The death of renowned actor Philip Seymour Hoffman from an apparent heroin overdose in New York City this month produced a wave of shock and grief and brought heightened attention to the growing plague and devastating toll of opiate drug abuse.
The 46-year-old Hoffman had been sober for 23 years, but after taking prescription pills last year he relapsed and spent time in rehab. He was found dead in his apartment on Feb. 2 with a syringe in his arm and an envelope of heroin nearby, news reports said.
For others in recovery, Hoffman’s death was a terrifying reminder of the intense hold that opiates, whether heroin or prescription painkillers like Oxycontin, have on the addicted brain.
Opiates work by mimicking the effect of endorphins, chemicals produced naturally in the body that occupy receptor sites in the brain and relieve pain or stress. But opiates are much stronger than endorphins, and users can control the dose. The fading high is replaced by anxiety, nausea and other withdrawal symptoms and an overpowering compulsion to use again.
The United States has a long history of opium and heroin abuse, including a surge in the 1960s and 1970s when soldiers began returning from Vietnam with addictions.
But as Hoffman’s experience demonstrates, the epidemic has grown in a new direction in recent years due to the wide availability of pain medications such as Oxycontin, Percocet and Vicodin. The drugs are frequently prescribed and can be found in many home medicine cabinets. Like heroin, they are derived from the opium poppy plant.
“The direction of that has been partially good in that I think we’re more sophisticated in handling chronic pain,” said Dr. Neal Schofield, medical director for addictions programs at Princeton House Behavioral Health in Princeton. “Unfortunately a spinoff of that has been a disaster with the proliferation of some of these medications in our community.”
Almost 6,000 people have died in New Jersey from overdoses in the last decade, according to state Sen. Joseph Vitale, who has spearheaded legislation aimed at preventing such fatalities. Prescription drugs were implicated in more than 700 deaths in both 2011 and 2012, according to state figures. In 2009 more than 75 percent involved opioids, according to the Drug Policy Alliance.
The number of deaths has soared in the last decade. From 1999 to 2010, fatal overdoses in the state increased 51 percent to a rate of 9.8 per 100,000 people, according to the Trust for America’s Health.
Hoffman had said in an interview that he had a drug problem dating back more than two decades, to when he was in his early 20s.
Doctors say that now they are increasingly seeing opiate addictions in even younger people.
Teenagers are particularly vulnerable because their young brains are “plastic” and still maturing, making them prone to risk-taking, less able to understand the consequences of their actions, and more likely to suffer long-lasting harm from drug use, Schofield said.
A 2013 national survey found that 15 percent of high school seniors used a prescription drug for non-medical purposes in the past year, according to the National Institute on Drug Abuse. Some 5.3 percent had used Vicodin and 3.6 percent used Oxycontin.
In particular, young people who have suffered physical abuse or other adversity early in their lives find that opiates provide real relief, a fact that Schofield said has gotten too little attention.
“For a lot of these people, these drugs meet a need of self-medication. The drugs meet a need of numbing things,” Schofield said during a conference on opiate addiction held last month, a few days before Hoffman’s death. “In my unit, the incidence of sexual trauma — either rape, molestation or prostitution in girls with opiate addiction — is about 90 percent. These things are addressed, imperfectly, badly, by the use of drugs.”
Research has shown that even growing up in a home where parents are abusive toward each other, but not the child, can still trigger “fight or flight” stress responses and lead to post-traumatic stress symptoms, making the young person’s brain hypersensitive to stress triggers over time, said Dr. George Wilson, medical director of the women’s program at Princeton House.
“The reason why this is so relevant to the question of adolescent addiction and adult addiction, particularly the growing epidemic of it and the difficulties treating it, is that one of the things opiates do is mediate the stress response,” he said.
Newly addicted patients tell him that “the first time they were exposed to any type of opiate, they suddenly felt the way they knew they always should have felt,” Wilson said. “They felt like this is who they really are. They’re no longer anxious, irritable, chronically depressed. Many of the secondary problems, that particularly many women have with eating disorders, chronic social anxiety, are washed away by the first dose of opiates.”
“That is why the first dose they had made it imperative they had another dose as quickly as possible. So there’s a unique type of dependence that they are vulnerable to, in which with the first exposure, they can within a couple of weeks, have a compulsive daily use. They will find the process of abstinence much more difficult,” he said.
That compulsion drives users who exhaust their supply of prescription drugs to overcome their aversion to injecting heroin, which is chemically similar to prescription opiates but much cheaper and easier to obtain. Doctors describe users who switch between pills and heroin as they are available, with many defaulting to the illegal drug.
“It’s very clear that the prescription opiates have not only been a ‘gateway’ but are a paved-access road to the whole word of opiate abuse, particularly heroin,” Wilson said.
The climbing death toll and advocacy by the families of overdose victims has spurred greater recognition of the problem in New Jersey and shifted perceptions so that drug addiction is increasingly seen a health issue, though a stigma remains.
Gov. Chris Christie has repeatedly cited the importance of drug rehabilitation programs, and in 2012 he made rehab a requirement for low-level offenders. Last May, he signed a bill that gives partial immunity from prosecution to those who call 911 to report overdoses and allows almost anyone to administer the drug antidote naloxone.
Vitale, the bill’s lead sponsor, led a Senate health committee hearing on drug policy in October and has called for additional legislation to tighten monitoring of prescriptions help more people get into treatment, and promote prevention efforts.
“While law enforcement certainly has a role to play, in general, opioid abuse and addiction is a public health issue and requires a public health solution,” Vitale said last month.