The Enduring Myth of “Killer Heroin”

I was at a meeting with the Australian drug addiction researcher Shane Darke last week, which gave me the chance to congratulate him for publically predicting correctly that Philip Seymour Hoffman’s autopsy would show that the actor’s tragic overdose death was due to a combination of drugs and not an unusually strong or contaminated batch of heroin.

I talked with Harold Pollack recently about how careful research on overdoses destroyed my prior belief in “killer heroin” hype:

There’s a very nice paper just out by Professors Shane Darke and Michael Farrell, who are two of the world’s leading experts on the topic…toxicology studies of overdosed people very rarely find that impurities played an important role…victims didn’t particularly receive high doses, either. Such findings surprised me. The fact that we’ve got 16,000 people a year dying from pure, legally-manufactured opiate analgesics shows you that it’s really not about the unpredictability of illegal markets, it’s about the drugs per se.

The killer heroin/impure heroin narrative sounds plausible on its face, but the data completely undermine it. Data notwithstanding, here it is again from Isaac Campos in a recent article by German Lopez.

The most dangerous thing about taking heroin right now is you don’t know what you’re really taking. You don’t know how pure it is, which makes it very easy to overdose,” Campos says

I can’t be judgmental of Campos as I would have said the same thing, with confidence, at one point (particularly before the nation was flooded with pure, consistent, labeled opioids like Oxycodone and the result was…an overdose epidemic). But I would respectfully ask him and everyone else to look at the data on overdoses and have a rethink. Successfully tackling the overdose crisis — which is now causing almost as many deaths in the U.S. a year as AIDS did at its peak — will not be facilitated by incorrect assumptions about the nature of the problem.

Author: Keith Humphreys

Keith Humphreys is a Professor of Psychiatry at Stanford University. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans and drugs. He is the author or co-author of numerous books and scholarly articles, and has written for the New York Times, Wall Street Journal, Washington Post, The Guardian (UK), the San Francisco Chronicle and other media outlets. When he is not in the San Francisco Bay Area, he is usually in London, where he is an ad hoc policy adviser to the national and city government, an honorary professor of psychiatry at Kings College, a senior editorial adviser to the journal Addiction, and a member of The Athenaeum. When he is not in the San Francisco Bay Area or London, he is usually in Washington D.C., where he serves as a frequent science and policy advisor to federal agencies, and where he has served previously as an appointee to a White House commission and several Secretarial task forces. From July 2009-2010, he served as Senior Policy Advisor at the White House Office of National Drug Control Policy. When he is not in the San Francisco Bay Area or London or Washington D.C., he is usually in the Middle East, where since 2004 he has volunteered in the international humanitarian effort to rebuild Iraq’s mental health care system. This work has taken him to Turkey, Egypt, Iraq, Jordan and Lebanon to teach and consult with Iraqi health professionals and policy makers.