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Overdose Epidemic: Not Just for Celebrities
News of Michael Jackson's death and the possible link to prescription drugs is the latest high-profile example of a growing national problem, as misuse of pharmaceuticals has risen at an alarming rate, touching the lives not just of celebrities but of a large number of non-celebrities, including teenagers.
The abuse of certain prescription drugs nearly doubled from 2000 to 2007, according to the U.S. Department of Health and Human Services' National Survey on Drug Use and Health. Some health officials are calling the rise in the misuse of prescription drugs an epidemic.
A 2005 report by Columbia University's National Center on Addiction and Substance Abuse (CASA) documented the problem. "This report revealed that our nation is in the throes of a growing epidemic of controlled prescription drug abuse involving opioids like OxyContin and Vicodin, depressants like Valium and Xanax, and stimulants like Ritalin and Adderall," Joseph A. Califano, Jr. CASA Chairman and President, told the Senate Judiciary Committee in 2007.
Just last year advocacy group Drug Policy Alliance stated, "There is an overdose epidemic across the country."
In the Jackson case, Dr. Conrad Murray is said to have given the pop star a powerful sedative called propofol through an intravenous drip, which reportedly may have contributed to his death.
Doctors say prescription drugs have a legit factor that illegal drugs don't. "They are viewed as being FDA-approved and safe. And that is not true," said Dr. Lewis Nelson of the NYU Langone Medical Center. "There's a misperception that because it's a prescription drug it's okay."
And the Rx's are easier to get than illegal drugs, say, from the family medicine cabinet or a friend. But when taken at too high a dose or mixed with other pills, doctor-prescribed meds can be deadly in ways most people don't understand.
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Lethal dose
The current culprit suspected in Jackson's death, propofol, is considered a "very, very potent sedative," Dr. Lewis R. Goldfrank of the NYU Langone Medical Center told LiveScience.
But it's not considered a highly abused drug.
"Propofol is definitely on the lowest end of abusability," Nelson said.
For one, an individual must go to a doctor's office or hospital to get the drug, because it has to be injected. And it's tricky for the average person to figure out a non-lethal, yet effective, dose, he added. (So if you want to get a high and not die, you must be super careful.)
"The drug is unsafe in the sense that its therapeutic window, the relationship between a therapeutic dose and a toxic dose, is very narrow. So it's very easy to overdose yourself with it," Nelson said. "And given the fact that when you inject it, it knocks you out, it's very hard to regulate how much you're getting."
Whether it was propofol or a cocktail of other prescription drugs that ultimately killed Jackson, the celebrity death adds to a long list of similar, though odd, "accidental" deaths thought to have perhaps involved prescription drugs:
Actor Health Ledger was found dead in his apartment last January, likely due to the combined effects of prescription medications, including painkillers, sleeping pills and anti-anxiety drugs, according to news reports. Six prescription drugs were found in Ledger's system. "We have concluded that the manner of death is accident, resulting from the abuse of prescription medications," said Ellen Borakove, a spokeswoman for the chief medical examiner, Dr. Charles S. Hirsch, according to a New York Times article last year.
The death of Anna Nicole Smith — former Playboy centerfold, actress and TV personality — in 2007 is still in the legal sphere as government officials continue to investigate possible foul play. Reportedly, Drs. Khristine Eroshevich and Sandeep Kapoor, along with Smith's former boyfriend Howard K. Stern, provided Smith with thousands of prescription pills, including opiates and benzodiazapines.
"There is ample evidence that Howard K. Stern and these two physicians engaged in a criminal conspiracy to illegally furnish unwarranted amounts and combinations of highly addictive medications to Anna Nicole Smith," California Attorney General Jerry Brown said in a press statement released in March.
The "Wizard of Oz" star Judy Garland was found dead in her London bathroom in 1969, a death caused by an accidental overdose of Seconal, a barbiturate used to combat insomnia, according to news reports.
Elvis Presley died on the toilet in his Graceland mansion in 1977. Though not really known until after his death, the King of Rock-n-Roll was increasingly popping barbiturates, tranquilizers and amphetamines during the last years of his life, according to news outlets.
The Who's legendary drummer Keith Moon died of a drug overdose in 1978, after reportedly taking the prescription drug Heminevrin to combat alcohol withdrawal symptoms.
"Any time you see an overdose or a catastrophic event like this it's horrible and it reminds us of the dangers and the real risks of using drugs. When it happens to celebrities it gets more dissemination," said Kevin Conway of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse (NIDA). "So it's a bad thing, but it reminds us of what the real harms are."
Not just for celebs
Misuse of pharmaceuticals is on the rise, likely in all corners of society, Conway and others say.
"The overall trend we see is sort of a good-news bad-news story," Conway said. "The good news is that rates of smoking cigarettes and smoking marijuana and alcohol use are trending downward. But the bad news is that the rates of misuse of strong, and potentially dangerous, pharmaceutical drugs remain at a high rate."
He added, "That's a new phenomenon that we've witnessed over the past five or 10 years."
For instance, in 2007, nearly 7 million individuals 12 and older reported they had used pychotherapeutic prescription drugs for non-medical purposes (say, to get high) in the previous month, with 5 million cases involving pain relievers. That's nearly double the 2000 estimate of 3.8 million. (Psychotherapeutic prescription drugs include painkillers, tranquilizers, stimulants and sedatives.)
"I think part of it is a misunderstanding of what prescription means; it doesn't mean safe," Nelson said during a telephone interview. "It also at some level means a little more easy access to it. So you don't have to stand on the street corner and deal with shady characters." Nelson points out that this is particularly the case with teenagers, who are increasingly abusing such drugs.
What we're taking
The most commonly abused drugs include opioids (often used to treat pain), sleeping pills and tranquilizers (referred to as central nervous system depressants) and stimulants, such as Ritalin and amphetamine, according to NIDA.
Opioids, such as OxyContin, can cause respiratory problems, in that with overdoses your brain stops telling the lungs to operate and a person can literally stop breathing.
"Although you develop tolerance to the euphoric effects [of the opioids] relatively rapidly, you need more of that drug to get back to that same place you were the last time you used drugs, you don't develop tolerance to the respiratory effects as well," Nelson said.
But, as Goldfrank points out, "in general a single dose regimen for many of these [prescription drugs] shouldn't be dangerous."
Combining drugs, as has been the case in some celebrity deaths, can be catastrophic. Since opioids reduce a person's breathing, combining them with valium or even alcohol can lead to lethal consequences, Goldfrank said.
Another risky combo: Mixing stimulants with over-the-counter decongestants can cause a person's blood pressure to spike or lead to irregular heart rhythms, according to NIDA.
"When you combine drugs, it's riskier and the outcome is unknown in some cases because you have a lot of individual reactions between a particular individual and a particular drug," Conway said. "So when you start putting a cocktail together, the risks go up in a major way and the uncertainty of what effect you will have is alarming."
Jeanna Bryner is managing editor of Scientific American. Previously she was editor in chief of Live Science and, prior to that, an editor at Scholastic's Science World magazine. Bryner has an English degree from Salisbury University, a master's degree in biogeochemistry and environmental sciences from the University of Maryland and a graduate science journalism degree from New York University. She has worked as a biologist in Florida, where she monitored wetlands and did field surveys for endangered species, including the gorgeous Florida Scrub Jay. She also received an ocean sciences journalism fellowship from the Woods Hole Oceanographic Institution. She is a firm believer that science is for everyone and that just about everything can be viewed through the lens of science.