>>> Part 3 of 9...
fills a prescription for a hundred barbiturate tablets, for example, and
is found dead the next morning with only a few tablets left in the
bottle, death from barbiturate poisoning is a reasonable hypothesis to
be explored. Similarly, if an addict dies after "shooting up," and
friends who were present report that he injected many times his usual
dose, the possibility of death from heroin overdose deserves serious
consideration.
Further, in cases where an addict has died following an injection of
heroin, and the syringe he used is found nearby or still sticking in
his vein, the contents of the syringe can be examined to determine
whether it contained heroin of exceptional strength. And there are
other ways of establishing at least a _prima facie_ case for an
overdose diagnosis.
A conscientious search of the United States medical literature
throughout recent decades has failed to turn up a single scientific
paper reporting that heroin overdose, as established by these or any
other reasonable methods of determining overdose, is in fact a cause of
death among American heroin addicts. The evidence that addicts have been
dying by the hundreds of heroin overdose is simply nonexistent.
At this point the mystery deepens. If even enormous doses of heroin will
not kill an addict, and if there exists no shred of evidence to indicate
that addicts or nonaddicts are in fact dying of heroin overdose, why is
the overdose myth almost universally accepted? The answer lies in the
customs of the United States coroner-medical examiner system.
Whenever anyone dies without a physician in attendance to certify the
cause of death, it is the duty of the local coroner or medical examiner
to investigate, to have an autopsy performed if indicated, and then
formally to determine and record the cause of death. The parents,
spouse, or children of the dead person can then ask the coroner for
his findings. Newspaper reporters similarly rely on the coroner or
medical examiner to explain a newsworthy death. No coroner, of course,
wants to be in a position of having to answer "I don't know" to such
queries. A coroner is *supposed* to know - and if he doesn't know, he
is supposed to find out.
At some point in the history of heroin addiction, probably in the early
1940s, the custom arose among coroners and medical examiners of labeling
as "heroin overdose" all deaths among heroin addicts the true cause of
which could not be determined. These "overdose" determinations rested on
only two findings: (1) that the victim was a heroin addict who "shot up"
prior to his death; and (2) that there was no evidence of suicide,
violence, infection, or other natural cause. [24]  No evidence that the
victim had taken a *large* dose was required to warrant a finding of
death from overdose. This curious custom continues today. Thus, in
common coroner and medical examiner parlance, "death from heroin
overdose" is synonymous with "death from unknown causes after injecting
heroin."
During the 1940s, this custom of convenience did little apparent harm.
Most deaths among heroin addicts were due to tetanus, bacterial
endocarditis, tuberculosis, and other infections, to violence, or to
suicide, and they were properly labeled as such by coroners and medical
examiners. It was only an occasional death which baffled the medical
examiner, and which was therefore signed out as due to "overdose." But,
beginning about 1943, a strange new kind of death began to make its
appearance among heroin addicts. [25] The cause of this new kind of
death was not known, and remains unknown today - though it is now quite
common.
A striking feature of this mysterious new mode of death is its
suddenness. Instead of occurring after one or more hours of lethargy,
stupor, and coma, as in true overdose cases, death occurs within a few
minutes or less - perhaps only a few seconds after the drug is injected.
Indeed, "collapse and death are so rapid," one authority reports, "that
the syringe was found in the vein of the victim or on the floor after
having dropped out of the vein, and the tourniquet was still in place on
the arm." [26]  This explains in part why nalorphine and other narcotic
antagonists, highly effective antidotes in true opiate overdose cases,
are useless in the cases falsely labeled overdose.
An even more striking feature of these mysterious deaths is a sudden and
massive flooding of the lungs with fluid: pulmonary edema. In many cases
it is not even necessary to open the lungs or X-ray them to find the
edema; "an abundance of partly dried frothy white edema fluid [is seen]
oozing from the nostrils or mouth" [27] when the body is first found.
Neither of these features suggests overdose - but since "overdose" has
come to be a synonym for "cause unknown," and since the cause of these
sudden deaths characterized by lung edema is unknown, they are lumped
under the "overdose" rubric.
Not all of the deaths attributed to heroin overdose are necessarily
characterized by suddenness and by massive pulmonary edema, but several
studies have shown that a high proportion of all "overdose" deaths share
these two characteristics. [28]
(3) Evidence demonstrating that these deaths are not due to overdose is
plentiful.
This evidence has been summarized in a series of scientific papers,
beginning in 1966, by New York City's Chief Medical Examiner, Dr. Milton
Helpern, and his associate, Deputy Chief Medical Examiner, Dr. Michael
M. Baden. At a meeting of the Society for the Study of Addiction held in
London in 1966, Dr. Helpern explained that the most conspicuous feature
 >>> Continued to next message...
___
 X Blue Wave/DOS v2.30 X
--- Maximus 3.01
---------------