February 05, 2014
This past weekend Americans were shocked and saddened to learn that one of our greatest actors, Philip Seymour Hoffman, had died at age 46 of an apparent heroin overdose. Hoffman’s death, in the prime of his life and career, is a poignant reminder of some of the harsh realities of a disease that 17.7 million Americans struggle with and that all too often cuts their lives short.
It reminds us, first of all, that addiction is a chronic, relapsing disease. Having undergone treatment in his early twenties, Hoffman is reported to have remained drug-free for over two decades, until a developing prescription drug problem led finally to heroin use and entry into a detoxification facility last year. Drugs change the brain—as we at NIDA tirelessly repeat—and even decades of abstinence from drugs may not entirely erase their imprint from the brain of a person in recovery.
Hoffman’s case also reminds that, as with any other chronic disease (such as heart disease or diabetes), treatment must often be repeated or may need to be ongoing. In the case of opioid addiction, there are effective medications that can make all the difference, but they remain frustratingly underutilized. The opioid antagonist naltrexone, for example, can now be delivered via extended-release injection, to block the effects of heroin or other opioids; and buprenorphine and methadone are effective maintenance medications that can reduce cravings and help an addicted person recover. But many treatment centers fail to offer medication-assisted treatments, or prescribe maintenance therapies at too low a dose, in the harmful and inaccurate belief that such treatment simply substitutes one addiction for another. It is time to move past this reluctance to treat opioid abuse with pharmacotherapies, as it only adds to the death toll from heroin and prescription painkillers.
We do not yet know the details of Hoffman’s relapse or what his treatment last year consisted of. We do know, though, that his path from prescription drug use to heroin is all too common. Graduates from prescription opioids to heroin may be driving the current rise in heroin use being seen across the country both in national surveys and in reports from NIDA’s Community Epidemiology Work Group (PDF, 4MB).
Hoffman’s overdose death is tragic, and we all feel the loss. We must remember, however, that this is not something that only happens to celebrities. Every day in America, 105 people die from drug overdose, although in most of those cases, few hear about it—they are just part of the statistic. Hoffman’s death further highlights the urgency to prevent and treat the disease of addiction.
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