What Must Heroin Feel Like?

This post originally appeared at the Knight Science Journalism Tracker.

How good must heroin feel? Good enough to abandon three children? Good enough to abandon friends, other family members, professional colleagues, and a brilliant career?

I should be angry at Philip Seymour Hoffman for doing what he's done to his children. But I'm not. I'm just sad. He was one of my favorite actors, somebody I thought of as a personal favorite. It wasn't until he died that I discovered he was everybody's favorite.

Now I'm sorry that I never saw him onstage. I'm sorry that he won't make the movies he could have continued to make for years to come. Mostly I'm moved by the pain that Hoffman must have experienced -- the craving, the attempts to fight it, failing again and again. I'm sad that he chose to experience heroin rather than to experience all the things he will now miss, including watching his children grow up, and performing.

What makes somebody do that? Are we all walking the same razor's edge, only one injection away from heroin addiction? Or could some of us sample heroin and decide to pass it up as easily as we might pass up a second piece of pie? Can addicts ever really be cured?

What is the reporting telling us?

The New York Times ran an obit yesterday and otherwise chose to devote its reporting to examining a surge in heroin sales in New York. That story must have saddened or infuriated Hoffman's family and fans. The headline was "Hoffman's Heroin Points to Surge in Grim Trade." A man that a lot of people cared about died. Maybe we'd want to do a bit of reporting on that before broadening coverage to related stories on the drug trade.

The Wall Street Journal ran an obit. I couldn't find anything else. The Chicago Tribune, like the Times, reported on the surge in the heroin trade. If this was such a big deal, why did it take a celebrity death to prompt the Times and the Tribune to cover it? Yes, I understand the value of the news peg. But "the growing use of heroin in the U.S. as well as an alarming rise in drug-overdose deaths" should have been covered as soon as it was apparent.

The Los Angeles Times also wrote the heroin surge story. Who was orchestrating this?

The Associated Press wrote a short story that helped to ease my emotional reaction: It wrote that Broadway theaters would dim their marquee lights briefly on Wednesday night at 7:45 p.m. in Hoffman's memory.

But where is the science reporting, if not at the majors?

Maia Szalavitz, one of the smartest, most informed and adept reporters covering addiction, wrote an excellent story under the disturbing headline, "Philip Seymour Hoffman Didn't Have to Die." Much of what she said was a surprise to me. Take this, for example: "Although preventing opioid addiction is difficult, preventing deaths from it is far simpler." Most, she said, can be prevented with a few simple measures, such as knowing the signs of overdose and keeping an antidote in first-aid kits. The U.S. has been slow to adopt such measures, she wrote, because of "the stigma of addiction and the lack of organized advocacy for affected people." A dirty, disheveled man drooping on a subway platform is not likely to attract the sympathy and help that we direct to a child with cancer or a disabled veteran.

As I read on, Szalavitz surprised me again and again. At least half of overdoses occur in the presence of others, not alone at home, as seems to have been the case with Hoffman. But it typically takes one to three hours for opioids to kill, she wrote. If anyone who might have been there had recognized the signs of overdose, he "would have had an excellent chance of surviving," she wrote.

If someone takes drugs and starts "snoring funny" or breathes unusually slowly, letting them sleep it off can be fatal. And an injection of the antidote naloxone, otherwise known as Narcan, can save the life of a victim of overdose. Szalavitz goes on to explain what could be done to prevent deaths from overdose. I found this story far more important and enlightening than the stories reporting the rise in heroin use.

At ABCNews, Liz Neporent wrote a story explaining why, tragically, "it's not all that surprising that Hoffman fell off the wagon." She quotes an authority who explains that a stint in rehab doesn't make addiction go away; staying clean requires "lifelong vigilance." She wrote about how heroin affects the brain, and why relapse is such a frequent occurrence. Once the brain has been changed by heroin, it doesn't change back. But addicts who have stayed clean have a reduced tolerance for the drug; if they start with a dose close to the amount they took when they were using regularly, it can be fatal.

And The Economist, rather than decrying the rise in heroin use, talked instead about what can be done to prevent or reverse it -- public policies that have worked elsewhere. The unbylined story was good, and so was the writing:

Like many people, I reacted to the death of Philip Seymour Hoffman by heroin overdose with a similar sense of unfocused outrage, as though we had just been insulted by the universe. Mr. Hoffman was among the best of a generation of actors who over the past two decades have become so good, and have undertaken such challenging and surprising projects, that they seemed to be ripping open unconsidered elements of the human experience with each new film. From "Happiness" to "The Master", his characters were simultaneously self-hating and authoritative, sadistic and compassionate; he was a Generation-X Orson Welles...

Switzerland and the Netherlands have set up safe injection rooms monitored by staff where addicts who cannot or will not comply with treatment get free heroin, The Economist wrote. The Dutch incidence of new heroin users has fallen to nearly zero, and the aging population of users is shrinking.

New York "has no safe injection sites," the story continued. "It might have been impossible for someone of Mr. Hoffman's notoriety to use one even if it existed; but no one can say for sure."

We don't know whether a different political climate regarding drugs could have saved the lives of Hoffman and many others. But the author of the piece in The Economist argues that "great artists and regular Joes will still hunger for mood-altering substances and will sometimes end up killing themselves, and we will continue to feel furious at them when they do. But we can channel that anger into finding ways to make their deaths less likely."

That's the kind of reporting I was looking for.

Now -- when will we channel our anger and our sorrow? And who will be covering that story?