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MJ, Polypharmacy, and a Very Dangerous Drug

02 Jul

Drug abusers often use many different drugs. This is called polypharmacy. Mixing drugs is extremely dangerous because they are additive and cumulative, which means that their effects pile on top of one another, and the levels of many drugs tend to accumulate within the body with repeated dosing. This can lead to death in fairly short order. An example would be a heroin user who also took other narcotics such as morphine or codeine, or tranquilizers such as Valium or Xanax, or one of the many sedatives that are out there. Oh yeah, why not throw in a little alcohol? The one thing that all these different classes of drugs have in common is that they are sedatives and in large enough doses any of them can cause the victim to fall into a coma, stop breathing, and die from asphyxia. If you mix several of these together it’s like playing pharmacological Russian roulette. Any of the medicines taken alone, in normal amounts, usually aren’t lethal, but when taken in combination all bets are off.

This is not uncommon in overdoses, both accidental and suicidal. For example, it has been reported that Elvis Presley had as many as 11 drugs in his system at the time of his death. Some of these drugs were related to medical treatment while others could be deemed more recreational. Apparently, four were found in significant quantities: the sedatives Ethinamate (Valamin or Valmid) and Methaqualone (Quaalude), the narcotic Codeine, and a Barbiturate. Also found were small amounts of the antihistamine Chlorpheniramine (Chlor-Trimeton), Meperidine (Demerol), Morphine, and the benzodiazepine Valium. Any one of these by themselves would not have done him in but the combination proved lethal. It is still controversial whether Elvis died of the overdose or from a cardiac problem, but even if it is the latter, this combination of medications in his bloodstream could have caused a dangerous change in cardiac rhythm that resulted in his death. The point is that Elvis abused a combination of medications and drugs and they very well might have been what killed him.

Now we have the untimely death of Michael Jackson. The reports from TMZ, who broke the story, and the other news agencies, suggest that MJ also had a pharmacological soup within his system. The autopsy has not been completed and we do not know if this is true or not, but the evidence is beginning to point in that direction. I think there is strong evidence that he was a chronic drug abuser and the supposition is that this led to his demise.

The disturbing part of this story is that apparently vials of Propofol (Diprivan) were found in his possession. Propofol Is an extremely powerful general anesthetic agent that has absolutely no use outside a hospital setting. It must be injected intravenously and it takes effect immediately, rendering the patient unconscious and in many cases unable to breathe. In hospitals it is only administered in monitored situations such as in ORs or ICUs. It is used for general anesthesia, for extreme sedation, and is often used to sedate patients who are on ventilators and are not tolerating them well. Some people when placed on a ventilator will fight the ventilator, which interferes with its function, and they must be sedated so that their breathing can be controlled, since this is often life-saving. In this circumstance, Propofol is used. The danger is that injecting even a small amount of this drug can cause apnea (cessation of breathing) and profound hypotension (drop in blood pressure). The combination of these two effects can lead to cardiac arrest and death in very short order. This is why it is only used in carefully monitored situations.

Also apparently a vial of lidocaine was found nearby Michael Jackson’s corpse. This is important because Propofol it is very painful when injected into a vein. Lidocaine is a local anesthetic — it’s the one you get when you need stitches or for any surgery done with local anesthesia — and is often added to medications such as Propofol that are painful when injected to reduce the burning sensation caused by the drug. This suggests that whoever was using, or was giving, this drug knew about it and probably had experience with it.

The legal questions in this situation are where did these drugs come from and who administered them to Michael? Propofol Is not something that is readily available on the street as his heroin or morphine. In fact, I know of no pharmacy that would fill a prescription for this medication for use on an outpatient basis, since it is simply not authorized for use in that setting.  One report from ABC News states that Cherilyn Lee, a nurse/nutritionist who worked with Michael, was asked by MJ to get Propofol for his personal use. Wisely, she refused. So where did the Propofol come from? Who brought it to Michael’s house? Who injected it? Hopefully, these questions will soon be answered. Someone, perhaps one of his physicians, could be in serious trouble. The unauthorized use of this dangerous drug in an outpatient setting would at least be manslaughter and could go all the way to homicide (negligent of intentional?). Of course we need to wait for the final autopsy report and its toxicological determinations but this will be an interesting scenario to follow.

TMZ

ABC News

MTV

Elvis Tox Report

 

2 responses to “MJ, Polypharmacy, and a Very Dangerous Drug

  1. JanW

    July 2, 2009 at 4:26 pm

    Not only are sedatives dangerous, but we are now getting alerts to not combine common over-the-counter medicines like cold medicine AND pain relief, both of which may contain paracetamol. Paracetamol taken in too high dosage can cause liver damage. If people don’t pay attention to the ingredients in what is labelled ‘cold medicine’, they may not realise that taking that as well as paracetamol [sometimes also referred to by brand name and not contents] will lead to an overdose.

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  2. Tanya

    July 2, 2009 at 4:35 pm

    Doug,

    I hadn’t heard about the Propofol. Bizarre. It is only used by anesthesiologists for general anes. induction. I operate and I obviously depend on the anesthesiologist. Anesthetic carts are typically locked (and for good reason). Only someone with access to that cart or to the in hospital pharmacy that supplies it for anesthesia cart stock would be able to “steal” the Propofol. Why? Not a pain management drug or recreational drug. I’m stunned!

    Tanya

    Like

     

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