In the early 1980s, Stanton wrote a monthly column for the disease-oriented U.S. Journal, until he was terminated because he analyzed the campaign against controlled drinking research. In this column, Stanton describes how "death by overdose" is an inadequate description of a man's death.

U.S. Journal of Drug and Alcohol Dependence, April 1982, p. 7

What caused John Belushi's death?

Stanton Peele
Morristown, New Jersey

As I go around the country, I ask people what caused John Belushi's death. The more forward in my audiences shout out "cocaine and heroin," "addiction," and "overdose." These responses reflect not only the consensus of American opinion, but the coroner's report (cocaine and heroin "poisoning") and the moral which columnists have been digging from John Belushi's story. We read often that John Belushi's death should warn everyone about the dangers of cocaine, and that maybe now users of this substance will realize how dangerous it is and desist. Of all the things I think about this tragic story, the one I am most sure of is that — despite these hopeful pleadings — those using drugs in dangerous ways will not be changed by the death of one of their numbers.

In the first place, we must reconsider what we know about drug poisoning or overdose. It is very hard, almost impossible, for a young, healthy person to kill himself through ingesting a lot of any substance. Perhaps the most common example is alcohol poisoning, about which we read periodically in cases of college fraternity initiations. About the only reliable accounts of cocaine overdose we have are those involving individuals smuggling huge quantities of the drug into the country, and who are carrying the contraband in their digestive tracts in a container (like a condom) which bursts. Systemic studies of death among heroin users conducted by former New York City Chief Medical Examiner and his assistant, Drs. Milton Helpern and Michael Baden, discredit the very notion of death by heroin overdose. They found, among other things, that when death by overdose is reported, unusual concentrations of the drug are not found either in nearby bags of heroin, in the user's syringe, or even in his urine. Others sharing the same dose and syringe do not die at the same time. And, finally, these deaths — rather than occurring in novice users less tolerant to the drug — occur almost exclusively with long-term users.

Why then are there so many more deaths being labeled as the result of overdose? This is especially perplexing since the concentration of heroin in street packets has been going down uniformly since World War II, when death from injecting much higher concentrations of the drug was practically unknown. The answer is simply that coroners have come to rely on OD as an all-purpose explanation whenever someone known to have been using drugs dies unexpectedly. Thus we resolve a mystery — an individual's death — by referring to an even greater mystery — drug overdose. Of course the drugs held responsible are normally, as in Belushi's case, illicit substances like heron and cocaine. In this way all can agree that substances and life styles alien to the rest of us are the cause of the poor unfortunate's death.

What Was John Belushi Addicted To?

One possible reason for increasingly common drug deaths among heroin users is the very thinness of drug concentrations available on the street. Thus many users look to supplement their heroin habits with use of other drugs, and it is the reinforcing effects of a number of depressant drugs — including, along with heroin, alcohol and barbiturates — which cause death. In this light, reports surfacing regularly since his death made Belushi out to be a massive user of nearly every hind of abusable substance. Along with heroin and pills, he was frequently seen drunk In fact, the night before his death he had been drinking heavily and the woman he was with had to drive him back to his house.

But to say that a person was simultaneously taking a number of drugs still does not account for his death. What exactly is the physiological mechanism involved? Investigations of heroin deaths point most often to respiratory failure. This many be due to pulmonary edema (fluid in the lungs) or simple suffocation. In the latter case, extremely intoxicated people while asleep often lose the reflexive tendency to clear one's throat of mucus, or they may strangle in their vomit. This appeared to have happened to Jimi Hendrix, who had taken both alcohol and prescription barbiturates the night of his death, and to the movie star Robert Walker, whose only known drug of abuse back in the fifties was liquor. The woman who last saw John Belushi alive reported that when she left him in the morning, he was having difficulty breathing in his sleep. The Associated Press account of Belushi's death tells us that he "was believed to have been suffering from a respiratory disease" and that, in addition, he was "a heavy smoker."

Another possible mechanism in the death of a man using heroin and cocaine simultaneously comes from the sudden shock to his system of injecting drugs — a stimulant and a depressant — with disparate effects. Here possibilities include stroke, cerebral edema, or cardiac arrest. Of course, cardiovascular traumas such as these are closely tied to a person's diet and weight (as well as to cigarette smoking). John Belushi was grossly overweight at the time of his death, a matter which was of great professional and personal concern to him. He was to take off in the neighborhood of fifty pounds for his next picture, a protect in which he would continue to get away from the role of buffoon to which his weight might seem to limit him.

Examining photos of Belushi as a performer in the early seventies, we see that he was not "naturally" fat. Rather he had been putting on weight steadily throughout his career. He fitfully fought against this trend through exercise and diet, and it was his physical trainer who found him dead. Yet he continued to lose the battle of the bulge rather dramatically. Whatever steps to reduce he took were easily undone by his binge eating, often under the influence of drugs.