More Misinformation on Ledger Death, Prescription Drug Misuse

Salon has just published a virtually data-free article which blames Heath Ledger's overdose death on patients' misunderstanding of pharmacology, busy doctors and pharmacists, and drug company advertising. But the research on similar cases suggests that it's writer and doctor Larry Zaroff who is misinformed-- both in describing the problem and in suggesting a solution.

To start, Zaroff cites CDC statistics which make it look as though medical overdoses are rising dramatically. Problem is, those numbers don't distinguish between addicts' overdoses and those caused by doctor or patient error: the studies which do look more closely find that the overwhelming majority of these deaths occur amongst people with a history of drug problems.

This leads into the article's next false assumption: that Ledger's death was due to medical error. You'd never know it from reading Salon's story, but the medical examiner determined that the actor's death was caused by drug abuse.

If Ledger had been an elderly woman with a history of chronic pain and no history of addiction, it would be entirely reasonable to suspect medical or patient error.

But statistically, young men are the highest risk group for addiction. Ledger himself admitted heavy drug use-- it is believed to be the reason why the mother of his child left him. And the way his death was handled by the person who found him made clear that something was fishy: if you find someone unresponsive and you think they have taken too much prescribed medication, you don't call friends and private security before you call an ambulance.

Further, in a climate where many doctors fear prescribing any pain medications to people with documented injuries and disorders, it would be extraordinary for a legitimate physician to prescribe one strong opioid-- let alone two-- to a man of his age without serious evidence of severe pain.

While Ledger was known to have severe insomnia and could have appropriately been prescribed a benzodiazepine for it (three were found in his body, along with the opioids), opioids are not prescribed for insomnia and there is no evidence that he had any condition for which they could legitimately be used. The fact that no charges have been filed against any doctor so far suggests, too, that the medications were not legally obtained.

Zaroff goes on to describe a hypothetical situation in which someone "doctor shops" because she has become tolerant to drugs and sees multiple doctors for this "medical" problem. But this, again, does not fit what we know about prescription drug abuse.

You don't start seeing multiple doctors to get controlled substances-- which can be a crime-- if you find your painkillers and sleeping pills have stopped working. If you have nothing to hide, you see your regular doctor and ask for either higher doses, different treatment, referral to a specialist or help quitting.

Studies of people who abuse prescription pain medications find that the vast majority have prior histories of drug abuse and that pain patients do not turn into criminal addicts simply because they receive certain medications.

So, a young man in his twenties with a history of illegal drug use dies with five prescription drugs in his system: sorry, Dr. Zaroff, Occam's razor suggests that this is not a case of medical error, but of addiction.

And articles like this make matters worse. By trying to pretend otherwise, they scare doctors away from helping pain patients, stigmatize addicts because we can't bear to see an actor we like as "one of them," and obscure the best way to help prevent overdoses by giving a false picture of the way they most commonly occur.

Zaroff claims that the solution is a national database containing our most private medical information to allow doctors, pharmacists and police to check up on patients. But do we really want physicians, pharmacy staff and police pawing through our pain prescriptions, our anxiety diagnoses, our Viagra scripts?

And since addicts-- not patients-- are the problem, sacrificing everyone's privacy for this false form of security isn't going to solve it. Most prescription drug abusers obtain their medications from friends and family: not from doctor shopping. Most use multiple drugs: so cutting off the prescription opioids just leaves more room for heroin.

When will we start to use what we actually know about drugs to create sane policies?

Comments

[MotherWarrior]

Parents of young male drug addicts had a bad feeling as reports of Heath Ledger's death began unfolding last January. We couldn't know for sure it was a drug overdose, but the media blitz had all the red flags. We dreaded the toxicology report that would devastate his parents. They lost not only their child, but they would be faced with a different reality of the person they knew.
The Heath Ledger in the endless clips on TV was oddly familiar. Those of us who have lived with the disease of addiction in our children could almost sense the shame emanating from him in his interviews, the desire to escape and be someone else. His death was a reminder of what we all fear. We called our recovering and using sons to check on their whereabouts and tell them we loved them, in case it was our last opportunity to do so.
Heath was a stunningly gifted actor. But the truth is that all our drug addict children are brilliant actors. They don't want to hurt their parents nor do they want to be found out. We are the perfect audience since we do not want to believe that they are abusing drugs. We did not raise our kids to be drug addicts.
Two days after Ledger's death, in a pre-planned launch, the Partnership for a Drug-Free America and the White House Office of National Drug Control Policy announced a major new initiative to raise national public awareness alerting parents to the dangers of prescription drug abuse by our children. Teenagers all over the country have access to similar mixtures of prescription medications that killed Ledger"Oxycontin, Vidodin, Valium and Xanax--not because their family physician prescribed them, but because they have become a desirable commodity in their peer group and provide a new way to escape reality. They're not hard to get. Supply meets demand.
Maybe Heath Ledger's "accidental overdose" will finally convince people of the dangers of overdosing on prescription medications. Or maybe the particulars of his death will soon be forgotten and we will support each other in our denial that our kids are abusing drugs.
How can Heath Ledger be an addict when he was capable of such memorable acting roles and of earning so much money? We asked ourselves the same question when our children were holding down jobs and going to school, despite signs that they were using drugs. Then we became aware that our best friends, professional colleagues, waiters at our favorite restaurants, columnists at our daily newspapers, TV newscasters, our dry cleaners, therapists, and mechanics also struggled with drug abuse.
Addiction is a chronic illness that can generally be managed with proper treatment and care, but"as with hypertension, diabetes, and asthma--relapse is a part of the disease. We're beginning to understand some things about addiction"for instance that it is a no-fault brain disorder and that it is often accompanied by another diagnosis such as depression, anxiety, or bipolar disorder. We don't yet know why we are addicts or how to cure addiction. We only know that any one of us who has a child may one day face the same loss as Heath Ledger's parents unless we can, as individuals and a society, admit there is a problem, accept that addiction is a disease like any other medical disorder, and advocate for more resources for treatment of drug addiction.
Even now, we don't want to label Heath Ledger a drug addict. We don't have all the facts and never will. It's a bitter pill for a family to swallow. But it's not a pill that kills. Is anyone going to state the obvious? Heath Ledger was a drug addict. Let us not be ashamed that he was an addict. Let us be ashamed that we do not recognize the seriousness of drug abuse and offer more help to those who need it.
MotherWarrior blogs about adolescent addiction at motherwarriors.blogspot.com and is a member of the Parent Advisory Board of Partnership for a Drug-Free America (but does not speak for them)

[lizbunz]

I asked my doctor to tell me if you are addicted to marijuana is it better to use a vaporizer or just smoke joints? She told me they don't do "harm reduction" studies so she couldn't really tell me but she thought so. I still can't believe this. Instead of studying how we can help drug addicts, keep them safer if they are going to use, educate them as to how to treat an overdose so they don't die, make rehab affordable for actual humans... the government spends money on some "war on drugs". It isn't working, it hasn't worked and it isn't going to work. Prisoners in jail can get drugs. War not working and talented young people like Heath are dieing.

[OttoMann]

Good points. It seems, in this instance, people are bending over backwards to concoct scenarios whereby Heath Ledger comes off as a wronged innocent. Like blaming the bartender when the alcoholic drinks himself to death. Except, in this case, there might not have even been a "bartender." (i.e., the drugs might not have been prescribed to Ledger, if at all.)

[Guitarsandmore]

Perhaps addiction was the problem but it is just as likely that the doctor was trying different types of drugs to find one that agreed with the patient. You don't like this one? Let's try another one. That happens all the time. They don't ask you to take the first prescription back (maybe they should).

The other thing that happens is when you are taking a drug it also causes side effects that lead you to believe something else is wrong when in fact if you would just stop taking the drug the side effects would go away too. Instead people take more drugs to treat the side effects of the first drug.

It can get ugly. Just say no.

[Maia Szalavitz - Huffpost Blogger]

actually, it's not just as likely that the doctor was trying multiple drugs. doctors are not stupid and they won't prescribe like that for a young actor with the complaints he had. you just don't do that with controlled substances if you want to keep your medical license and stay out of jail.

[AreYouSerious]

I completly agree with you, and I can say myself I have told lies to different doctors to get different presecriptions (xanax from my psychiatrist, ambien from my GP, etc), also I can't even tell you how many young people I know who abuse the system to get medications from their doctors, a lie here to get adderall, a lie there to get pain killers, young people know how to abuse doctors to get what they want, its up to the patient to be honest about the prescriptions they are on, not the doctors.