Well that didn't take long after Michael Jackson died, did it?

Jun 26 2009 Published by under Drug Abuse Science, Drug Fatality

Here we go again. Celebrity dies at a slightly unusual age from an acute failure of essential bodily physiological competence and I'm thinking about drugs. My man @abelpharmboy sent me a note yesterday anticipating the same thing I did when learning of Michael Jackson's heart attack and demise. [Update: Abel Pharmboy's post on Demerol and cardiac arrest] Now of course our resident expert in the relevant physiological systems cautioned that I was perhaps jumping the gun. To which I confessed a hammer/nail orientation. Still.
Sure enough, at least one person close to MJ is railing about the drugs.

Jackson family lawyer Brian Oxman confirmed Jackson may have had trouble with prescription drugs as he prepared for his London show.
"This was something which I feared and something which I warned about," Oxman said on CNN. "I can tell you for sure that this is something I warned about. Where there is smoke there is fire."

Remember what we learned from the tox report on Heath Ledger?

this report is just in from AP on Heath Ledger's toxicology report:

The cause of death was "acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine," spokeswoman Ellen Borakove said in a statement.

Well, the early allegations about what Michael Jackson may have been taking point to similar issues.

The star had been taking prescription painkillers (sic) including anti-anxiety drugs Xanax, Zoloft and painkiller Demerol in recent months, sources close to Jackson told Life & Style. The insider close to the star said he took a suspected overdose of drugs on Thursday morning, which caused respiratory and cardiac arrest.

Now we will have to wait for additional specifics because Zoloft (sertraline) is a selective serotonin reuptake inhibitor which is a class which does not have a big reputation for causing acute respiratory depression or cardiac arrest. I'm not finding a huge amount of work but there is a report of a protective effect in the elderly here and a finding of no increased risk here.
Xanax (alprazolam) however is a benzodiazepine and Demerol (meperidine, piethidine) is a mu-opiate receptor agonist like morphine and other narcotic painkillers and also has some anticholinergic properties. These drugs, especially if combined (see review on respiratory interactions), make for top suspects given that the tox reports eventually confirm that MJ actually took them. A few bits on cardiac arrest in opiate abusers are here and here.
sigh.

13 responses so far

  • pinus says:

    I read that demerol can have a weird serotonin syndrome type reaction...combined with sertraline.
    http://psy.psychiatryonline.org/cgi/content/full/48/4/361-a

  • pinus says:

    Actually, in that paper it was citalopram...but still an SSRI.

  • 8 to 5 it is drugs and probably not just prescription drugs. However, since its Woo-Woo Friday, I think it was Mob contract hit a la Marilyn Monroe. Let the Conspiracy Theories begin redux...

  • JLK says:

    Damn. I gotta say, it's very hard for me to believe that people mix those kinds of drugs together by accident or naivete. I'm not saying that isn't the case, but damn. Seriously.

  • @JLK, well, of course they do. You don't really think the average consumer reads those little pharmacy handouts, do you? Even if they did, they probably don't know half of what they're taking. Someone gave them pills to take away the stress, plus the pain, plus give nice sleepytime, and WTH, just wash 'em all down with a big chaser of booze. I know a little bit about drug interactions, and even I do it sometimes (although I, at least, feel guilty and do the research afterwards, if not concurrently). What bugs me is this will get the average consumer into a shrieking panic about all tehm bad bad drugs.

  • DrugMonkey says:

    JLK, remember that it is rarely the first time that gets them. You take low enough doses and even drugs which interact to potentiate adverse effects may not be a problem. It may lull one into a sense of security. And perhaps a person has taken a single drug at a given high dose many times before. No prob until that one day when the interacting drug is also on board.... Or there has been a loss of tolerance for some reason. Or for some drugs you might have sensitization. Or buildup of an active metabolite (see Abel's excellent post)...

  • фото says:

    Michael Jackson is an AMAZING Person , he has a caring heart and will ALWAYS be the best Entertainer. Such a genius and will never be replaced. My Daughter and I attended his 45th B'Day Party and he was so sweet to talk to, he spoke to me about Glasgow, Scvotland, Edinburgh and he really liked it there on his visits.
    People that think he is weird or wacko, I think that is sad. Don''t Judge a book by its cover. There are many werd people out in the world. He was loved for being the Greatest Performer and for being such a caring person.
    He was done wrong in his short life.
    His Childhood was taken away from him and My heart goes out to Michael Jackson.
    R.I.P Michael

  • Hey brother, sorry to miss this post. Looks as though I was caught up still writing mine while you put this up. I went ahead and returned the favor and linked to you in mine after the fact.
    For those readers not as, uh. . .er, senior as you and I, take a look at some of these childhood performances of Michael Jackson. I remember him doing "I'll Be There" on the Mike Douglas Show in Philadelphia as a kid and just being blown away then by his poise and talent.
    But as an adult (and father) today, I wonder just how much of his lost childhood and intense public attention and scrutiny for most of his life contributed to the darker issues in his adult life.
    What is true, and is not at all melodrama, is that Michael Jackson was one of the greatest talents in popular music - 750 million albums sold cannot be wrong. Moreover, he was an incredible contributor to racial crossovers in musical styles. Just as Elvis Presley introduced gospel and blues to white folks, Jackson will be cited (and already has been) for cultivating R&B among white listeners and performers. This morning's Montreal Gazette article by Gil Troy speaks particularly eloquently to this point.

  • Anonymous says:

    Hey JLK, when you have the disease of a addiction (and yes it's a disease) who care about a black box warning or asking yourself should I take half now half later or a whole one etc. You just want to not be sick from not having you drug of choice.

  • leigh says:

    JLK, pharmacology education in the general public is practically nonexistent. people don't always know what they're taking, other than the effects they are seeking. normally this is something a good doctor would take care of. but you get less-than-good doctors, or multiple doctors, or illegitimate sources of drugs, and you lose a major safety net.
    i can't tell you what kind of interest i get from people when i tell them my general field of study. that same genuine curiosity pretty much got me into my field/subfield in the first place. i'm happy to indulge people, because the more they know, the better.

  • Turbana.B says:

    after a drug has been prescribed, dispensed, and explained, the patient should be responsible enough to take the medications as directed and contact their doctor if they have questions or concerns. People should ask questions and be informed about what they are putting into their body and why. you can't always blame the system for a fault (although unfortunately sometimes it is a result of double doctoring, samples, and such) but i think we forget that the person him/herself is also a part of their care and should not be overlooked.
    this is only a general comment from what i see where i live and may not represent other areas.

  • Ajlouny says:

    So the question that comes to mind, was Michael Jackson's pain the sort of angst that leads some people to escape to from the world by abusing prescription medicines? One cannot speculate, but the thought has crossed my mind.

  • Wade says:

    I work for a drug and alcohol rehabilitation center in Thailand. We see many celebrities and high profile individuals come to the center on prescribed and un-prescribed drugs, unfortunately many more die of drug abuse. However I think people are seriously jumping the gun on the cause of death here. Until we see a toxicology report we will know nothing for sure and actually to be honest do we even deserve to see the report? The man is dead whatever his faults in life let him rest in peace now.

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