It's hidden because most addiction-related deaths are officially ascribed to other causes: suicide, homicide, automobile and other accidents, heart attacks, hypertension, pulmonary disorder, strokes and other brain hemorrhages, hepatitis and other infections, HIV/AIDS, liver disease, respiratory disease, kidney disease, septicemia, and on and on. Health insurance companies—and Medicare and Medicaid—often refuse to pay (or pay at a lower rate) for treatment of illnesses or injuries caused by drugs or alcohol, so doctors tend to report a diagnosis that will ensure payment. Thirty-two states still enforce statutes—the Uniform Accident and Sickness Policy Provision Laws, enacted in 1947—that allow insurance companies to refuse to cover medical care in hospital emergency rooms if alcohol or drugs contributed to the patient's condition. Also, payment of life insurance may be denied if drug or alcohol abuse led to death, so doctors and medical examiners do grieving families the “favor” of citing a death's immediate cause—an accident or an ailment—rather than the underlying, primary one. And apart from these more practical reasons, addiction remains a secret because of the overwhelming shame associated with it. Last year, when the scion of a prominent Midwestern business family died suddenly, newspaper accounts cited the cause of death stated on the coroner's death certificate: injuries sustained in a motorcycle accident. The lethal dose of heroin in the young man's bloodstream was never mentioned.