National Geographic News
A vigil of candles, flowers and portraits sits outside the apartment of actor Phillip Seymour Hoffman.

A vigil outside the apartment of the actor Philip Seymour Hoffman, who was found dead of an alleged drug overdose on February 3, 2014.

Photograph by Andrew Burton, Getty

Susan Brink

National Geographic

Published February 4, 2014

When people hear the phrase "accidental drug overdose," they naturally assume that someone mistakenly snorted, shot up, or swallowed too much. But a heroin overdose, such as the one likely suffered by the actor Philip Seymour Hoffman over the weekend, is not that simple.

A heroin overdose happens because use of the drug alters the neurons within every addict's brain—but the alterations occur in different parts of the brain at varying rates of speed. The pleasure center, increasingly hard to satisfy, is screaming "More!" But primitive centers that control breathing and heart rate are not building up tolerance at the same pace and are whispering "Enough."

"As your dosage goes up, you have a rapid tolerance to the euphoric response, but not nearly as much to the respiratory response," says David Smith, an addiction treatment specialist and founder of the Haight Ashbury Free Clinics of San Francisco.

Added to the brain's biological dilemma are some very practical problems for the addict. Since heroin is an unregulated substance, addicts have no way of knowing what is in that plastic bag of powder. Pure heroin? Heroin cut with sugar, starch, or powdered milk? Or heroin enhanced with an even more powerful substance, like fentanyl, an opioid similar to heroin but many times more potent?

"Literally, every time someone injects heroin, they're taking a risk of an overdose," says Jack Stein, director of the Office of Science Policy and Communications at the National Institute on Drug Abuse. And the pool of people at risk is growing. The number of heroin users has increased from 373,000 in 2007 to 669,000 in 2012, a rise of 80 percent.

Photo of confiscated heroin in New Jersey.
PHOTOGRAPH BY MEL EVANS, AP
A police officer holds a packet of confiscated heroin; drug overdose deaths are increasing nationwide.

Heroin Hijacks the Brain

When injected, heroin makes its way across the blood-brain barrier, is converted into morphine, and fits into the mu opioid receptor in the brain and turns it on. Within seven to eight seconds, the drug user feels a rush of euphoria. Soon after, the user goes into a "nod," alternating between wakeful and drowsy states for perhaps several hours.

The pleasure of the first rush of heroin doesn't repeat itself over prolonged usage. That initial euphoria becomes a lasting memory, and one to be obsessively chased. "Drugs hijack the brain, and you stop feeling the pleasure of the experience. The addict who used to feel great, now is lucky to feel a little better," says Stein.

The experience of using heroin changes the brain permanently. People like Hoffman, who had said he was clean for more than 20 years before relapsing into drug abuse, remain vulnerable to falling into addiction again and again. "Drugs have a powerful effect on memory centers in the brain," says Stein. "Very positive, reinforcing memories of that drug use are really ingrained in the brain."

Hoffman may also have fallen victim to the compromised content of East Coast heroin. "We've gotten reports in Pennsylvania, Vermont, Maryland, and all up and down the East Coast of heroin mixed with fentanyl," says Stein. "People are getting a much stronger dose than they expected."

And when addicts bounce back and forth between recovery and relapse, as many do, it gets increasingly hard for them to calculate their own tolerance levels. They may think they can try to use a little bit, but they often relapse faster and harder than in previous bouts of addiction. "It's like being allergic to a bee sting," says Smith. "When you get stung, you have this very intense reaction. Every time you get stung, it's worse than the last time."

With too much heroin, the brain stops sending its automatic messages for the continuation of heartbeats and breathing, and the person dies of an overdose.

One final tragic note: If Hoffman had not been alone, he might have been saved. Naloxone is an injectable opioid antagonist that most paramedics have in emergency vehicles. "Having access to this medication can provide a miraculous recovery," says Stein. It jump-starts the brain's primitive areas, and the brain again tells the body to breathe, tells the heart to pump.

22 comments
Skeeter McDaniel
Skeeter McDaniel

My niece, 45 years old, died this week, August 5, 2014, in Pittsburgh, PA. She left behind 5 children. My niece had been a crack addict most of her life but I believe had been using heroin also these last few years. She was found with both needles and a pipe. She had been in and out of rehab, as well as jail since her 20's. She had been clean at least a few days before and had just moved in a friend to try stay away from the drugs.

I am devastated. She was like my little sister, rather than a niece. May you rest in the arms of the angels, dear Jackie.

Shannon McClure
Shannon McClure

I an a paramedic and do TONS of research on new drugs and diseases....I like to stay on top of things.....this is one of them. I have a hypothesis that his heroin was "cut" with acetylfentanyl , about 80 times stronger than morphine. FDA approved Fentanyl is about 100 more times potent. This drug added to his "normal" dose, whatever that would be...depending on his opioid tolerance. This new "cutting" agent to dilute the drug seems to have made it stronger and deadly. I am curious of the autopsy results to see of the illicit form of the drug was in his system. I am sure a man of his stature and popularity wouldnt intentionally overdose...he had too much ahead of him. IF ANY OF YOU THAT READ THIS HAVE A HEROIN, or any opioid addiction for that matter, READ THIS....FIND A WAY TO KEEP a drug called NARCAN with you. it reverses all effects of opioid overdoses...but only for a short period. if you have a lot of drugs in you, a repeat 

2 mg dose may be required....BE PREPARED to go into IMMEDIATE withdrawl symptoms if it is given to you or you have to use it. Personally, I have given it multiple times and by Gods grace, was able to save many lives with Narcan. Please, let me knw his toxicology results if I don't get them first.

Michelle Morgan
Michelle Morgan

The tragic death of Mr. Hoffman is more evidence that we need to deal with drug addiction as a social mental health issue, and not as a criminal offense. If he wasn't alone that night, hiding his drug use and his addiction from the world, he might have been able to get the medical care he needed to reverse the overdose. Our society teaches us that, as a drug addict, we are the scum of the earth and therefore, irredeemable and undeserving of social acceptance and help. We need to help and support each other in our society, against the demons!  

Honeybee Johnson
Honeybee Johnson

The death of Mr. Hoffman saddened me deeply. I, too, am a recovering addict. Most of my fellow recovering addicts that I met when I first got into 12-Step recovery have anywhere from 25-31 years sober. I will have, a day at a time and if I live, 13 years this year. For me, getting sober REQUIRED me to totally come to an end of my self. I had to fully give over that maybe the steps could teach me SOMETHING that I just don't know. I am a creative person by gift, and for some reason, many people that are creative have this demon of addiction.

I had to leave where I was born, (Los Angeles) and begin to practice my crafts in an unknown environment and live a quiet, unexcited lifestyle, which is working for me. I stay in contact with my sponsor and my sober friends. I have a spiritual connection with God and that relationship and my program are TOP priorities in my life. I am also respectfully AFRAID of drugs. So many of my friends, family and celebrities have died from them...I am appointed to die once, but I DO NOT want to die of an overdose.

I pray that anybody who has been plagued with the horrible demon of addiction find the sober lifestyle that they MUST--if they want to LIVE...and stay VIGILANT about their sobriety...


May Mr. Hoffman rest in peace.

Penguin Assange
Penguin Assange

If only people could be allowed to obtain Naloxone without bringing the DEA and the FEDS down on their necks. Every addict, and the friends and families of addicts, should be allowed to keep Naloxone at home for accidental overdoses. This simple change in the drug laws could save tens of thousands a year. As it stands now, if you ask for a prescription or try to fill it at a pharmacy, you run the risk of the doctor, nurse, or pharmacist calling the authorities to turn you in. Shameful, really.

Sethu Narayanan
Sethu Narayanan

It is a nice article that captures the problems addicts face. These problems to which addicts succumb and how the mind of addicts miserably do not work but creating only "an illusion of working" should become a book chapter for the science curriculum of the 9th or 10th standard students throughout the world. That will prime the future generation to behave more responsibly during the adolescence and later in life. But who will fasten the bell to the cat?

Jose Rivera
Jose Rivera

I tried it in the early 80's.  But  did not like the feeling,  made me sick, vomits, sleepy, embarrasing......

John OGrady
John OGrady

Sounds like a relatively merciful death-penalty drug. Only problem is we only talk the 'mercy' talk.

Maggie Collins
Maggie Collins

I am an addict with 18 yrs. clean and sober.  But I really only have today.  Every day

my brain still tries to trick me into using or drinking, luckily today I just say "thanks for

sharing".  This is all thanks to AA and NA (Narcotics Anon.).  I learned how to save my

own life in many, many meetings.  Every time I hear about another addict dying it breaks

my heart.  I wish someone could figure out what demons torture our souls, bottle it and sell it.  LOL  I was so sad to hear about Mr. Hoffman.  I also read he told someone just a few weeks ago at Sundance "I'm an addict and if I don't stop I'm

going to die".  If he did say those words, that person should have found a friend or

family member and told them.  Although only one person can get you clean and that

of course is the addict himself.  RIP Mr. Hoffman, and I really do hope you find peace

now.

Cathy Darling
Cathy Darling

This is the best explanation of heroin addiction I have ever read.

Thank you. I really want to understand, and now feel, the utterly

impossible tic-tac-toe of the brains reaction to heroin.


Diane Morrison
Diane Morrison

Excellent and simple explanation, easy to understand.  I believe most addicts ride solo.  Maybe they don't want help, or the brain no longer has the ability to reason that need along with being unable to rationalize the family that will be devastated over the loss or damages these drugs cause.

Paul Riley
Paul Riley

"Every junkie's like a setting sun"  Neil Young


Drug addiction is about death, whether fast or slow, beer or smack.

Maryl Roulston
Maryl Roulston

now i understand what happened with my brother. we lost him at 31 after 18 months of being clean.  they found his body in the public washroom above a bank in san diego, with the needle still in his arm. he had been dead 24 hours. absolutely heartbreaking.

annie branwen
annie branwen

So sad, why try it in the first place, with so many deaths, you can see the out come will only be bad.

Shannon McClure
Shannon McClure

@Penguin Assange  Why make an antidote to an illegal illicit drug OTC? The only reason I can fathom is to make the additcs feel a but "Safer" I have been a paramedic 24 years and use Narcan (naloxone) multiple times and, by the grace of God, saved many lives.

Addiction is a disease whereas, dependency is a curse. I suffer from chronic pain and take oxycodone daily, however, I don't need NARCAN in my arsenal to save me...I take my medication for a purpose and not recreation.


 Chronic pain sufferers on mega high doeses of liquid oxycodone, (FDA approved)Fentanyl, Dilaudid in high dose, ect., aught to havve access to prescribed Narcan...***.not acetyl-fentanyl (my opinion the cause of death of  Mr. Hoffman)*** Illicit recreational abusers can call 3 numbers and have the help they need in minutes....and hopefully even more help to kick the opioid stronghold. Yes, I realize, some addictions start out innocent...Lorcet from a broken ankle....lots of kidney stones....ect...however, the choice was made to keep taking the medication or refuse to try another less dangerous pain medication..


.I hate to say,... Ultram (tramadol)...just because I have seizures caused by it at therapeutic dosage I cant take it, however,would if I could.It has awesome pain control attributes in two ways....a synthetic Mu opioid agonist and an anti-depressant effect and it has been proven, depression increases pain levels.....Overdose is also possible (reversable partially with Narcan) but Serotonin Syndrome is the Beast of the Med....look it up...too much to explain.


In recap, No OTC Narcan aught to be legal...this will just encourage higher dosage attempts. Learn the difference between dependence and addiction and PLEASE get help for the addiction before more wind up ten toes up! If you are a chronic patient, try a less potent medication....remember, if you are on pain management for a diagnosed chronic issue....NEVER expect to be PAIN FREE...only EXPECT enough relief to tolerate or have a comfort level w pain. IF you do take MEGA PRESCRIBED DOSAGES of OPIOIDS, ASK the doc about Narcan for home....the most he/she can say is no......and that liability willl be on them. 


By the way, There is no SHAME in recognizing an issue and getting help for it, rather than THINKING its shameful to want Narcan legal so the abusers have even more reason to abuse and reverse the overdose and start the same vicious cycle over and over. NOT SMART.....Just call 9-1-1 and the ambulance EMT's and Paramedics can give you Narcan...or....is it.....too embarrassing to call 9-1-1 because too much was pushed? No Narcan + OVERDOSE = DEATH...alternative  OVERDOSE+(9-1-1 X NARCAN)=POSSIBLE SEEKING ANOTHER DAY TO GET HELP....Please, the math is simple,...just do the math......Like I said, from a medic w 24 yrs exp, Please, get help and get well....one day at a time!

Vanessa Foster Elander
Vanessa Foster Elander

Turn you in? If you live in say, NYC like Seymour Hoffman, I have a hard time imagining the police asking Drs for "leads" on heroin users so they can go bust them. But otherwise I see your point.

Shannon McClure
Shannon McClure

@Cathy Darling  Cathy, nothing is impossible if you truly want to make a change in your life. I was a 2 GM a day cocaine addict and dropped it cold turkey. I do take opioids for a chronic shoulder condition from 24 years of lifting an average of 230 lbs on the ambulance...however, I will cross out the "tac" right now....the difference is dependence is a curse w a cause and addiction...a person searching for the eternal buzz.. 


I take my percocet as prescribed and have pain MANAGENT...not relief. I WILL NEVER be pain free....just want to tolerate it to live a semi-normal life and ask no more. I am dependant because if I quit, I'd have withdrawls just like the addicts, however, I have to take the meds for a diagnosed medical reason, not for recreation to fill opioid receptors in the brain  nad raise my tolerance to the point where NO AMOUNT of medication will ease my pain.


Yes, I know certain personality types are prone to addiction....I AM ONE OF THEM...rememeber the cocaine comment?...I also use smokeless tobacco, however, I have made the CHOICE not to abuse what keeps me at a reduced pain level and become a legal dependent that suddenly jumped the fence to the addict side, again. I learned my lesson the first time....pleasure receptors or not, the human will IS and ALWAYS will be stronger than any issues you may have with substance abuse....I was a paramedic, 24 yrs,and can tell MANY more success stories....and unfortunately, failures....However,point being...there are MANY success stories to prove my point.


Remember: For every action, theres an equal and opposite reaction.....The question is, what reaction will be chosen when the action is taken? Theres ALWAYS HELP and a CHOICE!

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