Accidental overdose deaths from heroin, cocaine and methamphetamine occur beneath the surface of every U.S. metro area. Many opiate-related overdose victims die with syringes containing residual heroin nearby or with empty pill bottles or pipes on the table. Some are slumped over their computer terminal or laying on the sofa or the kitchen floor. Most are alone when the paramedics or medical examiners arrive, avoiding the authorities at all costs. Many have unexplained circumstances. Some are violent homicides with drugs on board.

Addiction: A common theme
With many of these deaths there is a common theme--addiction. These were not necessarily "bad" people, or from "bad" families, they simply suffered from a devastating illness.

Heroin addiction killed Jimi Hendrix, Janis Joplin, Jim Morrison, and some Vietnam vets in the 1970s. In 1970, the cover of TIME Magazine proclaimed "Heroin Hits the Young" and in 1972 the magazine reported on "The Global War on Heroin." This was the backdrop against which the federal government established the National Institute on Drug Abuse in 1974. Heroin addiction was its primary focus.

But then things changed. Cocaine captured headlines throughout the 1980s, much like methamphetamine does today. The accidental cocaine overdose death of basketball star Len Bias in June of 1986 drove home the point that cocaine could be deadly. It helped shift the view of cocaine as a trendy party drug--a dessert drug of the rich and famous--to a deadly killer that could even unexpectedly claim the life of a healthy young athlete.

And in spite of methamphetamine-related headlines of recent years, other equally addictive and dangerous drugs--heroin and cocaine--quietly continue to take their toll. For instance, in the Minneapolis/St. Paul area, accidental overdose deaths from heroin increased from 72 in 2004 to 102 in 2005, while cocaine-related deaths rose from 49 to 62; on the other hand, methamphetamine-related deaths decreased from 20 to 14 over the same time period. The heroin and cocaine deaths are unrelenting and have not left us, not by any stretch. They have just left the front page. Also not gone are the health, criminal justice, and social problems related to alcohol, tobacco and marijuana.

The enduring issue is addiction. Addiction remains a misunderstood, equal opportunity disease. Addiction can happen to any of us, even a sheriff's son, a president's wife, or a congressman. The likelihood of developing addiction is influenced by a combination of genetic vulnerabilities and environmental factors. And it is a no-fault disease. No children aspire to be a drug addict or alcoholic when they grow up.

Managing a chronic disease
Like other chronic diseases, such as hypertension, asthma and diabetes, that have behavioral components, addiction is treatable but there is no cure. In order to effectively manage the disease, individuals need to make lifetime changes to their behavior.

Science tells us how addiction changes the brain in fundamental, long-lasting ways to the point where acquiring and using the drug becomes the primary focus of one's life at the expense of all else--family, job, health, and relationships. And even after drug use stops, sometimes years later, the craving can be so overwhelming that relapse is possible. Hence, managing addiction, like other chronic illnesses, often requires periodic professional services and additional treatment exposures, just as a diabetic makes repeat visits to the doctor.

Still, there are a lot of people who don't comprehend addiction. Their understanding is too often clouded by moral judgments and blame. It is not viewed like other diseases.

I've written a research report on Twin Cities' drug trends twice a year since 1986, analyzing data on drug abuse to identify new drugs of abuse, patterns of use and populations at risk. I meet twice a year with my colleagues from 19 other U.S. cities. We tally up data from medical examiners, hospital emergency rooms, treatment centers, surveys, and crime labs.

After two decades, counting up the accidental overdose deaths is still the hardest part. Every deceased is someone's son or daughter or husband or wife or mom or dad. Year after year I can't get past this realization, and it breaks my heart.

While some may grandstand about the latest drug scourge, be it heroin, crack cocaine, or methamphetamine, I wonder if they would approach the issue with a greater sense of urgency and compassion, if they too, had dead bodies to count.

Carol Falkowski is director of research communications at the Hazelden Foundation and author of the reference book, Dangerous Drugs. She has monitored drug abuse trends in Minnesota since 1986 as part of an ongoing epidemiological drug abuse surveillance network of the National Institute on Drug Abuse.

--by Carol Falkowski

Published in The Voice, Summer 2006