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cases.
The same suggestion has been tentatively made by Dr. Gay of the
Haight-Ashbury Medical Clinic. Thirty-seven percent of the addicts
attending the clinic, Dr. Gay states, report using barbiturates "for
sedation and sleep" when heroin withdrawal symptoms set in; and 24
percent report using alcohol similarly. [49]  Thus the stage is set for
shooting heroin while drunk on one or the other - and, perhaps, for
sudden death from overdose."
Two of the most publicized "overdose deaths" of 1970, Dr. Gay informed
the National Heroin Conference in June 1971, fit precisely this pattern.
These were the deaths of the rock musician Jimi Hendrix and the singer
Janis Joplin. Hendrix was known to use both alcohol and barbiturates -
and possibly also heroin. Janis Joplin "drank [alcohol] like an F. Scott
Fitzgerald legend," Dr. Gay adds - and also used narcotics. [50]
The magazine _Time_ reported on October 19, 1970, shortly after Janis
Joplin's death:
"The quart bottle of Southern Comfort [whiskey] that she held aloft
onstage was at once a symbol of her load and a way of lightening it.
As she emptied the bottle, she grew happier, more radiant, and more
freaked out....
"Last week, on a day that superficially at least seemed to be less
lonely than most, Janis Joplin died on the lowest and saddest of
notes. Returning to her Hollywood motel room after a late-night
recording session and some hard drinking with friends at a nearby
bar, she apparently filled a hypodermic needle with heroin and shot
it into her left arm. The injection killed her." [51]
Janis Joplin's death, of course, was popularly attributed to
"heroin overdose." If the alcohol-barbiturate-heroin theory is
correct, her fatal injection of heroin while drunk on alcohol was
the prototype of many other deaths similarly mislabeled "overdose."
The British experience with deaths attributed to heroin overdose is
consistent with the alcohol-barbiturate hypothesis. Dr. Ramon Gardner
of the Bethlem Royal Hospital and Maudsley Hospital in London studied
the records of 170 deaths known to have occurred among addicts in
Britain during the five-year period 1965 through 1969. Twenty of these
deaths were deemed suicides, 24 were traceable to infections, 12 were
from natural causes, 11 were drownings, falls, murders, or other
accidents, and 6 occurred during treatment (of which two followed
abrupt withdrawal of narcotics when the addicts were imprisoned). Eight
more were due to overdose of barbiturates or other nonopiate drugs.
This left a maximum of 89 mysterious deaths out of 170 which might have
been caused by accidental opiate overdose - or by something else. [52]
Dr. Gardner then went on to study in more detail 47 of these deaths
*possibly* due to heroin overdose. In a number of cases, he found that
the addicts bad been confined in a hospital, prison, or detention center
or had for other reasons been abstinent from opiates for a week or
longer, and had thus lost at least a portion of their tolerance for
opiates. They had then injected an opiate - some of them on the day of
discharge, others within the next day or two. Thus these deaths *might*
have been due to overdose - though evidence was lacking that the victims
had in fact taken fatally large doses. (Merely doubling or quadrupling
the dose, it will be recalled, will not kill even nonaddicts.)
But in at least 21 of the 47 cases, there had been no withdrawal from
opiates prior to death, so that tolerance had *not* been lost. And in
some cases, the dose preceding death was so small - as little as 20 or
30 milligrams of heroin, for example - as to establish beyond question
that overdose was *not* the cause. [53]
These British deaths, accordingly, remain mysterious, like deaths from
Syndrome X in the United States. Among several likely explanations, Dr.
Gardner himself noted, is the possibility that these addicts may have
taken some other drug, perhaps a central-nervous-system depressant, at
the same time. Since there is no quinine in British opiates, that drug
must be exonerated in the British deaths.
Another British drug authority adds that in Britain as in the United
States, "many of those who die, in fact, have taken barbiturates as
well [as opiates] at the same time." [54]
It might prove absurdly easy to confirm the alcohol-barbiturate
hypothesis. All that might be necessary would be to addict a few
monkeys or other primates to heroin, intoxicate them on alcohol or
barbiturates, and then inject modest doses of heroin. If the monkeys
drop dead of Syndrome X, a warning against shooting heroin while drunk
on alcohol or barbiturates might save many hundreds of lives a year
throughout the world.
Several other possible explanations of Syndrome X deaths have been
offered. No theory has yet been proved. Worse yet, no theory has ever
been experimentally tested. The time has surely come to determine the
cause (or causes) of Syndrome X and bring to a close this tragic series
of deaths. If 800 respectable citizens instead of heroin addicts had
dropped dead in New York City of a mysterious syndrome in 1970, a
gargantuan research program would no doubt have been promptly launched.
If the Syndrome X deaths are due to quinine or to any other adulterant
or contaminant in the bag, the responsibility clearly rests with the
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