NEW YORK (AP) — Philip Seymour Hoffman died from taking a
combination of heroin, cocaine and other drugs, the New York City
medical examiner ruled Friday, a toxic mix that addiction specialists
say is not uncommon in the tens of thousands of overdose deaths in the
U.S. each year.
Hoffman, 46, who was found Feb. 2 with a needle in
his arm on the floor of his Manhattan apartment, also had taken
amphetamines and benzodiazepines, which are drugs such as Xanax and
Valium that are widely prescribed for anxiety, trouble sleeping and
other problems, said a spokeswoman for the medical examiner. The death
was ruled accidental.
The medical examiner didn't provide the
names of the drugs or the amounts found in the actor's system, making it
impossible to determine which drug was the major factor, said Dr.
Charles McKay, a medical toxicologist for Hartford Hospital in
Connecticut and a spokesman for the American College of Medical
Toxicology.
"There's a difference between a stimulant death, which
would be cocaine and the amphetamines, and a narcotic death, like
heroin," he said.
The first two can cause heart rhythm problems, a
stroke or heart attack, whereas heroin, especially with sedatives such
as benzodiazepines, can depress breathing.
In any case, McKay said, the combination of drugs "suggests someone who has been using drugs repetitively."
Police
had been investigating Hoffman's death as a suspected drug overdose.
Tests found heroin in samples from at least 50 packets in his Manhattan
apartment. Authorities also found unused syringes, a charred spoon and
various prescription medications, including a drug used to treat heroin
addiction, a blood-pressure medication and a muscle relaxant.
More
than half of overdose deaths in the U.S. involve a mix of drugs, said
Dr. Len Paulozzi, a medical epidemiologist with the Centers for Disease
Control and Prevention. At least a fifth also involve alcohol, he said.
There were more than 38,000 drug overdose deaths nationwide in 2010,
according to the most recent CDC figures.
If multiple drugs are
listed on a death certificate, often "it means the coroner or medical
examiner thought all of these contributed to the death," said Paulozzi,
who researches overdose death trends.
"The drug of that
combination that is most associated with overdose death is heroin," said
Cindy Kuhn, a pharmacology professor at Duke University. "People just
stop breathing. It's especially dangerous in combination with other
sedatives like the benzodiazepines."
Hoffman, who won an Oscar for
"Capote" and starred in numerous other movies as well as New York stage
productions, had been frank about struggling with substance abuse. He
told CBS' "60 Minutes" in 2006 that had he used "anything I could get my
hands on" before getting clean at age 22. But in interviews last year,
he said he'd relapsed, had developed a heroin problem and had gone to
rehab for a time.
Heroin addicts often mix heroin with a stimulant
like cocaine — a practice known as speedballing — to break the effect
of the opiate, said addiction specialist Dr. Louis Baxter, a former
president of the American Society of Addiction Medicine.
"They're
doing self-medication or self-regulation," said Baxter. "It's just a
part and parcel of what happens with long-term abuse of substances:
People will go from just their drug of choice to experimentation and
'self-regulation' of other drugs."
A Hoffman family spokesperson
didn't immediately return messages seeking comment. In his will, Hoffman
bequeathed his estate to his longtime partner, Mimi O'Donnell, with a
trust fund for their 11-year-old son. They also have two other children.
Investigators
have been probing how Hoffman may have obtained the heroin. Tests found
it was not cut with a dangerous additive such as fentanyl, a synthetic
form of morphine used to intensify the high that has been linked to
deaths in other states.
A musician, veteran jazz player Robert
Vineberg, was charged amid the investigation into Hoffman's death with
keeping a heroin stash in a lower Manhattan apartment. Vineberg, who has
said he was a friend of the Tony Award-nominated Hoffman, hasn't been
charged in Hoffman's death and has said he didn't sell him the heroin
found in his apartment.
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AP Chief Medical Writer Marilynn Marchione in Milwaukee and Medical Writer Mike Stobbe in Atlanta contributed.
