Dopes on Dope
A bad batch of reporting on NYC's heroin-related deaths.
Nearly every identity group employs a watchdog to defend its interests when the press stoops to filling news stories about its members with misinformation and stupidity. Gays have the HRC, Jews have the ADL, gun owners the NRA, and laboratory animals PETA. Alas, no group speaks on the behalf of America's dopers when journalists shovel manure and half-truths into print, so until such a group forms, I'll have to serve as their proxy.
In the last week, six people in Lower Manhattan have died in what appear to be heroin-related incidents. The New York dailies have swarmed the story—especially the deaths of Maria Pesantez and Mellie Carballo, two 18-year-old coeds.
Based on their sources in the police department, the medical examiner's office, and elsewhere, the dailies are speculating about a "bad batch of heroin" ( Daily News), "a batch of tainted heroin" ( New York Sun), "the same bad batch of heroin" that killed the other four users (Associated Press), "a poison or … [drugs] so pure and strong as to be lethal" (New York Times), "a $20 bag of bad cocaine and possibly heroin" ( New York Post), and "uncut heroin or cocaine" ( Newsday) rampaging through the town.
It could be that bad, tainted, poisoned, pure, or uncut heroin or cocaine killed Pesantez and Carballo, as well as the other four (Christopher Korkowski, Ivan Rivera, Anatoli Filistovic, and Charles Sicker). But I doubt it. A more plausible explanation for Pesantez and Carballo's deaths—multiple drug use—is as close as a search of the PubMed database of science journals.
To begin with, it's possible to inject a life-stopping quantity of heroin. Yet a 1996 review of the scientific literature published in Addiction states that, "In a substantial proportion of cases, blood morphine levels alone"—the body converts heroin into morphine—"cannot account for the fatal outcome of a heroin 'overdose.' " Authors Shane Darke and Deborah Zador continue:
It appears that a great many "overdoses" are in fact fatalities due to multiple drug use. Furthermore, many cases of apparent heroin overdose have either blood levels at the low end of the range, or at levels no higher than for survivors of "overdose" or heroin dependent users who die of other causes.
Likewise, toxic contaminants added to heroin can play a role in heroin-related death. But how often? The Addiction paper calls the role of heroin impurities "relatively minor, and possibly subject to regional variation."
Studies of heroin-related death support the multiple-drug-use theory. Morphine usually has company when autopsies test for drugs. In only a minority of such cases is morphine the only drug detected. And, depending on the study, alcohol was one of the other drugs detected in 29 percent to 79 percent of autopsies. In cases testing positive for alcohol, the blood-morphine levels were "significantly lower" than the morphine-only cases, according to a 1996 study. Benzodiazepines, the drug family to which Valium belongs, are "frequently noted at autopsy," states Addiction. Benzodiazepines are central-nervous-system depressants, like heroin and alcohol, and it's well known that mixing these drugs can lead to coma or death.
The authors conclude:
In many, perhaps the majority, of cases, it may be that heroin is no more than a contributory cause of death. … For a substantial number of heroin-related fatalities, then, heroin "overdose" may be a misnomer. To attribute the cause of these deaths to "heroin overdose" ignores the likely causal contribution of other drugs to the mechanism of death.
If the New York papers can be believed—and I'm not sure they can—we have reason to believe that Maria Pesantez and Mellie Carballo died not from heroin alone but from multiple drug use. The Aug. 16 Timesreports that the two men who were with the girls when they collapsed told detectives they had been "using drugs and drinking." The Postcites unnamed sources who say "the girls went to a Lower East Side bar shortly after breakfast to begin a drinking binge" and that "cocaine, alcohol and opiates" were found in Pasantez's urine. Newsdayreports allegations that the women had been drinking. "Sources" told the Daily News that the women had used cocaine and "had fresh needle marks on their arms." If this amalgam of assertions turns out to be true, then the easiest explanation for the tragic deaths would be the mixing of drugs, not the consumption of tainted or super-pure heroin.
The Sun entertained the contamination thesis, quoting Robert McCrie of the John Jay College of Criminal Justice on the topic. McCrie told the paper that diluents like quinine, sugar, talcum powder, milk sugar, or a new cutting agent or combination of cutting agents might have helped kill the users. Even though contaminants don't figure highly in contemporary heroin-related death literature, McCrie gets a large brownie point for telling the Sun that alcohol or other sedatives might have played a role. (Permission granted to the Sunto share the brownie point.)
Autopsy reports, which are due in a week to 10 days, should settle the debate. Still, how can the press (exclusive of the Sun), the police, and the medical authorities be so clueless about heroin-related death that none of them availed themselves of the facts of the case and the scientific evidence to hypothesize that a cocktail of drugs might have killed Pesantez and Carballo? Why isn't anybody alerting heroin users to the dangers of multiple drug use instead of warning about the chimeras of poison and super-dope?
Willful ignorance is probably the best explanation, especially for the press and the cops. But New York City's public health officers, who should know better, may refrain from warning users about multiple drug use because it comes a tad too close to advocating harm reduction. To their ears, saying, "If you insist on using heroin, use it as safely as you can," sounds too much like advocating a citywide BYO-smack party. Even if it saves a couple of lives.
Stupid drug story of the day: Meth causes users to disassemble bicycles. (Thanks to reader Eli Dickinson.) [Whoops! Not so stupid after all. See this update.] For the latest in the meth chronicles, see my new favorite blog, "Meth Mouth." Send your tips via e-mail to firstname.lastname@example.org. (E-mail may be quoted unless the writer stipulates otherwise.)