Addiction

07.17.13

How a Mix of Heroin and Alcohol Killed Cory Monteith

‘Glee’ star Cory Monteith overdosed on a cocktail of heroin and alcohol. Dr. Kent Sepkowitz on the strange history of the addictive drug that ruled the ’60s.

Canadian health authorities announced yesterday that Cory Monteith, a star from the hit TV show Glee, died of an overdose of heroin and alcohol. With the disclosure, Monteith joined the long and sad list of entertainers who died a drug-related death, either from too much, such as Monteith, or too many, such as Elvis, who at autopsy had 11 different prescription medications in his bloodstream.

That Monteith would die of heroin in the year 2013 might seem surprising. In the 1960s, heroin was the main illicit drug scourge and stories of overdose were common. Replaced in subsequent decades by other, cheaper, more available choices including cocaine, Ecstasy, Oxycontin, and amphetamines, heroin fell away a bit. In recent years though it has seen a resurgence—the price is right, and the quality more predictable. Plus, just as users learned that cocaine could be injected as well as smoked, snorting, rather than injecting, heroin became increasingly popular as a way to avoid the risk of dirty needles. The Centers for Disease Control and Prevention (CDC) estimated that in 1996, 2.4 million people had tried heroin once in their lifetime and at least half a million people were “heavy” users.

Heroin has a strange history. Named "heroin" to celebrate its "heroic" properties (irony initially not intentional), it was synthesized late in the 19th century by scientists at the German pharmaceutical Bayer, the maker of aspirin. They hoped to provide an alternative to morphine for those requiring cough medicine. Morphine was viewed as simply too addictive for a guy with a hacking cough. Once synthesized, it sputtered a while despite Bayer's aggressive marketing attempts, then, early in the 20th century, a potential use was finally found as something of a prototype for methadone—a "clean" drug to give to addicts to assist them in their attempts to kick the habit without painful withdrawal symptoms.

The number of overdoses goes up suddenly as addicts accustomed to a certain dose suddenly are overwhelmed by a more pure product.

Its unanticipated highly addictive nature however soon became evident, and it quickly moved from the clinic to the streets, where it gained it current reputation. The biggest danger regarding heroin other than its addictiveness is the fact that, since it is always contraband, its concentration is unpredictable. Countless Hollywood movies have featured a savvy addict sniffing or tasting or boiling a small sample to determine how cut with white starch or other filler the potential purchase might be.  

In practice it apparently is not so easy. Emergency rooms and morgues are usually the first places to register the news when high-grade heroin comes to town—the number of overdoses goes up suddenly as addicts accustomed to a certain dose are overwhelmed by a more pure product that simply is too much. (See Pulp Fiction.) In Minnesota, the Twin Cities currently are in the throes of such a problem with a disturbing increase in heroin-overdose deaths among established addicts. Almost certainly the explanation is that literally killer stuff appears on the street that looks and tastes just like the usually somewhat-watered-down version. The Twin Cities in recent years have the distinction of having heroin that is among the most pure in the country—93.5% pure, according to local public-health testing.

The symptoms of heroin overdose are pretty straightforward. (See Pulp Fiction and dear Uma once again). Assuming only alcohol and heroin were present, Monteith likely died from the direct respiratory-suppression effects of heroin—in plain English, he just quit breathing. Cocaine, a chemical cousin, can cause marked constriction of blood vessels leading to heart attack or stroke, but this is not expected with heroin. Morphine too can kill by suppressing respiratory drive. Plus each of these three narcotics causes nausea and vomiting in many people. Some sedated people vomiting then aspirate the regurgitated stomach contents into their lungs, leading to suffocation. Grim indeed. This is often given as the cause of death of rock star Jim Morrison. 

We will probably learn a few more sordid details in the days or weeks ahead, but the basic story will remain the same. Another truly talented, restless, haunted young man with easy access to too much too fast. Another Hollywood star who met a non-Hollywood ending. And perhaps more than anything else, another reminder that despite decades of screaming evidence and painful reminders such as this, mental illness and dug addiction remain the last taboos of modern society, the diseases that everyone insists must remain tragically underground and out of sight.