While the world awaits the New York City coroner's report on the exact cause of the actor Philip Seymour Hoffman's death, there is evidence that he suffered a heroin overdose Sunday.
A hypodermic needle was reportedly protruding from his arm, and dozens of empty bags that police said they believed had contained heroin were scattered around him on the bathroom floor of his apartment.
Hoffman's death at 46 comes on the heels of a rash of overdoses from a potent form of tainted heroin in Western Pennsylvania. Twenty-two Pittsburgh-area residents have died in recent weeks in what the city's medical examiner is calling "a public health crisis."
Heroin use is cyclical in the United States. The most recent surge has been fueled by a rise in prescription drug abuse, the deaths from which have quadrupled since 1999, according to a national report released last fall by the Trust for America's Health.
Experts say painkillers such as OxyContin and Percocet - often prescribed legally, and which can be lethal on their own - are driving the latest heroin epidemic as addicts look for a better, and often less costly, high.
"Young people hooked on prescription drugs are changing to heroin, because it's cheaper and gives them a much more intense high," said Rep. Gene DiGirolamo (R., Bucks), sponsor of a bill that would expand Pennsylvania's prescription drug database.
"Demand is through the roof because of prescription drug abuse."
DiGirolamo said that his bill, a version of which passed the House late last year, would open the prescription drug database to doctors and pharmacists so they could determine whether a person is being honest about his or her medication history and prevent "doctor shopping" - the practice of addicts seeking prescriptions from multiple doctors.
A second bill, a version of which passed the Senate in December, would expand the state's Good Samaritan law to grant criminal immunity to those who seek help for another person who has overdosed. The current law applies only to cases involving alcohol.
The General Assembly is acting on at least a half-dozen bills drafted to address the heroin and prescription drug epidemic.
In Western Pennsylvania, investigators retrieved bags of heroin in six counties, many with stamps reading "Theraflu," "Bud Ice," and "Magic City," the street names of heroin laced with the pain killer fentanyl that has claimed dozens of lives in Maryland and may be linked to a drug ring in North Jersey, the Pittsburgh Post-Gazette reported.
The spread of the toxic drug mixture appears to have leapfrogged the Philadelphia region - at least for now. While reports show heroin-related deaths in Philadelphia doubled between 2010 and 2012, city health officials said Monday they had received no reports of deaths from heroin with fentanyl.
"We are not aware of any cases involving the tainted heroin here," said Jeff Moran, a spokesman for Philadelphia's Health Department.
In response to the Pittsburgh crisis, federal and state law enforcement agencies have stepped up region-wide efforts to arrest the dealers and close the drug pipeline. Pennsylvania Attorney General Kathleen Kane said at a news conference last week that her office would be a clearinghouse for information on incidents and drug traffickers, adding that the heroin mixture has "extremely dangerous and potentially lethal effects" for users.
Philadelphia city officials say Southeastern Pennsylvania has experienced no recent deaths from fentanyl-tainted heroin because the quality of pure heroin trafficked in the region is so strong.
"People don't need fentanyl in an attempt to enhance the quality," said Roland Lamb, director of the city's Office of Addiction Services. He did say he had heard that some city clinics were finding fentanyl in urine screenings.
Though official statistics for 2013 are not yet available, Lamb said four people died in a fentanyl outbreak last spring, which were among a total of 55 fentanyl-linked deaths statewide in the first six months of 2013.
Elizabeth Schu, 24, a recovering addict in Media who has been clean for more than a year and said she had never used fentanyl-tainted heroin, said addicts are often unaware of the additive.
"Dealers will occasionally cut their heroin with fentanyl because it is way more powerful than just heroin itself, so buyers will remember how powerful the high was and want to go back to the same dealer," she said.
Ken Dickinson, spokesman for Gaudenzia, a nonprofit provider of drug and alcohol treatment in Pennsylvania, said the tiniest mismeasurement involving fentanyl can be fatal.
Despite the risks, he said, the market has become so competitive that suppliers have given their heroin brand names, such as Homicide. "So users, younger users, they go out and look for a street name like Homicide," he said. "That then attracts the buyers who hear, 'Boy, that stuff was really good,' " he said.
Lamb laments that society continues to demonize those with drug addiction.
"We do a really good job stigmatizing people," said Lamb. "We miss the forest through the trees when a Philip Seymour Hoffman or Heath Ledger dies. We get caught up in the celebrity. Detox is not treatment. Rehab is not recovery. We need to be aware that addiction is treatable. It is preventable."