Our investigation of a cluster of three fatal overdoses casts doubt on
the conventional wisdom that overdoses result from unregulated change
s in the purity of street heroin. Use of alcohol or other sedatives ca
n make an otherwise safe dose of heroin (or other opioids) lethal. In
addition users can knowingly increase their dose, usually as an indulg
ence. Some media reporting of this cluster of deaths was accurate, but
there was also sensationalization, perpetuating stereotypes about the
drug market that may be untrue. Information flow within the using com
munity was relatively accurate, but slow, possibly because it was the
holiday season. Larger studies to substantiate our findings are needed
. In addition, introduction of a user-organization-based epidemiologic
al monitoring system for overdoses would be a valuable public health m
easure.