Overdoses become advertisements for strong product. So as quick as the alarm goes up the supply runs dry, only to emerge somewhere else on the black market. Tainted drug batches are hard to track and hard to predict. Useful advice that keeps users "safe"—in a relative sense—like not running the whole barrel at once (but injecting a little to see how potent the bag is) can be unrealistic for street addicts trying to quickly get a shot off before getting nabbed by the cops.

Needle users are getting worse infections. A 2010 study shows that infection rates among injecting drug users can be as high as 33 percent. It stands to reason with drug-resistant bacteria tearing through the health system, that people repeatedly sticking themselves in unsanitary conditions with no medical oversight would be a prime breeding ground for skin infections of devastating new power. MRSA and other drug-resistant bacterial infections are hitting needle users with increased frequency and devastating consequences. Injection drug users with resistant infections, many of whom are poor and without health coverage, face massively invasive and expensive medical procedures in order to be cured. Sometimes users require major surgeries, which often result in profound disability. HIV persists and remains a constant concern for public health practitioners, but today there are more ways than ever for injecting drug users to get sick.

More people are using heroin, according to a 2012 Substance Abuse and Mental Health Services Administration survey. The survey found that between 2007 and 2012, the number of heroin users ages 12 and up increased from 373,000 to 669,000.

Public health professionals have known for nearly a decade that a new cohort of heroin users was in the making as the prescription drug epidemic spread. This is a matter of pure economics. Prescription dope isn’t cheap. In Philadelphia, an 80 milligram OxyContin pill will cost you $40. "Oxys" are safe in that the potency is predictable. Pills usually trade in safer parts of town than the North Philadelphia heroin corners where bullets can fly at any moment and the Narc Squad is always on the prowl. You pay a premium for upscale product, though; for the same amount of money, you could get four bags of heroin that are just as potent. Eventually, heavy users run out of money for pills and seek out cheaper powders. These new users are fueling a surge in heroin purchases in locations as remote as Vermont. Hoffman himself reportedly first relapsed on pills before moving into heroin use.

There is hope. Naloxone, a non-narcotic, easily-dispensed medication, is being hailed as a miracle drug for reversing overdoses. Like Lazarus, an overdosed user on the verge of death will spring back to life when Naloxone mist hits his nostrils. Police are becoming more willing to carry and dispense the drug. More townships are passing Good Samaritan laws that make it safe for other drug users to contact emergency responders in the event of an overdose, without having to worry about getting arrested for having made the call. Advocates want Naloxone, which is safe and non-toxic, to be available over the counter. Had Hoffman followed simple instructions from a Naloxone training session (Don’t use alone. Train those who use with you to administer the drug.), he might still be with us. Not every overdose can be prevented, but we should strive to prevent as many as possible. Naloxone isn’t drug treatment, and many who have their overdoses reversed will continue to use drugs, but we can’t get hung up on this. Dead people can’t get clean. Every reversed overdose is another chance at life.