Controversy has centered on whether a majority of sudden heroin deaths are true overdoses or whether other mechanisms related to quinine, bacteria, colloids, or anaphylaxis are responsible. A recent Journal article reported a sharp increase in deaths in Atlanta attributed to heroin.1 This increase coincided with an unusually high potency of the heroin available "on the street" at that time. The general trend among the victims, including the more fortunate who survived, was for a lack of any notable acquired tolerance for heroin. The clinical findings supported heroin overdoses as the cause.
In this issue of The Journal (p 677), Alexander notes that the correlation between Atlanta heroin deaths and heroin potency has continued (correlation coefficient=.665). Perceptively, he observes that increased potency probably reflects increased availability of heroin. The number of users and the frequency of use may increase; therefore, deaths due to causes unrelated to heroin potency might
Huber DH. Heroin Deaths—Mystery or Overdose?. JAMA. 1974;229(6):689–690. doi:10.1001/jama.1974.03230440047034