However, prescription drugs are more expensive than heroin, and have been reformulated to be harder to abuse.

“The crackdown on prescription drug abuse is having this unintended consequence of creating more heroin users,” Deeney said.

This kind of news always chills recovering people to the bone.
– Jeff Deeney

Additionally, a batch of heroin laced with a powerful opioid called fentanyl has resulted in a number of deaths across the country.

“It’s really dangerous,” Deeney said. “It has more of a respiratory effect than heroin does. A lot of users actually don’t like it, because they say it has less of a euphoria.”

He adds though, that experienced users seek out the fentanyl-laced heroin precisely because it’s so potent — it provides the strongest high for the money.

Deeney says Hoffman’s death is particularly disturbing to people in recovery.

“This kind of news always chills recovering people to the bone,” Deeney said. “I’ve been clean 10 years, I just celebrated 10 years in my recovery. But, when you hear about somebody who had 23 years, who had it all: a beautiful family, this career, and gave then it up for a bag of dope and then turned up dead, it really hits you, and you wonder, ‘Am I doing enough, basically, to maintain my recovery?’”

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Guest

  • Jeff Deeney, social worker in Philadelphia, former heroin addict and contributor to The Atlantic. He tweets @jeff_deeney.

Transcript

JEREMY HOBSON, HOST:

The New York Medical Examiner's Office is beginning an autopsy today on the body of actor Philip Seymour Hoffman. That's according to officials there. As you've no doubt heard by now, the actor was found yesterday in his Manhattan apartment, dead of an apparent heroin overdose.

Well, our next guest has been thinking a lot about this and heroin use in general. He is Jeffrey Deeney, a former heroin addict; now a social worker in Philadelphia, working to help rehab drug offenders. Jeffrey Deeney, welcome.

JEFF DEENEY: Thank you, Jeremy.

HOBSON: Well, let's broaden this out. How many people are using heroin in the U.S. right now?

DEENEY: I think it's roughly about 1 percent of the population, though I think it's gone up in recent years.

HOBSON: And you say that it is, in part, a matter of economics. It's cheap.

DEENEY: Well, there's two parts to this story. There's prescription drugs, and then there's street drugs like heroin. A lot of users start out on prescription drugs, which are actually far more expensive. So a lot of new users who get addicted to prescription drugs eventually find themselves in this position where they're running out of money. They can't afford, say, $40 for an 80-milligram OxyContin pill that has the same potency as a $10 street bag of heroin. So...

HOBSON: But in Philip Seymour Hoffman's case, he wouldn't have been facing a financial problem to get whatever he wanted.

DEENEY: Right. And I don't think that that was necessarily the case for him, though, in terms of availability and in terms of potency; also in terms of ease of using. For injecting purposes, it's worth noting that the manufacturer of OxyContin, Purdue Pharma, recently reformulated the pill to make it harder to abuse.

So that it used to be that you could get an OxyContin, suck on it for a second, give it a rub with a tissue, and the time-release coding on it would come off. And what would be left is just this pure, little football of oxycodone that you could crush and snort or inject very easily. Now, if you tamper with the time release, it turns into like, a gelatinous mass that isn't really useful for any of those purposes.

DEENEY: So a lot of users who used to get prescription drugs are also moving on because the crackdown on prescription drug abuse is having this unintended consequence of creating more heroin users.

HOBSON: But how easy is it for people to get heroin right now?

DEENEY: Oh, very easy. In Philadelphia, take the subway to Kensington and Somerset and get off and, you know, somebody is going to be trying to sell it to you within two steps of walking off the subway. I mean, prescription drugs tend to trade in less violent parts of the city. They trade over cellphones a lot whereas, you know, the old-style, open-air drug market for drugs like heroin and crack is a very risky thing to do. I mean, you're risking robbery and potentially, winding up in jail or getting shot.

HOBSON: Well, let's talk about the danger of using it on its own. And right now, there is a batch of heroin circulating in many parts of the country that is mixed with a painkiller called fentanyl, which is used for cancer patients. It's very potent. It's been linked to many deaths across the country; and that has happened in the past, too. In previous years, there have been cases where there's heroin laced with this fentanyl, and it causes more people to die. There are questions about whether, perhaps, Philip Seymour Hoffman had that bad batch. But tell us about that, and how dangerous it is.

DEENEY: Right. That's what I'm wondering myself. It's really dangerous. I mean, you know, it has a greater respiratory effect that heroin does. A lot of users actually don't like it because they say that it has less of a euphoria; more of just like a heavy, sedating body feeling - like, it really pins you to the sofa. However, by the same token, a lot of experienced users seek those bags out. Like when you hear on the streets that people are overdosing; that, you know, they just pulled three bodies out an abandoned building, and this is the bag that they were using; a lot of expert-level users are going to go look for that bag because they have to support a habit, and they know that it's potent.

And you know, this is actually, really bad. I think it is about as bad as I've ever seen it, in terms of the frequency with which these fentanyl batches are popping up. There are some speculation about whether this is becoming easier to manufacture inside the U.S.; that there are, you know, there are chemists that are able to cook up a batch of fentanyl, and sort of cut it in with heroin just to sort of bolster their supply a little bit.

HOBSON: Now, you've been clean for 10 years.

DEENEY: Mm-hmm.

HOBSON: Philip Seymour Hoffman had been clean for 23 before he started using again. What saved you? And is there anything that could have saved him, that he could have done on his own?

DEENEY: Well, I mean, you know, pain, I guess, saved me - honestly, you know? And it's interesting. The first time, you know, I became hooked on drugs when I was young, I was using heroin; and I was injecting. I got some time abstinent, and then when I relapsed, it was actually primarily OxyContin, and that was what brought me in seeking treatment; was that I had really kind of exhausted my ability to afford an OxyContin habit. And I knew that in a short period of time, I was going to have to go back to injecting heroin. And that brought about a whole bunch of dangers that I really wasn't interested in dealing with - you know, running from the cops, and people that are shooting each other is more appealing when you're 19 than when, you know, when you're almost 30.

So, you know, Hoffman's decision to go back - I don't know if it was that he was prescribed medication and it got away from him. But, you know, this happens. And this kind of news always chills recovering people to the bone because, I mean, yeah, you know, I've been clean 10 years. I just celebrated 10 years in my recovery. But when you hear about somebody who had 23 years, who had it all - a beautiful family, this career - and then gave it up for a bag of dope and then turned up dead, I mean, it really kind of hits you and makes you wonder, you know, am I doing enough, basically, to maintain my recovery?

HOBSON: I have to say, Jeff, when I heard about Philip Seymour Hoffman, the first thing I thought of is, how could an actor who has a problem with heroin; following the news - that was so well-publicized - about Cory Monteith, the actor from "Glee" who died of an overdose last year; wouldn't that make somebody re-evaluate and say, "I'm in big trouble, I need to go and seek treatment right now"?

DEENEY: I actually think it has more to do with the kind of treatment that he was seeking out. And I think that in the professional addiction treatment community, you know, the focus is shifting from, you know, let's detox people and get them clean, and get them in the meetings to rather, you know, getting people on to a course of maintenance medication. You know, and that's an individual choice. I don't know how Philip Seymour Hoffman would've thought about that if somebody suggested that he go on to Suboxone and be maintained. But the bottom line is that if he was on a maintenance medication, it's definitely more likely that he would still be here.

HOBSON: Jeff Deeney is a social worker and contributor to The Atlantic. He's also a former heroin addict. Jeff Deeney, thanks so much for speaking with us.

DEENEY: Thank you so much for inviting me.

ROBIN YOUNG, HOST:

And, Jeremy, a quick thought. I happened to be driving home from New York on Saturday, listening to the All News Channel's "All Day" on Saturday, talking about a bad batch of heroin that had killed in New York, Long Island.

HOBSON: This is the day before, yeah.

YOUNG: And then to wake up Sunday and find that Philip Seymour Hoffman was dead - quite something. Transcript provided by NPR, Copyright NPR.


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  • S David H de Lorge

    As prohibition has reduced the availability of oxycodone and related prescription drugs, overdose deaths from them has diminished by maybe 1/3. Simultaneously, the heroin overdose death rate has increased by >>1/3rd. Heroin, of course, being completely prohibited, comes with no standardization of doses or other quality control, resulting in more, easier overdoses. People who became unable to get their oxy have gone looking for heroin instead. Meanwhile, unexpectedly powerful heroin compounds have hit the street.

    I have no idea how this applies to Phil, but it sure applies to the heroin topic.

  • Fran

    Hi. I have read much about the over prescribing of painkillers, and subsequent addiction to said pain killers, (& make no mistake, anyone with chronic pain & the need for chronic pain care will become addicted. That is the nature of the drug. They will also develop a natural resistance to the drug & therefore need higher doses for the medication to be effective. So in MA at least, doctors are now terrified to prescribe painkillers to people w/valid and severe chronic pain. The result is they cut them off, and these people are forced to ether suffer all kinds of condescending “mindful” pain clinicians, who’s job is to tell the patient their pain can be “lived with” and even “overcome”, as the mind is a powerful thing.
    I was a cancer patient, live with chronic pain, and have undergone this process in which a doctor fears they will be perceived as “over prescribing” and sent me to “chronic pain clinics”, where I am told it’s all about attitude and diet, exercise, focus, what-have-you. The primary tactic used at these clinics is humiliating, and shaming, as they suggest the mind body connection is enough, if you do it right, to lead a pain free life. It reminds me of an Aunt I had, who for years was told her pain was imaginary, and she was sent by every doctor to for mental health services, rather than medical treatment. After years of being shamed and accused of needing mental health services, she was FINALLY diagnosed with the painful and debilitating disease, Lupus.
    I too, after suffering crushing pain from cancer treatment, as well as suffering some permanent effects of chemo, wake daily in crippling back caused by the cancer & treatment as well as long term neck and back problems, from herniated discs, to nerve pain an numbness. But I am given no pain medication because my pain is chronic, I am admittedly alcoholic, sober for 19 years, and this leads my doctor to fear legal troubles should she prescribe, or trouble with her colleagues, because chronic use of pain medication will inevitably lead to DEPENDANCE.
    But how is it ethical to a patient with valid and chronic severe pain which limits the way they can lead their lives…?

    • Fran

      I meant to end with the thought, no wonder people seek out pain relief from dangerous and illegal sources. Chronic pain is debilitate ting in every aspect of life. Our medical community ought to treat patients for this kind of pain, even if it’s life long. This way they can provide the best medications, and regulate the patient’s use. Instead, those of us w/chronic pain are treated punitively, suspected to be drug seeking addicts, cut off, and often told it’s all in our mind. This may be true of some people, though no one should receive punitive care, but the fact is…THIS IS NOT TRUE OF ALL PATIENTS, but fear and ignorance and moral judgement have forced treatment to be one size fits all, and that size is, tough luck. Get it together. Be happy and you’ll be pain free. See a psychiatrist. And the GREAT LIE… This antidepressant is known to work quite well as a pain killer, too!

  • Happy_Dancing_Monkey

    listen he was a college educated individual, he had everything to live for and chose to take his life with drugs, be it intentional at this time or not he knew drugs can kill. Good riddance. If you don’t want to be on this planet anymore I couldn’t care less if you choose to leave it.

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