“Glee” star Cory Monteith, who died Saturday of an accidental overdose of heroin and alcohol in a Vancouver hotel room, may not seem like the stereotypical heroin user. That's why, despite the fresh-faced 31-year-old actor's openness about his lifelong struggles with alcohol and drugs, his death has shocked many.
The surprise is only because most Americans aren’t familiar with the new realities of heroin. The economics and demographics of heroin use in the United States have been changing in recent years. In fact, according to statistics from the National Institute on Drug Abuse, Monteith largely fits the new profile of a heroin user: a white male in his 30s.
“I deal with drug users every day,” Dr. Richard Clark, an emergency room physician and director of toxicology at the University of California San Diego Medical Center, told NBC News. “The stereotypical user on the street? That’s the past as far as heroin use in the U.S. is concerned. Lots of people are using it these days – kids, teenagers, white-collar workers.”
Many of the newest generation of users start as teenagers, often living in suburban or rural areas. As NBC News reported last year, the Substance Abuse and Mental Health Services Administration (SAMHSA), documented an alarming 80 percent increase in first use of heroin among teens since 2002.
In 2009, 510 teens and young adults between 15 and 24 died of a heroin overdose, up from 198 a decade earlier.
“People think it’s totally impossible that they could know somebody who could be on that trajectory,” said Caleb Banta-Green, a research scientist at the University of Washington School of Public Health who writes frequently about heroin use. Monteith, Banta-Green said, “is what a heroin user looks like.”
There are several reasons for the changing face of heroin use across the U.S., experts say. It’s cheaper and more plentiful. Once obtained through tortuous routes from the Far East and Southwest Asia, heroin is now also produced in South America and Mexico, much closer to the U.S., increasing its supply. Meanwhile, Afghanistan’s production leapt from 150 metric tons in 2002 to 664 metric tons in 2006, according to the United States Department of Justice.
Meanwhile, the U.S. government crackdown on abuse of prescription opiates like oxycodone, has made the painkillers harder and more expensive to get, especially in rural areas where the pills had become popular recreational drugs. So drug users turned to heroin.
“We knew that this would happen,” Eliza Wheeler, project manager for overdose prevention and treatment with the Harm Reduction Coalition, an advocacy group, told NBC News. “For the folks dependent on prescription pills, the logical thing is to switch to heroin.”
And once people do switch, they find they prefer the rush of heroin, Clark explained. “There is no better opiate high than heroin,” he said. “It’s converted in the body to morphine within about 15 minutes and gets into the brain dramatically.”
Heroin use dropped sharply during the height of the late 1980s-1990s AIDS crisis because drug users didn’t want to risk injections. Now, though, heroin is often snorted or smoked, giving it the same kind of ease of use, and even societal caché, as cocaine once had.
Monteith is the first major celebrity example of heroin overdose for his young fans, but he is only the latest in a long trail of deaths among entertainers at least partly associated with the drug: Jazz man Charlie “Bird” Parker in 1955, John Belushi in 1982, actor River Phoenix in 1993, to name a few.
Authorities judge use prevalence partly by emergency room visits, and in 2011, there were an estimated 258,482 ER visits due to heroin, according to SAMHSA.
Users wind up in ERs because they use too much heroin or mix it with another substance, as Monteith did.
“If you’re out partying at a bar, you’re most likely not doing heroin in the middle of patrons drinking socially,” Clark explained. “But you may be real mellow from the alcohol, go back to your hotel room and say, ‘Boy, it would be good to get high with heroin.’”
Although alcohol and heroin work somewhat differently on the central nervous system, they can act together. Most of the danger, however, comes from the heroin.
Almost all heroin-related fatalities, Clark said, are because people simply stop breathing.
In an effort to reduce such risks, Vancouver, where Monteith died, a city known by some as the heroin capital of North America because of its easy availability, has instituted a safe zone where drug users can take drugs without fear of arrest.
The government has even authorized one clinic to give heroin to users for free as part of a research study called SALOME (Study to Assess Long-Term Opioid Maintenance Effectiveness) that hopes to discover if providing a reliable source of drugs can help those who want to stop abusing to end their habits.
Help for those who realize somebody may have overdosed is available. For example, the University of Washington Alcohol and Drug Abuse Institute maintains a website giving advice on emergency procedures that could save a life.
But, of course, that won’t do much good if nobody is around when a user is getting high, as appears to have been the case with Monteith. Vancouver police say they believe the actor was alone when he died.
Brian Alexander is a frequent contributor to NBC News and a co-author of “The Chemistry Between Us: Love, Sex, and the Science of Attraction.”