Heath Ledger's Accidental Overdose - Discussion Thread (Was: Breaking News)

[Phillip Dampier]

So finally we know, it was an accident. What I don,t understand is, and forgive me for being dense, but HOW did all those combined drugs actually kill him? I mean did they cause him to have a heart attack, or just fall asleep and not wake up? Poor Heath.  

Many medications work synergistically when combined, occasionally amplifying their potency when combined.  But in this case, it is more probable that Heath built up a tolerance for the medications, especially Oxy and Hydrocodone, which means you have to take more of them to get the same effect.  Unfortunately, although you may achieve some symptom relief, the physical impact of the medications in their ever-growing dosages or combinations can have a cumulative devastating effect on your body.  In this case, it likely depressed his system sufficiently to cause his heart to stop.

[Jeff Wrangler]

"Me neither." And it would stand to reason that if he did indeed have a respiratory infection, there would have been strong antibiotics around. An early report said that antibiotics prescribed in England were found, but I guess that was false.

And apparently he wasn't taking any antibiotics at the time of his death.

So he might just have stopped breathing?

Yup.

Thanks, Leslie.

[Toast]

....

"Mr. Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine," medical examiner's spokeswoman Ellen Borakove said in a statement.

The drugs are the generic names for
the painkillers OxyContin and Hydrocodone,
the anti-anxiety drugs Valium and Xanax, and
the sleep aids Restoril and Unisom.

None of the drugs were taken in concentrations high enough to be lethal on their own, the report said, but the combination was deadly.

The actor was reported to have prescriptions from several doctors in the U.S. and the U.K.

Police said there were no illegal drugs in his apartment and no indications that he took his own life.
....


CBC.ca

[Phillip Dampier]

In other words--and this will not be popular on this thread at this time--Heath bears at least some responsibility for his own death.

I was thinking this. ... 

I think this depends on who gave him the medication.  If he was buying some of it off the street and it was not prescribed to him, then he does bear some responsibility here.  I am more sympathetic to people to develop a tolerance to medications or a dependence which leads them to some abuse of the drugs.  Again, big pharma has a vested interest in hiding the powerful physical addictions some painkillers have, and I don't blame people for prescription drug addiction.  If he took them in combination, as prescribed, I don't blame Heath at all.  I blame the prescription mills that some doctors practice, without tracking prior prescriptions.  It's a strong argument for a national tracking database doctors can use to track prescriptions, regardless of who prescribed them.

Good people die from prescription drug issues every day, so I am less interested in finding fault and more interested in finding ways to prevent future tragedies.

[Verona]

None of the drugs were taken in concentrations high enough to be lethal on their own, the report said, but the combination was deadly.

Which is why I wish they would not use the term "abuse." Abuse suggests that he took more than he was supposed to.

A very likely scenario: Heath went to different doctors (which is common for people who travel a lot), told them what he had been taking and said it didn't work for him, so they prescribed something different. The doctors may not have realized that he would keep taking the one he said didn't work anymore, so they didn't advise him about the interactions. So Heath, in his mind, had disclosed what else he was taking... but wasn't told they'd be dangerous to take together, so he assumed--as they were all both prescribed and disclosed--that they were all safe in combination.

This is what I choose to believe.

[Jeff Wrangler]

Good people die from prescription drug issues every day, so I am less interested in finding fault and more interested in finding ways to prevent future tragedies.

Sadly, this is very true.

All I meant to say was--he had all those meds in his system at one time because he took the pills.

[Meryl]

None of the drugs were taken in concentrations high enough to be lethal on their own, the report said, but the combination was deadly.

Which is why I wish they would not use the term "abuse." Abuse suggests that he took more than he was supposed to.

A very likely scenario: Heath went to different doctors (which is common for people who travel a lot), told them what he had been taking and said it didn't work for him, so they prescribed something different. The doctors may not have realized that he would keep taking the one he said didn't work anymore, so they didn't advise him about the interactions. So Heath, in his mind, had disclosed what else he was taking... but wasn't told they'd be dangerous to take together, so he assumed--as they were all both prescribed and disclosed--that they were all safe in combination.

This is what I choose to believe.

He probably believed what all of us would have thought, too.  That a young, strong, basically healthy man would not be in any real danger of succumbing to over-medication, especially when the drugs used were not seen to be particularly dangerous in themselves.

Quite often, unfortunately, people don't read the literature that accompanies prescription drugs, which contain warnings about interaction.  Also, not all interactions are documented.  There are infinite combinations possible.

[TOoP/Bruce]

Many medications work synergistically when combined, occasionally amplifying their potency when combined.  But in this case, it is more probable that Heath built up a tolerance for the medications, especially Oxy and Hydrocodone, which means you have to take more of them to get the same effect.  Unfortunately, although you may achieve some symptom relief, the physical impact of the medications in their ever-growing dosages or combinations can have a cumulative devastating effect on your body.  In this case, it likely depressed his system sufficiently to cause his heart to stop.

There were reports that some of his scrips were filled both here and abroad (I have no way of knowing if this is accurate).  When filling prescriptions, it is important to have all meds filled through the same pharmacy.  Pharmacies routinely screen for drug interactions and will alert a person or a physician when a particular combination is contraindicated.

[Phillip Dampier]

A close friend of mine died a few years ago of cancer.  During the latter stages, the district nurse would come in on a daily basis to administer painkillers.  He didn't have a home supply.  I honestly don't think my doctor would prescribe these under any circumstances.  

My mom, during the last six months of her life, was given enough painkillers for me to open my own drug house.  She was prescribed Oxycontin, Hydrocodone, Methadone (incredibly dangerous stuff), Morphine, and Fentanyl.  That is simply ridiculous, but it was what was needed to regulate and manage her pain.  As her cancer progressed, certain meds proved useless, and our family made the decision with the doctor to discontinue those and replace them with others.  So as the Oxy and Vicodin quit working, we tossed them out.  Morphine and Methadone proved to be an effective combination.  The Methadone came in a liquid suspension that resembled cough syrup.  We literally administered 1cc of that (a TINY amount).  If you mis-measured even by a small amount, you could easily kill someone.  Luckily, we got training to help administer the medications and we have a nurse in the family.  But all of these drugs could be obtained from a hospital pharmacy and, frankly, self administered.

The medical care industry in this country is cutting back on oversight and nursing care.  You are more and more on your own.  We were activists in my mom's care, so we pushed the doctors on medical issues, such as prompting the discontinuing drugs that no longer worked.  Most doctors do not do this... they just cumulatively add on more prescriptions, assuming that older ones will run out of refills or expire.  But as anyone with an older family member or relative can attest, the end result is often medicine cabinets overfilling with medications, and people taking 8, 10, or even 12 different drugs every day, with little or no periodic comprehensive review.  It sounds like Heath was also being handed a new pill everytime he went to a doctor.  Same problem.

I just hope more and more people will come to push for major medical reform in this country.  Everyone, including Heath, deserves better.

[moremojo]

Does anybody know or remember if the initial autopsy report said anything about pneumonia? They must have examined the lungs, but I don't remember reading anything about confirming that he had a respiratory infection at the time he died.

Christopher Plummer speculated that Heath had "walking pneumonia" in London; apparently, he was showing signs of respiratory illness while there.

However, it is my understanding that there was actually no sign of pneumonia from the autopsy. My coworker told me this, and stressed that pneumonia would have been easily detectable from a routine autopsy.

My coworker also offered the possibility that Heath may have been willfully abusing some of these prescription drugs, and that he didn't necessarily acquire all of them through doctors (in other words, some of them may have been obtained from the streets). Whatever the reason for the combination of drugs, my coworker definitely finds it extraordinary that so many powerful substances would have been found in combination. He says it was definitely a lethal cocktail, even though we can assume now that death was not consciously sought by anyone.