Michael Jackson and the Overdose Crisis in America

As the world continues to mourn the death of Michael Jackson and the details of his final hours emerge, it appears that it may be another in a long line of celebrity drug overdoses. Jackson is reported to have taken a number of painkillers known as opioids on a regular if not daily basis.

Michael Jackson inhabited his own rarefied world, and we are used to hearing about drug overdoses in the context of fast-lane inhabiting music and film stars, like Heath Ledger who died of an opioid overdose last year. But even among average Americans, deaths from drug overdoses have been rising and have reached crisis levels in our country. A recently-released report by the Drug Policy Alliance documents the extent of the problem: drug overdose is now the second-leading cause of accidental death in America, surpassing firearms-related deaths. Many of those affected are young people. Among teenagers there has been a steep rise in misuse of prescription drugs. A December 2008 survey of high school seniors reported that more than 15 percent of high school seniors reported using prescription drugs for non-medical reasons. But it's not just young people who are dying of overdoses: overdose is the number one injury-related killer among adults in Michael Jackson's age group: 35-54.

This spike in overdose deaths is almost entirely attributable to increasing numbers of people overdosing on legal, prescription drugs; overdose deaths from heroin and other illegal drugs have leveled off in many places as a result of harm reduction efforts. Most of these drugs are opioids, which can include both opium-derived drugs like morphine and codeine, and synthetics like Oxycontin and Vicodin, both of which were allegedly used by Michael Jackson, and Demerol, with which he reportedly was injected just before he died. Other commonly prescribed opioids include Percodan and Percocet. Some of the drugs involved in overdoses have been diverted to the black market and sold illegally, while others are obtained through legal prescriptions. Pain patients can misunderstand their doctors' instructions and accidentally exceed their prescribed doses of painkillers.

But in Michael Jackson's case, if it was caused by an opioid overdose, his death might have been averted had people close to him had access to a simple and reliable antidote: naloxone, otherwise known as Narcan.

Naloxone, if administered to someone who has stopped breathing as a result of an opioid overdose, can reverse the effects of the overdose and restore normal breathing in two to three minutes. Naloxone has been used effectively in emergency rooms to reverse overdoses for over 30 years. Tens of thousands of lives could be saved if naloxone were more widely available and more people (including doctors, pharmacists and other health care professionals, as well as law enforcement professionals, many of whom are currently unfamiliar with naloxone), were trained in its use.

Cities with programs that increase the availability of naloxone, among them Chicago, Baltimore and San Francisco, have seen their overdose rates decline dramatically. New Mexico, which for years had a high number of deaths from drug overdoses, saw a 20 percent decline in such deaths after the state's Department of Health began a naloxone distribution program in 2001. Naloxone itself has no abuse potential, making it a good candidate for over-the-counter availability. If people who are prescribed an opioid were also be given a prescription for naloxone, with instructions for them and their caregivers on how to administer it, this spike in overdose deaths could be reversed.

But our country's drug war mentality prevents this safe and effective remedy from being made more widely available. Fear that doing so will encourage drug use causes the government to restrict naloxone's availability. This "abstinence only" mindset is the same one that for years has prevented the federal government from funding syringe exchange programs -- proven to reduce the spread of HIV, hepatitis C and other blood-borne diseases -- for injection drug users. Just as the "abstinence only" model has proven a failure at preventing unwanted pregnancy and sexually transmitted diseases, it has been a failure at reducing drug use or the harms associated with drug use. Rather than continuing these failed policies, we need evidence-based solutions to the problems of drug misuse and drug overdose.

Fortunately some attention is now being paid to the overdose crisis. A bill known as the Drug Overdose Reduction Act was recently introduced in Congress by Rep Donna F. Edwards (D-MD). The bill would create a federal grant program to provide cities, states, tribal governments and community-based groups with funding to prevent and reduce overdose deaths; task the Centers for Disease Control and Prevention with responsibility for reducing overdose deaths; commission studies on the efficacy of various strategies to reduce overdose deaths; and create a nationwide surveillance system for monitoring overdose trends. A Facebook group called Purple Ribbons for Overdose Prevention now has nearly six thousand members across the country and is growing daily.

Another part of the solution to the overdose crisis are "Good Samaritan/911" laws, which provide immunity from arrest and prosecution for drug use or possession to anyone who calls 911 to report an overdose. Many lives could be saved if friends of overdose victims weren't afraid of being prosecuted if the police are called to the scene. New Mexico last year became the first state to pass such a law, and similar legislation is now pending in several states.

We need to accept the reality that people will always use drugs, whether legal or illegal, prescribed or sold on the street, mood or performance enhancers, pain killers or stress reducers or sleep-enablers. We are a nation of drug users. We must learn how to reduce the harms associated with our drug use, including reducing the unconscionable and unnecessary number of deaths from overdose.

Jill Harris is the Managing Director for Public Policy at the Drug Policy Alliance.

Comments

[peanut]

The answer from every doctor for just about every medical problem is take more drugs. Back in February, I had a sport related injury to my lower back and was in agonizing pain for more than a month. It was a effort to just put on clothes. The medical doctors ( I saw both my internist and an orthopedic specialist) wanted only to prescribe drugs....muscle relaxants and pain killers. I refused to take the muscle relaxants since I know the effect they have on me. I did take over the counter pain killers and when I was desperate for sleep, I took Vicodan. However, I would cut the Vicodan in half because I wanted as little as possible in my system. I worked through the pain with chiropractic visits and physical therapy. I belong to a fitness center and would use the therapy and regular swimming pools to work through the pain. While the medical profession frowns on chiropractics as a form of "alternative " care, I got more relief from almost daily spinal alignments than from any drug. There was no "instant" relief and it took more than 2 months, for me to be pain free but I did it without loads of drugs in my body.

[Layman23]

Great article. Never knew about this before.

[Dorothy Swart]

"He practiced for hours" - uppers; after practice: downers. Same as Elvis with one exception: food. Any doubt?????

[RevRayGreen]

medical marijuana would save all the lives of those going down the road of opiate pain pill pushers........

[wltdnfaded]

I asked my husband last night, "Name me a list of celebrities who've died of drug overdoses in the last 3 years."

He said, "Anna Nicole Smith, Heath Ledger, Michael Jackson."

Then I said, "Name me one who's died of an ILLEGAL drug overdose."

He couldn't.

Makes ya think, don't it?

[marignymitch]

I think the overdose in Michael Jackson's media coverage is a bigger crisis.

[Rebecca Fischer]

Please note that the official cause of death for Heath Leger is due to a mix of drugs including Ambien.

[youknow]

All good ideas. Here is another one. BAN all drug commercials from Television. Newspaper ads and Doctors are sufficient for information. When I watch TV every 5 seconds (it appears) there is another drug commercial, ultimately making drugs the easy way out for everybody. And of course then there is that taboo subject of legalizing drugs. Oh my God then we will have the brightest of the brightest on our back.

[karinova]

Word to THAT!
I long for the good old days (the 1980s) when those ads were still illegal.
I just don't understand how they EVER thought it was a good idea to legalize them.
Misleading claims? Poor efficacy? Serious side effects? Whatever...!

The worst part of it is that I don't see them going backward.
When the FDA wises up and cracks down on it, you know what the drug makers are going to do?
Label their drugs as "homeopathic."
And keep right on hawking them on TV.

[Malkin71]

WHY are they advertising to me?

I can't write prescriptions, my doctor can. Don't worry, I know they are spending billions in pens and coffee mugs to advertise to my doctor, too.

Greed is the rot at the core of our society.

As long as we worship the ultra rich instead of asking them a lot of hard questions about how they got that much more....

[LadyXoc]

I watched Narcon save my father's life. He elderly and confused and couldn't remember when and if he'd taken his medication, and would brook no interference. A retired lawyer, he would never have deliberately abused prescription drugs. My children survived their adolescence, but two of their friends died of overdoses. Many of the teenage drug abusers whom they knew have gone on to become clean and live productive lives.

[felliott]

Gee, why does Michael Jackson's death our national Rorschach test?

I feel sorry for him and even cried, but I'm tired of every opportunist chiming in with his own agenda.

BTW, if you're going to speculate about medical causes for the man's death you ought to mention that he had a chronic often lethal illness associated with heart attacks, Lupus, but that's only if you want the appearance of legitimacy.

[karinova]

Slightly OT, but...
Many years ago I read a book about drugs in America. The most striking thing-- the thing I remember the most-- was a section on opioid (specifically, street heroin) overdose. Basically, it put for the idea that it's a myth. The classic image of heroin overdose is the guy who's died so suddenly that the needle's still in his arm. But in fact, opioid overdose is NOT fast; it can take an hour or more. And if naloxone is administered in that hour, the overdose is averted.

So the question the authors put forth was: What is that sudden-opioid-death syndrome that ki||s addicts so quickly that the needle is still in place? If it's not heroin overdose, what IS it? (They seemed to think it might have to do with mixing it with alcohol or other drugs?) And if we care so much about addicts, WHY DON'T WE FIND OUT? Why don't we warn them (and the general populace) about mixing drugs?

It's only going to become more of a problem...

[ianrthorpe]

Street heroin os cut so much it is often less than 10% pure. And that means the user has to inject a lot of crap to get enough heroin into them to get high. And that crap could be rat poison or who knows what. The dealers don't care. We have been warning users for years, they don't listen.

You make a good point but I don't think MJ would have been shooting up stuff bought on the street.

As with everything about Jacko in the past two decades there will be so many hangers on trying to make an easy dollar we will never get near the truth.

http://www.greenteethmm.com/career_in_substance_abuse.shtml

[karinova]

Right... MJ would not have been taking street heroin.
I admit it's slightly off-topic.

I bring this all up, though, because I don't think it's common knowledge that there is in fact an antidote for opioid overdose (naloxone). And even if it was, I'm not sure it's common knowledge what opioid overdose looks like-- we're used to the foaming-at­-the-mouth­, needle-han­ging-out-o­f-his-arm image, which is not accurate. (Whatever that is, it's not going to be fixed by naloxone.)

So basically, we've got a large and growing opioid-user population, but most of us don't know the basics. Street users think that all they need to worry about is overdose. Bystanders think that if you don't seize up and expire in 5 minutes, it's NOT an overdose-- and even if they recognize that it IS, they don't know what to do about it. And of course, nobody associates street heroin with oxycodone et al-- which is REALLY problematic, because a real overdose is much easier with Rx opioids (but potentially less deadly, what with the naloxone). Put it all together, and we've got a potential "overdose crisis" for sure.