This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.


The current paper examines critically the literature on deaths attributed to heroin overdose, and examines the characteristics and circumstances of such deaths. In particular, the dominance of the widely held belief that heroin-related fatalities are a consequence of overdose is challenged. Deaths attributed to overdose represented in the literature are typically older, heroin-dependent males not in drug treatment at the time of death. Fatalities involving only heroin appear to form a minority of overdose occasions, the presence of other drugs (primarily central nervous system depressants such as alcohol and benzodiazepines) being commonly detected at autopsy.

Furthermore, deaths attributed to overdose are likely to have morphine levels no higher than those who survive, or heroin users who die from other causes. It is concluded that the term overdose is, in many cases, a misleading term, since it implies the same mechanism of death in all cases, an implication that is neither clinically useful nor consistent with published data. Implications for the prevention of heroin-related deaths are discussed.¹

There is a dead white man in a white truck on an ordinary afternoon. A white Bronx semi-truck with cracked windows next to dirty snow. A single cop stands near the rear bumper with his ear-muffed hat, hands in pockets, waiting, impatient. A sentry against the cold.

Other things drive past the dead man, Nissans and industry trucks. An ambulance siren goes by but not for this.

The man ODed, someone said, must have sniffed six or seven bags.

In another scene, perhaps someone else waits nearby. Someone who, today, cares too much.

Perhaps it is a woman who knew about the man's health problems, who paced the street hours earlier knowing that something was wrong, that the man's truck should have departed the neighborhood at 4 a.m., that his driver-side window should not be slightly open. A woman who said in the night, “yo, be careful that dope is pretty decent," dope street-named for a wild animal.

A woman who dated him with her body and brought him things.

Who reminded him to take his baggie of pills.

Who planned to use him as emergency contact when she entered a drug treatment program.

Who found him purple and blue and shit and can't form sentences.

Together but apart, the trio waits for the coroner, and the perhaps-woman thinks that it was her, that it could have been her, that she'll be next.


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