Philip Seymour Hoffman's 'Mixed Drug Intoxication' Is Typical of So-Called Heroin Overdoses



On Friday the New York City medical examiner's office released autopsy results indicating that the actor Philip Seymour Hoffman died accidentally on February 2 from "acute mixed drug intoxication" involving cocaine, amphetamine, and benzodiazepines as well as heroin. The combination of heroin and benzodiazepines, a class of drugs that includes Valium and Xanax, presumably was what killed him, since both depress respiration. The stimulants may have masked the effects of the depressants, leading Hoffman to consume more than he otherwise would have.

Drug combinations like this are typical of deaths attributed to heroin or other narcotics. Data from the Drug Abuse Warning Network (DAWN) indicate that "multi-drug deaths" accounted for most fatalities involving opiates or opioids in 2010: 72 percent in surburban New York, 83 percent in Los Angeles, and 56 percent in Chicago, for example. Back in the early 1990s, the share of heroin-related deaths reported by DAWN that involved other drugs was even higher, 90 percent or more. (Note that the numbers in the table are misaligned and need to be shifted downward.) In short, when someone dies from what is described as a heroin overdose, the actual cause is usually a fatal mixture of two or more substances, frequently including depressants such as alcohol or prescription tranquilizers.

That fact can make it difficult to assign legal blame for an "overdose" death. Under federal law, for instance, a drug dealer faces a 20-year mandatory minimum sentence when "death or serious bodily injury results from" consumption of his product. In January the Supreme Court unanimously ruled that when a death involves multiple drugs, the prosecution has to show that the one supplied by the defendant was a necessary or independently sufficient factor.

Under New York law such a case is even harder to make. According to a 1972 decision that was upheld by the state's highest court, a drug dealer is not guilty of criminally negligent homicide merely for supplying heroin and syringes to someone who died after injecting the narcotic. Prosecutions for criminally negligent homicide have been upheld in cases where the defendant played a more active role in someone's death—for example, by injecting him with heroin or encouraging excessive alcohol consumption in the context of a drinking game. The musician suspected of supplying heroin to Hoffman, Robert Vineberg, has been charged with felony drug possession, but so far he has not been accused of homicide.

Given the circumstances of the typical heroin-related death, avoiding risky drug combinations is an obvious harm reduction measure that should be promoted by anyone interested in preventing such fatalities. Yet it is rarely mentioned in the aftermath of high-profile overdoses such as Hoffman's, perhaps because of a bias against advice that aims to make drug use less dangerous rather than eliminate it completely. As I have argued, that all-or-nothing attitude may also help explain why Hoffman was so reckless once he fell off the wagon.

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  1. obvious harm reduction

    If it’s so obvious then why do so many people disregard it? I could understand if this were 1990 and accurate information on drugs was hard to find. But today no one has an excuse for not knowing exactly what they are taking and what potential adverse effects or combinations exist. It’s very difficult for me to sympathize with people unwilling to deploy even a sliver of due diligence with risky behavior.

  2. Can we say the War Against Drugs killed Hoffman?

    If he’d just been able to pop into the local Walgreens and pick up a bottle of Vicks Brand Heroin — all quality-controlled in a tamper-proof package, there would have been no question about what and how much he was taking and no liability to anyone but himself if he mixed a dangerous drug cocktail.

    1. making everything found in Hoffman’s system legal would not have prevented his death, so no, the WoD did not kill him. His actions did.

      The WoD is criminal for a host of reasons but casting it as a causal factor for bad choices is not one of them. Hoffman battled addiction for a long time and it’s likely he would have even if drugs were legal.

    2. Can we say the War Against Drugs killed Hoffman?

      Uhh, no not really. I’m 100% against the WoSD, but this is not a good example as to why.

    3. No, since, for example, people die of overdoses of Tylenol, or Tylenol and alcohol, or cough syrup that they didn’t realize had acetaminophen in it all the time.

      1. And a lot more die from just plain alcohol.

        Legalization won’t do much to help cases like Hoffman. Some people just can’t moderate. But there are a good number of truly accidental overdoses that could be prevented if a dependable legal source for drugs were available.

        Regarding Hoffman specifically, I remeber hearing an interview with him a few years ago and the interviewer asked if he wished he could just enjoy a drink now and then. His response was basically that he never had enjoyed a drink or two now and then. He enjoyed getting out of control wasted.

        1. Right. There are people who would gladly kill themselves on OTC Oxy or Vikes or Xanies or whatever. It would just take them less time and cost less.

          1. Or on fast cars or other vices. Some people are just like that.

  3. “In short, when someone dies from what is described as a heroin overdose, the actual cause is usually a fatal mixture of two or more substances, frequently including depressants such as alcohol or prescription tranquilizers.

    That fact can make it difficult to assign legal blame for an “overdose” death.”

    The real blame belongs to the dumfs who voluntary load themselves up with potentially lethal substances.

    Dishonest dealer, you ask? Caveat emptor.

    1. Dishonest dealer, you ask? Caveat emptor.

      needz moar regulashun

      1. needz moar Darwin

    2. Yeah, this all strikes me as similar to arresting the guy who sold James Dean the Spyder.

  4. We should make these drugs illegal. Then no one will use them. Problem solved.

    1. At the very least, only criminals will use drugs then. And if criminals die, who cares?

      1. ergo, Hoffman is a criminal and we don’t care, though with all the stories about him, we have an odd way of showing our indifference.

        1. I’m still indifferent.

  5. Now, he was the driver of the car that killed Paul Walker, right?

    1. No, cars are autonomous killing machines that go on rampages all by themselves, especially when fuelled by ethanol.

  6. I have a friend who is an ex-junkie. According to him, lots of heroin users die because when they can’t score, they drink booze (or do other drugs) to help with the withdrawal symptoms. And then they score, rush off to shoot-up, and the combined effects is enough to depress the system to the point where they die.

    Or at least that’s how I remember him telling it. He’s always good for a 90s-era drug story, like doing crack with hookers at the local Red Roof Inn and having the dealer borrow his car to do deliveries. Or being hounded by the police – helicopter and all – but still never getting a conviction. Or going doctor shopping and the odd characters at the drug rehab – a place he eventually escaped from, minus his wallet. The fellow is lucky to be alive considering the amount of smack that has flowed through his veins.

  7. I had an acquaintance die of a heroin overdose. Didn’t know him that well.
    Knew another guy who shot up so much cocaine that his buddies put him in the shower and poured could water on him because he was having a seizure. This was in an apartment building, and a bit of a crowd had formed by the bathroom window wondering what was causing the BAM-BAM-BAM-BAM. After a bit he emerged, soaking wet and high as hell saying “Woooo! I’m OK! Yeah! I’m OK!” Later that night when I was trying to sleep, every time I moved and made a spring creak, I could hear one of the coke-heads outside saying “You hear that? I know that sound! That’s a 30-06 being cocked!” That was a long night.

    1. ah, good times. And one time, at band camp….

  8. If only there was a fake drug counselor to comment on this story…

    1. oh man. The gift that keeps on giving. He’s like a cornucopia of mockery.

      1. I nominate him as H&R’s proprietary Sacher-Masoch, or Socker Mascot.

        1. +1 Venus in Furs

        2. Would say he’s more of a pinata, or a whipping boy?

          1. Well, good stuff is supposed to come out of a pi?ata when you beat it, so I’ll go with whipping boy.

            1. How about a pinata, but instead of tasty treats it is filled with chicken shit.

    2. That Tulpa “incident” was beautiful, btw.

      1. Best. Snow. Day. Ever.

        1. My hat is off to you. The drama rivaled anything on HBO nowadays.

          P.S. Got the email from Sloop. Now I get it *nods knowingly*

          1. *nods knowingly in return*

    3. hey hey hey – that’s state-approved fake drug counselor to you, prole.

  9. The good news is that he’s been off drugs for 29 days now….

  10. “cocaine, amphetamine, andbenzodiazepines as well as heroin”

    That’s a hell of a mix. I have to wonder if he didn’t get the exact result he was looking for.

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