It’s a particularly bad time to be an injecting heroin user. That's not to say there's ever a good time. You could argue that things were worse in the '80s and early '90s before syringe exchanges became increasingly available, and HIV was leveling entire communities of drug users. Nonetheless, these are not good times to be cooking drugs off the street and shooting them in your veins. We didn’t need Philip Seymour Hoffman—by all accounts a dedicated father and universally recognized as one of the great actors of his generation—to die tragically with a needle in his arm and five empty bags of dope next to him to know this.
Now that Hoffman is gone the one purpose his passing can offer is to bring into sharp focus the fact that overdose deaths have long been on the rise in the U.S. (according to the Centers for Disease Control and Prevention, deaths from drug overdoses increased by 102 percent between 1999 and 2010), and to more vigorously continue the discussion about what to do about it.
As a recovering addict who still works with active users in communities where heroin is sold on the street, I can tell you that it’s particularly dangerous out there right now. Recently, an unpredictable and hard-to-track bad batch of Fentanyl-tainted heroin dipped and dodged its way through the mid-Atlantic: Camden, Philadelphia, moving west to Lebanon, Pennsylvania, and now Pittsburgh. It also popped up to the south in Baltimore. Health practitioners in North Philly are getting bombarded with faxes from the Centers for Disease Control about the bad bags working their way around the streets, with instructions to warn their patients who might be using. Fentanyl-tainted bags go fast; ironically, when news of a batch laying users low spreads on the streets, heavy users seek the potent bags out by their brand stamp.
Overdoses become advertisements for strong product. So as quick as the alarm goes up the supply runs dry, only to emerge somewhere else on the black market. Tainted drug batches are hard to track and hard to predict. Useful advice that keeps users "safe"—in a relative sense—like not running the whole barrel at once (but injecting a little to see how potent the bag is) can be unrealistic for street addicts trying to quickly get a shot off before getting nabbed by the cops.
Needle users are getting worse infections. A 2010 study shows that infection rates among injecting drug users can be as high as 33 percent. It stands to reason with drug-resistant bacteria tearing through the health system, that people repeatedly sticking themselves in unsanitary conditions with no medical oversight would be a prime breeding ground for skin infections of devastating new power. MRSA and other drug-resistant bacterial infections are hitting needle users with increased frequency and devastating consequences. Injection drug users with resistant infections, many of whom are poor and without health coverage, face massively invasive and expensive medical procedures in order to be cured. Sometimes users require major surgeries, which often result in profound disability. HIV persists and remains a constant concern for public health practitioners, but today there are more ways than ever for injecting drug users to get sick.
More people are using heroin, according to a 2012 Substance Abuse and Mental Health Services Administration survey. The survey found that between 2007 and 2012, the number of heroin users ages 12 and up increased from 373,000 to 669,000.
Public health professionals have known for nearly a decade that a new cohort of heroin users was in the making as the prescription drug epidemic spread. This is a matter of pure economics. Prescription dope isn’t cheap. In Philadelphia, an 80 milligram OxyContin pill will cost you $40. "Oxys" are safe in that the potency is predictable. Pills usually trade in safer parts of town than the North Philadelphia heroin corners where bullets can fly at any moment and the Narc Squad is always on the prowl. You pay a premium for upscale product, though; for the same amount of money, you could get four bags of heroin that are just as potent. Eventually, heavy users run out of money for pills and seek out cheaper powders. These new users are fueling a surge in heroin purchases in locations as remote as Vermont. Hoffman himself reportedly first relapsed on pills before moving into heroin use.