Hype overdose: why does the press automatically accept reports of heroin overdoses, no matter how thin the evidence?

ON AUGUST 31 a headline on the front page of the New York Times reported: "13 Heroin Deaths Spark Wide Police Investigation." The article began: "They call it China Cat, an exotic name for a blend of heroin so pure it promised a perfect high, but instead killed thirteen people in five days." In less time than that, the story started to unravel.

On September 2, a brief article in the Times' B section announced: "Officials Lower Number of Deaths Related to Concentrated Heroin." By this time, published reports had attributed fourteen deaths to China Cat. But now the Times reported that "authorities yesterday lowered from fourteen to eight the number of deaths in the last week that the police believe are related to highly concentrated heroin." The medical examiner had discovered that "two of the fourteen men originally suspected of having died from taking the powerful heroin had actually died of natural causes. Four others died of overdoses of cocaine.... Of the eight whose deaths apparently did involve heroin, seven also had traces of cocaine in their system."

Thus, deaths that had been attributed to heroin overdose were now only "suspected" overdose deaths. Yet the Times felt no need to retract or apologize for its original report, simply attributing the overestimate to "authorities." Furthermore, six of the fourteen people (42 per cent) reported to have died of heroin overdoses had in fact not taken any heroin (two hadn't taken any drugs at all), while 92 per cent of the men who had died after taking drugs had taken cocaine, compared with 67 per cent who had taken heroin.

Given these facts, you might wonder how the "authorities" and the Times decided that so many men had died of China Cat. According to the second article, "the police said they found packets of China Cat, the street name of a powerful heroin blend, and a syringe" beside the body of one dead man. "They had no similar evidence connecting the China Cat brand to the other victims, but ... they considered it probable that a purer blend of heroin was involved" (even with those who, it turned out, had taken no heroin).

Without Apology

THE CAVALIER attitude with which America's leading newspaper reported speculation and misinformation as fact illustrates the reluctance of the mainstream press to question negative statements about drugs, no matter how ill founded. When such statements turn out to be wrong, readers are not likely to see an apology or even an explicit correction. For many news outlets, reporting bad things about illegal substances is part of a moral mission aimed at discouraging drug use, a mission that makes truth secondary.

So it's not surprising that the Times continued to pursue the overdose story even after it had become clear that the scare had little basis in fact. A front-page article on September 4 reported: "At first, the police suspected that the men ... had all died after using an extremely potent blend of heroin called China Cat.... Now the police and the New York City Medical Examiner, Dr. Charles Hirsch, say the men may have been victims of that brand or some similar, equally powerful blends of heroin.... But as one police officer put it: 'They're all still dead.' In the end, drug experts said, the brand name probably has little significance."

Maybe, but China Cat was central to the original article. Furthermore, six of the men had not taken heroin at all. And even for the ones who had, there was no evidence of overdose. Given the results from the blood tests, it is more plausible that the men died from a mix of drugs, including cocaine, alcohol, and perhaps other substances.

Indeed, researchers who have studied the issue closely are skeptical about reports of heroin "overdoses" in general. In the 1972 book Licit and Illicit Drugs, Edward M. Brecher summarized the evidence that led him to conclude that all or nearly all such deaths are in fact due to other causes. Based on experiments with animals, toxicologists estimate that it would take at least 500 milligrams of heroin to kill an adult human being who is not addicted to the drug; and studies of addicts find that they can typically tolerate as much as 1,800 milligrams over a two-and-a-half-hour period. In research conducted at Philadelphia's Jefferson Medical Center in the 1920s, addicts who were injected with up to nine times their ordinary daily dose suffered no ill effects.

The historical record also offers grounds for skepticism about heroin "overdoses." In New York City, before 1943 deaths among heroin addicts were rarely described as overdoses. Between 1943 and 1970, the percentage of addict deaths attributed to overdose climbed to about 80 per cent. Yet heroin purity was falling steadily during this period. In the 1920s addicts reported daily doses forty times as concentrated as the typical New York City daily dose in the 1970s.

Big-city coroners, Beecher noted, tend to record as overdose deaths any cases involving addicts (or, as in the Times story, men who look like addicts) where there is no other obvious cause of death. "A conscientious search of the United States medical literature throughout recent decades," he wrote, "has failed to turn up a single scientific paper reporting that heroin overdose, as established by ... reasonable methods of determining overdose, is in fact a cause of death among American heroin addicts."

Brecher reviewed research by two prominent New York City medical examiners, Drs. Milton Helpern and Michael Baden, who examined New York City addict deaths in the 1960s. Helpern and Baden reported that the heroin found near the dead addicts was not unusually pure and that their body tissues did not show especially high concentrations of the drug. Although the addicts typically shot up in groups, only one addict at a time died. Furthermore, the dead addicts were experienced rather than novice users and therefore should have built up tolerance to large doses of heroin.

It is instructive to bear Brecher's points in mind while reading the recent articles in the Times. The third and most detailed article described the supposed heroin-overdose death of Gregory Ancona, the only case in which an eyewitness account was available. When Ancona and a date returned from a club to his apartment, he "was already staggering from the effects of cocaine and alcohol." While his date injected her heroin, Ancona snorted his. "Soon after, he nodded off and never woke up." The woman, meanwhile, "suffered no more than the usual effects of heroin."

From this account, it seems unlikely that Ancona died of an overdose. To begin with, men generally weigh more than women and show milder reactions to a given drug. Furthermore, he snorted the heroin, while his date injected it, getting more of the drug into her bloodstream more quickly. The probable cause of Ancona's death is the interaction of drug effects, particularly those of alcohol and heroin, which research suggests can be lethal.

IN THIS connection, careless reporting about heroin "overdoses" can have a perverse effect. If an addict believed that the real hazard was dosage, he might not recognize the dangers of combining drugs. In Ancona's case, he might have thought he was protecting himself from a heroin overdose by snorting the drug rather than injecting it. Moreover, Drs. Helpern and Baden concluded that impurities in heroin (particularly quinine) are more likely than the drug itself to be the culprit in addict deaths. If so, the most adulterated (impure) doses of heroin may be the most dangerous--exactly the opposite of the message communicated by the Times.

Like most of the mainstream press, the Times is blind to such unintended consequences, because of its own assumptions:

1. Drugs are so bad that any negative claim about them is justified. The Times will not be called to task for inaccuracy in reporting about drugs, as it might if it reported with similar credulity about crime or politics.

2. Heroin is the worst drug. On the face of it, the Times could have made a better case for the toxicity of cocaine based on the fourteen cited deaths, yet it chose to focus on heroin.

3. Blaming drug deaths on overdose is important for propaganda purposes. The press assumes that reports about purer heroin will deter drug use.

4. Heroin use and addiction have shifted to the middle class. The Times stressed that several of the dead men were middle-class.

These notions are both dubious and counterproductive. But you won't read about that in the New York Times.