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ensue, it is usually from respiratory failure. During the minutes or
hours following the injection of a potentially fatal overdose, death can
be readily forestalled by administering an effective antidote: a
narcotic antagonist known as nalorphine (Nalline). [10]  Nalorphine
brings a victim of opiate overdose out of his stupor or coma within a
few minutes. Since there is plenty of time and since nalorphine is
stocked in pharmacies and hospital emergency rooms throughout the
country, the death of anyone due to heroin overdose is very rarely
excusable.
But alas, the two standard precautions against overdose - warnings
against taking too much and administration of an antidote - are in
fact wholly ineffective in the current crisis, *for the thousands of
deaths attributed to heroin overdose are not in fact due to heroin
overdose at all.*  The evidence falls under three major rubrics.
"(1) The deaths *cannot* be due to overdose.
(2) There has *never been any evidence* that they are due to overdose.
(3) There has long been a plethora of evidence demonstrating that they
are *not* due to overdose."
[Figure 2 on page 103, omitted from this web transcript, features a
graph showing "Deaths from Narcotics Abuse in New York City, 1918-
1971." [11]  To summarize briefly, the graph shows that such deaths
hovered in a narrow range of about 50 to 75 between 1918 and the early
1950s. Deaths increased throughout the 1950s, surpassing 200 in 1960,
and rose from about 300 in 1965 to more than 1,200 in 1971. [Source:
New York City Medical Examiner's Office]
Let us review these three bodies of data in detail.
(1) Why these deaths cannot be due to overdose.
The amount of morphine or heroin required to kill a human being who is
not addicted to opiates remains in doubt but it is certainly many times
the usual dose (10 milligrams) contained in a New York City bag. "There
is little accurate information," Drs. A.J. Reynolds and Lowell O.
Randall report in _Morphine and Allied Drugs_ (1967). "The figures that
have been reported show wide variation." [12] This ignorance no doubt
stems from the rarity of morphine or heroin overdose deaths. The amounts
of morphine or heroin needed to kill a nonaddict have been variously
estimated at 120 milligrams (oral) [13],  200 milligrams [14],  250
milligrams [15], and 350 milligrams [16] - though it has also been
noted that nonaddicts have survived much larger doses. [17]
The best experimental evidence comes from Drs. Lawrence Kolb and A. G.
Du Mez of the United States Public Health Service; in 1931 they
demonstrated that it takes seven or eight milligrams of heroin per
kilogram of body weight, injected directly into a vein, to kill
unaddicted monkeys. [18]  On this basis, it would take 500 milligrams
or more (50 New York City bags full, administered in a single injection)
to kill an unaddicted human adult.
Virtually all of the victims whose deaths are falsely labeled as due to
heroin overdose, moreover, are addicts who have already developed a
tolerance for opiates - and even enormous amounts of morphine or heroin
do not kill addicts. In the Philadelphia study of the 1920s, for example,
some addicts reported using 28 grains (1,680 milligrams) of morphine or
heroin per day. [19]  This is forty times the usual New York City daily
dose. In one Philadelphia experiment, 1,800 milligrams of morphine were
injected into an addict over a two-and-a-half-hour period. This vast
dose didn't even make him sick. [20]
Nor does a sudden *increase* in dosage produce significant side effects,
much less death, among addicts. In the Philadelphia study, three addicts
were given six, seven, and nine times their customary doses -
"mainlined." Far from causing death, the drug "resulted in insignificant
changes in the pulse and respiration rates, electrocardiogram, chemical
studies of the blood, and the behavior of the addict." [21] The addicts
didn't even become drowsy. [22]
Recent studies at the Rockefeller Hospital in New York City, under the
direction of Dr. Vincent P. Dole, have confirmed the remarkable
resistance of addicts to overdose. Addicts receiving daily maintenance
doses of 40 milligrams to 80 milligrams of methadone, a synthetic
narcotic (see Chapter 14), were given as much as 200 milligrams of
unadulterated heroin in a single intravenous injection. They "had no
change in respiratory center or any other vital organs." [23]
(2) There is no evidence to show that deaths attributed to overdose are
in fact so caused.
Whenever someone takes a drug - whether strychnine, a barbiturate,
heroin, or some other substance - and then dies without other apparent
cause, the suspicion naturally arises that he *may* have taken too much
of the drug and and died of poisoning an overdose. To confirm or refute
this suspicion, an autopsy is performed, following a well-established
series of procedures.
If the drug was taken by mouth, for example, the stomach contents and
feces are analyzed in order to identify the drug and to determine
whether an excessive amount is present. If the drug was injected, the
tissues surrounding the injection site are similarly analyzed. The
blood, urine, and other body fluids and tissues can also be analyzed
and the quantity of drug present determined.
Circumstantial evidence, too, can in some cases establish with
reasonable certainly that someone has died of overdose. If a patient
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