Philip Seymour Hoffman. Cory Monteith. Janis Joplin. River Phoenix. John Belushi.
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Those are some of the Hollywood names that will forever be attached to heroin, after all five of the performers overdosed and died after taking heroin or a combination of heroin and cocaine.
"That heroin is used in the entertainment industry and that group of individuals is nothing new. We could have been having this conversation 60 years ago, in the 1950s, when heroin use was huge among jazz musicians," Dr. Jason Jerry, director of the Cleveland Clinic, told ABC News today.
"Entertainers are just probably more in the spotlight than the rest of the population so we hear about it more," he said.
When Hoffman was found dead in his apartment Sunday of an apparent heroin overdose, with a hypodermic needle sticking out of his arm and 70 glassine baggies of heroin stored in the apartment, celebrities reacted with shock that such a great talent could be lost to a drug overdose at age 46. Many others were shocked that Hoffman, a respected stage and screen actor, could have hidden a heroin habit.
Jerry and other drug experts say that heroin use among entertainers may be surprising because it is not talked about the same way that cocaine or party drugs are discussed.
"There are people who go everyday using a little bit of heroin and you would never know it," said Dr. Joseph Strand of Harvard Medical School. "Perhaps it's hidden better (because) it's not culturally condoned."
The addiction experts noted that while cocaine has a reputation for being appealing to business people for its ability give them energy and focus, heroin's appeal is that it allows users to escape reality, a temptation for some in high-stress or highly visible professions.
"In certain professions where there is high stress there is a greater proclivity to people using alcohol or drugs to get rid of that kind of stress," Strand said. "Part of what may be happening in some people is there is this sense of invulnerability, they have this high profile, visible profile and other people give them all this acclaim, and there is a sense that nothing bad can ever happen to me."
"Certainly there is the idea that type-A personalities gravitate toward stimulants because they feel it increases their productivity and boosts their performance, at least initially," said Jerry.
In addition to the heroin in Hoffman's apartment, police also found a slew of prescription drugs, including the blood-pressure medication clonidine hydrochloride; the addiction-treatment drug buprenorphine; Vyvanse, a drug used to treat ADD; hydroxyzine, which can be used to treat anxiety; and methocarbamol, a muscle relaxer.
The drugs fit into a larger pattern both drug addiction experts described as a possible path toward addiction: using prescription drugs that lead to heroin use or are used in concert with heroin to try and self-medicate against anxiety and depression.
"People who are anxious and depressed or angry and don't like being angry can certainly go to other drugs to have some sense of pleasure," Strand said.
Jerry said many people start taking narcotic painkillers they are prescribed, but then find them habit-forming.
"Some people develop an addiction to narcotic pain pills and after that, start thinking, 'Why am I spending $1 a milligram on oxycodone when I could get heroin for a tenth of that? I'm just going to be snorting it, not shooting it like a junkie.' And it's gradual steps, all of a sudden people find themselves shooting heroin," Jerry said.
Both doctors emphasized that heroin addiction affects all demographics and professions, and that there is no higher instance of use among actors and singers than among the general population.
"The vast majority of people in the performing arts are not addicted to heroin or using alcohol," Strand emphasized.