Philip Seymour Hoffman’s reported path from prescription narcotic painkillers to heroin is increasingly common among middle-aged Americans, experts say.
The Oscar-winning actor, found dead on February 2 of an apparent drug overdose at age 46, told TMZ last May that he had checked into rehab for treatment of a substance abuse problem after more than 20 years of sobriety. “It started slowly with prescription pills, and recently escalated to snorting heroin,” TMZ reported. Police reports say Hoffman died with a needle in his arm, surrounded by bags of what appeared to be heroin.
“There is a well-documented path of prescription opioid use leading to heroin use,” says Dr. Melinda Campopiano, a family physician who serves as Medical Officer for the Center for Substance Abuse Treatment at the Substance Abuse Mental Health Services Administration (SAMHSA).
More Treated for Heroin Abuse
SAMHSA, which tracked changing substance abuse patterns for Americans 50 and older in a June 2010 report, found the proportion of those admitted for treatment for heroin abuse doubled between 1992 and 2008 — from 7.2 percent to 16 percent.
Some people “may choose to use heroin for its pain-relieving properties” when their prescription for narcotic painkillers, or opioids, runs out, Campopiano says. “If you take a prescription opioid for as little as two weeks, you can be physiologically dependent on it,” she notes.
And if you stop taking it abruptly, as opposed to tapering off, you’ll experience opioid withdrawal. “That is a really physically, mentally punishing process,” Campopiano says. “Heroin is cheap and widely available, and it makes you feel better.”
In recent years, doctors’ prescriptions of opioid painkillers has increased “pretty dramatically,” says Dr. Dan Blazer, the Gibbons professor of psychiatry at Duke University Medical Center. Between 2001 and 2010, there was a nearly fourfold increase in the use of prescription opioids for the treatment of pain, according to SAMHSA.
In addition, boomers have used illicit and prescription psychotropic medications more than previous generations, on average, Blazer says. “We have a group of individuals who are just used to using drugs,” he says. “It makes it a little easier to go to something like heroin.”
But that's not to say that everyone who becomes dependent on prescription painkillers is likely to turn to heroin, says Jay Unick, an assistant professor at the University of Maryland School of Social Work. “People don’t wake up one day and decide to be a heroin addict,” says Unick, who coauthored a paper last year about the “intertwined epidemics” of heroin- and opioid-related overdoses.
“Heroin’s really stigmatized. But these prescription opioids are a totally different animal. You can start using them, enjoy the high. But then you fall down the rabbit hole, so to speak,” Unick says. “Your brain gets hijacked by these opioids. Eventually, the pill habit gets too expensive.” That makes a $6 to $10 bag of heroin an attractive bargain.
Relapse after decades of sobriety, as reportedly was the case with Hoffman, is not uncommon, Unick says. “It’s pretty clear that people have continuing risk. Once you’ve had an addiction problem, you’re at great risk of developing one in the future, even after periods of extended sobriety. Sometimes sobriety can make you more confident. You think: 'Oh, I’ve got this under control.'”
If you believe you might have a substance abuse problem, Blazer says, “probably one of the first steps would be to talk about it to a friend or a confidante,” such as a lay counselor affiliated with your religious group. Don’t keep it to yourself. “It’s very typical for people who have drug problems to think they can correct the problem on their own,” says Blazer.
As Campopiano notes, “There’s a lot of shame…It’s hard for a person to admit. They may hide it, so that increases their risk of accidental death. If a person is motivated to try treatment, that would be the next step.”
And if you suspect a loved one might have a substance abuse problem, “there’s nothing that prevents you from calling that individual’s primary care physician” and saying you’re concerned about the person’s use of a particular drug, Blazer says. “As a doctor, I can tell you that when family members call me up and tell me what they see, I listen.”
Middle-Aged People at Greater Risk
People who relapse are at an especially high risk of a fatal overdose, as are middle-aged people, who are more likely than younger individuals to have health problems such as high blood pressure, that could exacerbate the effects of drug abuse, Campopiano says.
In August, SAMHSA released the Opioid Overdose Prevention Toolkit, a 24-page document that provides advice for family members as well as first-responders, prescribers and other members of the community.
One of the key recommendations is increased accessibility to the drug naloxone, or Narcan, “the treatment of choice to reverse the potentially fatal respiratory depression caused by opioid overdose.” Naloxone has been used for this purpose for 40 years and is extremely safe, according to SAMHSA. However, it doesn’t work in treating overdoses of drugs that aren’t opioids, such as cocaine.
“With proper education, patients on long-term opioid therapy and others at risk for overdose may benefit from having a naloxone kit to use in the event of overdose,” according to SAMHSA.