Further Reading

Isn't there really an epidemic of heroin use and overdose among the middle class?

Dr. Peele,

I've very much enjoyed and learned from your books and perspectives on addiction. I'm not quite sure, however, what to make of your take on the epidemiology of heroin addiction or your thoughts on heroin overdosing. I work in Plano, Tx, and as you know, Plano has received national notoriety due to heroin-related deaths among youths recently. Reported cases of deaths from heroin "overdose" have spiked over the last few years; doesn't this suggest that heroin is more of a problem among affluent youths (most youths in Plano fall into that socioeconomic category) in the suburbs than before? Or is Plano an exception to suburban white America? Or have such problems simply gone underreported before? The police here certainly talk like it's a new problem.

Also, the authorities routinely talk about these heroin-related deaths as "overdoses." Yet I note that you suggest that deaths from heroin overdoses are somewhat rare. What do you think is killing these kids if not overdoses? Are there impurities in the drug that are toxic, or is it something else?

I think you have a far more rational take on addiction than the twelve-step zombies that have monopolized public dialog on this matter; but I am curious about your skepticism re what at least appears to be a problem of new significance, in my neck of the woods, anyway. If affluent youth abuse of heroin isn't increasing, how do you account for places like Plano? And if these kids aren't overdosing on heroin, what's killing them?

Thanks for your work.
Mark Lucke

Dear Mark:

Thanks for your questions. I wish you'd write me as new information comes from Plano.

I write specifically about "overdose" deaths in Plano. Most of the kids who died there combined other drugs or alcohol with heroin, and showed typical results from these mixtures — such as death from asphyxiation on their own vomit. Pure doses of heroin do not cause death except in extremely exceptional cases. According to authorities in other countries where overdose deaths have been reported, "It is actually rare to find someone has died taking heroin alone" (Scotland) while, in Australia, researchers warned, "Both heroin users and service providers need to be disabused of the myth that heroin overdoses are solely, or even mainly, attributable to fluctuations in heroin purity." The main worry is not the purity of the drug being consumed, but its impurity, and the tendency to use various combinations of drugs and alcohol.

I agree to being puzzled by the reported rise in heroin use and deaths. I know the Plano case is being reported all over the country. In my area (Morris County, New Jersey) we had a "heroin summit," accompanied by a newspaper series reporting that heroin deaths were rising among the young and affluent. An accompanying table and stories then proceeded to report the contrary:

"Parents in Morris County like to pretend that heroin is still a drug for the middle-age male laying on the streets of Newark or New York. It's not," said the Rev. Joseph H. Hennen, executive director of Daytop Village treatment center in Mendham Township. "it's here." "The more realistic profile (of a heroin user), — said Kieran Ayre, clinical director of the High Focus Center in Sparta, "is a 16- to 18-year-old white male or female from a middle- to upper-class environment, who is a B or C student."

The table provided by the newspaper of all reported heroin deaths in Morris County from 1997 through September 7, 1998 included only age and gender: In those two years, among 29 reported heroin deaths, none was reported for a teen age girl. Only three male teens died in connection with heroin use, compared with 8 people in their twenties, 10 in the thirties, and 8 in their forties. The typical heroin death was a 32 years old male — twice the age of Ms. Ayre's profile of heroin users.

Ms. Ayre's profile actually contained three other variables in addition to age and gender — social class (middle to upper), race (white), and grade point (2.0-3.0) none of which were provided in the table. However, accompanying the statistical profile, the newspaper presented a series of six case studies. The first such story on the first page along with Ms. Ayre's and Reverend Hennen's warnings did not describe a middle-class honor student.

This case was of John Wayne Healy, at 20 one of the five youngest heroin deaths in Morris County over the prior two years. The newspaper profile indicated that Healy "had had a difficult home life — his parents never married — and virtually no adult guidance." He saw his parents rarely. He himself impregnated the mother of his daughter when he was 16 and she was 15, but she told him she didn't know if he was the father.

Healy dropped out of school after his freshman year. Eventually, he got a high school equivalency diploma in prison. But he was fired from the only job the article mentioned he held for unreliable attendance. So, although closer than average to Ayre's age profile, Healy was from a broken home and underprivileged background, conditions he maintained throughout his own brief life. Needless to say, he had undergone social interventions and drug treatment repeatedly.

The cases presented in the newspaper then repeated these sagas of lives lost from almost the start. No middle class honor student who died of heroin during the two years of the latest heroin epidemic was identified in Morris County.

Writing for Slade, Jack Shafer listed a series of articles on the return of middle-class heroin chic, starting two decades ago with an article in Newsweek ("Middle-Class Junkies," Aug. 10, 1981), a sampling of which follows: New York Times ("Latest Drug of Choice for Abusers Brings New Generation to Heroin," 1989); U.S. News & World Report ("The Return of a Deadly Drug Called Horse," 1989); San Francisco Chronicle ("Heroin Making a Resurgence in the Bay Area," 1990); New York Times ("Heroin Is Making Comeback," 1990); Time ("Heroin Comes Back," 1990); Los Angeles Times ("As Cocaine Comes off a High, Heroin May Be Filling Void," 1991); Cleveland Plain Dealer ("Police, Social Workers Fear Heroin 'Epidemic,' " 1992); Rolling Stone ("Heroin: Back on the Charts," 1992); Seattle Times ("Heroin People: Deadly Drug Back in Demand," 1992); NPR ("Heroin Makes Comeback in United States," 1992); Newsweek ("Heroin Makes an Ominous Comeback," 1993); Trenton Record ("A Heroin Comeback," 1993); Washington Post ("Smack Dabbling," 1994); New York Times ("Heroin Finds a New Market Along Cutting Edge of Style," 1994); USA Today ("Smack's Back," 1994); Buffalo News ("More Dopes Picking Heroin," 1994); Fort Lauderdale Sun-Sentinel ("Heroin Makes a Comeback," 1995); Times-Picayune ("Heroin Is Back as Major Problem," 1996); Arkansas Democrat-Gazette ("State Gets Deadly Dose as Heroin Reappears," 1996); Rolling Stone ("Heroin," 1996); and Los Angeles Times ("Heroin's New Popularity Claims Unlikely Victims," 1996).

As I said in a letter published in the Times (May 12, 1999) about yet another in this series, "[your] May 9 news article, 'For Heroin's New Users, a Long Hard Fall,' indicates that heroin use and addiction has grown among the young and affluent. This claim has been made before. . . . It cannot repeatedly be true that such drug use is shifting from lower to middle classes. " Moreover, as I said, "epidemiological data do not support this idea."

Reports of a growth in heroin use overall that appeared throughout the nineties were not true, for a start. The 1996 National Drug Control Strategy reported the number of "casual users" (less than weekly) of heroin fell by more than half between 1988 and 1993 (539,000 to 229,000), and the number of "heavy users" (at least weekly) declined from 601,000 to 500,000. However, the National Household Survey on Drug Abuse for 1997, which at least lists race of users so as to compare white and black drug use, did not include heroin! The Monitoring the Future study of high school students found that 1% of seniors used heroin in the past year in 1998 (a drop of .2 percentage points from 1997), while half a percent used heroin in the past 30 days. The last figure has been constant since 1996, when it dropped from .6% in 1995. A jump in heroin use did occur between 1994 and 1995, doubling from .3% who used in the prior 30 days. This occurred after a half decade of stories on the rise in youthful heroin use.

Likewise, Shafer tracked the constant reports of the increasingly purity of heroin, noting the same logical inconsistency — if it was so pure ten or fifteen years ago, how could purity increase (in fact, the articles then list reported percentages of purity that rise and fall over the years). As Shafer put it, "Having hit 90 percent 15 years ago, you wouldn't think that heroin purity could keep rising."

Newspaper reports are part of a moral uprising that repeatedly claims that heroin is purer and more dangerous and more middle class kids are being tempted to their deaths by it. The data never support this as a major trend — at least they never have yet. This is a warning that seems to have no basis. Or, if we ever really believed it and it subsequently became true, then the warnings have obviously been ineffective.