Here Are Three Things New York Can Do Right Now To Save Heroin Addicts From Overdose

Photo by Nate "Igor" Smith
It's been three days since Philip Seymour Hoffman was found dead in a West Village apartment, reportedly surrounded by the detritus of his addiction: a needle, baggies full of heroin, other empty bags, prescription drugs. News stories have retraced his last days, speculated tastelessly on what his death means for the Hunger Games' final installment, and wondered whether the drugs that appear to have killed him were laced with fentanyl, a powerful painkiller that's recently made an unwelcome reappearance in the Northeast's heroin supply.

Yesterday, though, a test of the heroin in the actor's apartment found no trace of fentanyl. At the same time, four people, three men and one woman, were arrested in lower Manhattan on suspicion of having sold Hoffman the drugs that may have led to his death. The city's medical examiner is expected to release an official cause of death for him today.

It's important to do a few things here, quickly, while our minds are still collectively on addiction and the huge, brutal loss of losing someone so universally beloved to something so vile. The truth is, heroin addicts can stay safer, even when they're not ready to get clean. And as a city, we can help them.

1. Ask drug users not to use alone.

Before we talk about the dangers of shooting up alone, let's talk first about fentanyl. While it was irresponsible and kind of gross to automatically presume Hoffman's death was caused by that -- as multiple media outlets did -- the reality is that each time fentanyl reappears in the heroin supply, the consequences can be grave, and a reminder of just how unpredictable the drug really is.

Fentanyl has been around as a painkiller since the 1970s, the kind given to patients with serious chronic pain. These days it comes in both a sublingual pill and a sublingual capsule, both of which are relatively easy to crush up and use as an additive in heroin or other drugs. (Fentanyl can also be crushed, snorted or injected on its own.) The last serious fentanyl scare was in 2006; in a three-month period, 17 New Yorkers died after ingesting cocaine or heroin that was laced with fentanyl. The same year also saw deaths in New Jersey, Chicago, Philadelphia and St. Louis. This year, the heroin-fentanyl mixture has been linked to dozens of overdose deaths in both Pennsylvania and Maryland.

The main concern with fentanyl is that it's very, very strong. "Just a few grains is much more powerful than heroin," says Dr. Sharon Stancliff, a specialist in addiction medicine. "If you don't know the quality of what you're getting and you're thinking you're injecting one bag of heroin and it turns out to have a few grains of fentanyl, that's a much more potent drug."

Stancliff is also the medical director at the Harm Reduction Coalition, a nationwide advocacy group. As a concept, harm reduction is about reducing drug-related injuries and fatalities by educating drug users and providing them with resources to use more safely. Harm reduction groups pioneered needle exchanges, which try to insure that intravenous drug users don't re-use or share their needles. (You can find a fuller outline of harm reduction principles here.)

For Stancliff, the current discussion about fentanyl lurking in the heroin supply is just another reminder that when you buy heroin, you never know exactly what you're going to get. Although the drugs in Hoffman's apartment were reportedly in bags labeled with Ace of Spades and Ace of Hearts logos, there's no proof that it's the same "brand" of Ace of Spades heroin reportedly seen in Brooklyn back in 2008. Heroin, like cocaine and Ecstasy and every other drug, is cut with an unpredictable mixture of additives.

"We don't know how often fentanyl is really in heroin, but we know it's sometimes unevenly distributed," Stancliff says. "You buys ten bags, one's got fentanyl, the others don't."

What's more, when drug users hear about a death caused by a purportedly stronger brand of heroin like Ace of Spades, she adds, "they will seek it out. They think it's more bang for their buck."

Because of the inherent unpredictability, harm reduction groups urge drug users not to use alone. A buddy system means that in case of trouble, the other person or people present can immediately call 911, perform rescue breathing, and, perhaps most importantly, administer naloxone (often marketed under the brand name Narcan).

Naloxone has been around since the 1960s; when sprayed into the nose or injected into a muscle, it counteracts the effects of a heroin or morphine overdose. Quite a few studies have shown that take-home naloxone kits help reduce overdose deaths.

The easiest way to get a take-home naloxone kit is at the Lower East Side Harm Reduction Center, where according to their schedule, they're given out on Monday, Wednesday, Thursday and Friday afternoons, as well as the last Tuesday of the month for refills. There are many other needle exchange points throughout the city, some of whom also carry naloxone. A complete list of overdose prevention programs in the state is available here (you'll have to call to check which are still operational and carry naloxone).

There is, however, one hitch.

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