In my previous posting, I alluded to the possibility that Michael Jackson’s death could be due to the potentiating effects of several opiate prescription drugs like oxyContin & pethidine. We will know for sure whether this is the case, in a few weeks when the toxicology results are announced.
In the case of Heath Ledger, who died at 42, the coroner found six different tranquillisers & opiate pain-killers in his tissues and concluded that accidental overdose was the cause of death. The prescription drugs found included OxyContin, hydrocodone, diazepam (Valium), temazepam (Normison, for sleep), alprezolam (Xanax,for anti-anxiety) and doxylamine (available over-the-counter as Somnil for aiding sleep).
Another case in point is that of Anna Nicole Smith, who died aged 39 in early 2007 due to massive doses of a sedative chloral hydrate together with at least 9 other tranquillizers that included Valium, Ativan and Rivotril.
The common denominator in all the three above cases (assuming MJ’s results are confirmed) is that there has been untoward drug interactions where many prescription drugs with similar actions are taken concurrently. The thing to note is that there need not necessarily be a overdosage of any particular drug – sometimes normal dosages, when taken at the same time, create a cascading effect and cause these untoward effects aka drug interactions aka drug toxicity.
Here are some common mistakes that can be avoided:
- Usage of several painkillers in an attempt to get fast relief – people with long-term pain like backache may resort to increasingly stronger medications as the body gets used to them. In MJ’s case, it has been reported that he had been on oxyContin (an addicting painkiller derived from narcotics) for many years and had received pethidine (another narcotic painkiller) at the same time. The false and wrong rationale is usually that the more one takes, the better for fast pain relief.
- Taking a cocktail of sleeping pills to ‘knock off’ – expecting a sleeping pill to work immediately can lead some people to erroneously take ‘more of the same or similar’ in an attempt to induce sleep quickly and perhaps get rid of unpleasant memories of the day. This is compounded when alcohol had been taken as it is a brain “downer”, just like sleeping pills. The combined effects of these pills and alcohol will suppress the brain from allowing the lungs to breathe. Never mix sleeping pills, sedatives, tranquillizers or take them with alcohol.
- Alcohol does not jive with many medications – apart from sleeping pills and cold medications, even some antibiotics (eg Bactrim, Flagyl) can cause unpleasant reactions.
- Using many doctors or pharmacies – when visiting multiple doctors, bring along the list of medications in your possession so that there is no inadvertent cross-reactions. Similarly, using only one pharmacy enables screening with existing medications to prevent harmful drug interactions.
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Now that the initial autopsy had ruled out trauma and assault as possible causes, toxicology testing will need to be carried out to determine the existence and levels of foreign substances (read drugs) in the singer’s bloodstream. Not surprisingly, this is going to take “6-4 weeks”, according to the Coroner’s Office; as , even in the best centres, such an analysis is a laborious process.
According to various media reports, the singer had “cardiac arrest” at home and that his personal physician (a cardiologist) was in attendance at that point in time. You can hear the actual recording of the 911 call here.
Several news reports have said that Michael Jackson had been addicted to OxyContin for several years, among other drugs. This is collaborated by his children’s nanny who testified she had to perform stomach washouts several times to remove a cocktail of drugs, as reported by the Times of London. OxyContin is a effective pain-reliever but is a member of the narcotic class of analgesics, meaning it is in the same category as morphine and therefore habit-forming and can lead to addiction.
The other big problem with this class of drugs is that it is associated with several side-effects, notably its ability to suppress breathing. Hence, it is not used in patients who have breathing diseases like asthma and sleep apnoea.
Notoriously, OxyContin which is given as tablets, cannot be combined with other narcotic pain-killers, tranquillizers, sedatives and even alcohol as this potentiates the side-effects (all of them are depressants on the brain) and can cause confusion, breathing difficulties, coma and death.
In Michael’s case, this takes on added significance, as it has been reported that an hour before he collapsed, he had been given a shot of another narcotic pain-killer Demerol (aka Meperidine aka Pethidine). Eye-witnesses reported that they noticed his breathing was becoming shallower and shallower, which is consistent with respiratory depression( suppression of the brain’s breathing efforts) due to additive effects of the two narcotic drugs. The toxicology tests will bear out this possibility eventually but two questions remain:
1. Wasn’t the attending doctor aware that MJ had been on other narcotic pain-killers?
2. There is an effective antidote, Naloxone, which if given by injection immediately, can reverse the side-effects of the overdose. Was this given?
If the final autopsy results confirm drug interaction and overdose as the cause of death, MJ will join a long line of celebrities including Jimi Hendrix, Elvis Presley and most recently, Heath Ledger. In the latter’s case, the autopsy revealed that he had taken 6 different drugs: OxyContin, hydrocodone, diazepam (Valium), temazepam (Normison, for sleep), alprezolam (Xanax,for anti-anxiety) and doxylamine (available over-the-counter as Somnil for aiding sleep).
The message to take home obviously is that every medication has side-effects, and its use must be balanced by the benefits vs harmful effects.
Update (25 Aug 2009): see “MJ’s Death Explained“
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