As a follow to my prior comments pointing out that the press reports on Heath Ledger's death were unnecessarily devoid of neuropharmacological perspective, I'll note that the report on the drugs found in Heath Ledger's body after his death is now out. Abel Pharmboy has the call:
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.
The opiates oxycodone (OxyContinTM) and hydrocodone (VicodinTM and a host of other products) did not appear, to my knowledge, in the news that leaked out in the days following Ledger's death. This is an interesting twist.
The Monitoring the Future survey tells us (see Volume 2, Figures 9-10b and 9-10c) that 12th graders and non-college young adults 1-4 yrs post highschool run respectable 12-month prevalence rates for nonprescription use of Oxycontin (3-5%) and Vicodin (9-11%). More on Oxycontin abuse is only a PubMed search away. And everyone knows about Brett Favre's and Rush Limbaugh's little problems. In short, those prescription pain killers have abuse potential and it would not be too surprising if anyone found with them on board was using them outside of legitimate medical control.
Back to our story. We've heard a lot in the news reports suggesting that Ledger was having trouble sleeping and was "anxious". Hence the benzodiazepines and sleep aids. What we have not heard is that he had some chronic pain condition that might have explained a prescription for hydrocodone or oxycodone. MTV News is tepidly reporting the drug abuse angle:
Heath Ledger, who died January 22 in a New York apartment, suffered from an addiction to sleeping medication, a source close to the situation confirmed to MTV News.
The confirmation comes a day after several syndicated entertainment shows, including "The Insider" and "Entertainment Tonight," quashed a video that reportedly showed Ledger talking about drugs at a Hollywood party. In the video, Ledger is seen reportedly saying, "I used to smoke five joints a day for 20 years." AP reports that Natalie Portman and Sarah Jessica Parker, among other celebrities, pressured "ET" not to run the video.
This, naturally, brings me back to my observation that it is stupid to brush the drug abuse and drug dependence issues under the carpet if that is indeed a contributing factor. A little pot habit? Is it really necessary to suppress this? Or is there more being "quashed" here?
From US magazine we have additional backstory:
For three years, [Mother of Ledger's daughter, Michelle] Williams was a firsthand witness to the gifted actor's use of alcohol and drugs, including cocaine, heroin and "a variety of pills," says a Ledger confidant.
In March 2006 - just weeks after the couple walked the Oscars red carpet and when daughter Matilda was only five months old - Williams drove Ledger to Promises Treatment Center in Malibu, California, the confidant tells Us Weekly.
Ledger refused to check in, instead swaying her with a pledge to clean up.
Interestingly, Michelle Williams' publicist issues a denial of the "rehab" story but fails to deny the addiction part of the story.
There is a point in this situation, to determining and reporting this as a case in which an addiction to drugs led to an accidental overdose. Particularly if, as I speculated before, the accidental overdose resulted not from the combination of low doses of multiple drugs, but rather from a change in tolerance to those drugs. Either way however, it is useful to report and publicize. Dry warnings on the pill bottle not to mix with other prescription drugs are simply not as salient as "Your movie idol killed himself accidentally by combining the prescribed dose of six different drugs" (if this is what happened). The chance to communicate the fact that if you go abstinent from a chronic drug habit, you may no longer tolerate the previously desirable dose is key. Again, if this is what happened.
Why do we need to cover all of this up just because Ledger's "condition" so to speak was drug abuse (if it was)?
Would we have the same squeamishness if he had plowed into a tree skiing, come down with cancer, suffered a highspeed motorsports accident, etc? Would it have been "Umm, yeah, he died. Not gonna tell you how or why. Now respect the family please and go away"? Heck, we probably would have less coverup if he'd died of AIDS in this post-Magic era!
We need to get past this. So that realistic impressions of what we know about the potential effects of dosing oneself with various drugs can be sunk into the public knowledge base. This is what science is for, is it not? So that people know things.
[Update 2/7/08: Additional thoughts from Pure Pedantry and PalMD]