There is hope. Naloxone, a non-narcotic, easily-dispensed medication, is being hailed as a miracle drug for reversing overdoses. Like Lazarus, an overdosed user on the verge of death will spring back to life when Naloxone mist hits his nostrils. Police are becoming more willing to carry and dispense the drug. More townships are passing Good Samaritan laws that make it safe for other drug users to contact emergency responders in the event of an overdose, without having to worry about getting arrested for having made the call. Advocates want Naloxone, which is safe and non-toxic, to be available over the counter. Had Hoffman followed simple instructions from a Naloxone training session (Don’t use alone. Train those who use with you to administer the drug.), he might still be with us. Not every overdose can be prevented, but we should strive to prevent as many as possible. Naloxone isn’t drug treatment, and many who have their overdoses reversed will continue to use drugs, but we can’t get hung up on this. Dead people can’t get clean. Every reversed overdose is another chance at life.
U.S. drug policies are shifting. Slowly, and not enough, but there is progress. Mandatory minimums are being phased out. Treatment is increasingly available to those caught up in the criminal justice system. As the Affordable Care Act begins to take effect, treatment will become more broadly funded, especially for the poor. There is concern among public health professionals, myself included, that the policy shift will fall short of what we need to change conditions for injecting drug users.
Legal pot isn’t enough. For there to be an American version of Insite, Vancouver's celebrated, medically-supervised, legal injecting space, the U.S. would need to decriminalize entirely. If Philip Seymour Hoffman had taken his last bags to a legal injecting space, would he still be alive? Had he overdosed there, medical staff on call might have reversed it with Naloxone. Had he acquired an abscess or other skin infection, he could have sought nonjudgmental medical intervention. Perhaps injection site staff could have directed him back to treatment.
Safe injecting sites are an amazing, life saving, humanity restoring intervention we can’t have because our laws preclude them. Too frequently, heroin addicts instead utilize abandoned buildings and vacant lots to shoot up in order to evade arrest. The risk for assault, particularly sexual assault for women, in off-the-grid, hidden get-high places is incredible. Overdosed bodies are routinely pulled from such spaces in North Philadelphia.
There is a particularly chilling aspect to Hoffman’s death that only another recovering addict can feel. He had 23 years clean, and then went back out. Just two weeks ago, I celebrated ten years off my own crippling drug habit. Sometimes I feel convinced that I’ll never relapse and experience that kind of pain and insanity again. Recovery programs warn that this kind of thinking can be dangerous. The addicting substance is characterized as “cunning, baffling and powerful.” It sounds like a cliché until someone with more than two decades clean, with a beautiful family and a career that is the envy of the world trades it in for a glassine envelope of dope and a set of works.
Those of us in recovery need to remain vigilant in maintaining our mental health. There is much work to be done on America’s addiction problem. It involves ensuring effective treatment, expanding the science of the field, and making sure that those who are actively using can do so in a way that is safe and dignified. There is a way to make meaning from the otherwise senseless early death of Philip Seymour Hoffman, and that is to let it refocus our efforts on making sure the smallest number of people possible find the same fate.