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Author Mel Pohl
Mel Pohl

You may have recently read about Las Vegas entertainer Danny Gans whose untimely death was caused by “acute hydromorphone intoxication” and “chronic pain syndrome” according to the death certificate. The story is incomplete and may never be complete–but, clearly, this talented performer died as a result of taking a powerful painkiller, perhaps without a prescription.
Even more recently, pop superstar Michael Jackson died at age 50 in his Los Angeles home from cardiac arrest with the autopsy results pending at this time. News reports stated that he was taking “drugs from prescriptions acquired from multiple doctors.” Stories included information from “sources” stating that he took “straight morphine, Demerol and opiates like Oxycontin. He also takes Valium and Xanax.” Propophyl, a powerful anesthetic has also been implicated as a cause of his death. It would seem obvious from news reports that Mr. Jackson suffered from addiction.
Within the last year, we also lost Heath Ledger to an overdose of the opioid painkiller Oxycontin, anti-anxiety drugs Valium and Xanax, and the sleep aids Restoril and Unisom. And a year before that, Anna Nicole Smith overdosed and died on a combination of anti-anxiety medications and pain killers, specifically methadone.
I can only wonder how many others of lesser celebrity status have died from overdoses of these drugs.
There is an epidemic of prescription drug abuse in this country. The National Institute on Drug Abuse (NIDA) found in a 2003 survey of eighth, tenth, and twelfth graders that 10.5% of twelfth graders reported using Vicodin for non-medical reasons and 4.5% of twelfth graders reported using Oxycontin without a prescription in the past year. In 2006, 16.2 million Americans age twelve and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the year prior to being surveyed.
The Office of National Drug Control Policy Executive Office of the President reported in January 2008 that more teens abuse prescription drugs than any illicit drug except marijuana. In 2006, more than 2.1 million teens abused prescription drugs. Every day 2,500 youth (12-17) abuse a prescription pain reliever for the very first time. Sixty percent of teens (12-17) who have abused prescription painkillers first tried them before age fifteen with age thirteen being the mean age of first non-prescribed use of sedatives and stimulants. I have touched on but a few examples of this growing problem. If you would like to read more you can visit the National Institute on Drug Abuse (NIDA.nih.gov) or the Office of National Drug Control Policy (ONDCP.gov) websites.
These celebrity deaths are symptomatic of the effects of potent pain killers on individuals. Were they addicted? Were they addicts? We don’t have enough information to say. What I found intriguing and concerning is the implication that for them to be addicts would be such a terrible thing.
In Mr. Gans case, the coroner, Mike Murphy, seemed to go out of his way to state that “I want to make it very clear that this is not an issue of drug abuse,” again, as if this would be much worse than dying of the combination effects of taking a drug. This is a result of the stigma associated with drug abuse and addiction. Would his suffering be any less significant if he were an addict? In Michael Jackson’s case, we are reading that it was the fault of the doctor who prescribed the medication. We seem to be looking for someone to blame.
But what if there’s no one to blame? Addicts are sick–the disease is called addiction. It’s a brain disease and the symptoms of addiction are behaviors like being dishonest, fearful, and angry. Addicts display behaviors, which are often disturbing to the person’s well-being and to the people who care. But these behaviors are symptoms of an illness. Addiction is not a moral weakness, nor is it related to lack of will power or character. The disease of addiction is prevalent in our society–10-18% of the public are suffering and dying from it on a regular basis–from overdose, medical complication, accident, suicide, organ failure, or infections.
It seems to me that the media is suggesting that it’s ok to die from “chronic pain syndrome” but not from “drug abuse”–since drug abuse is much worse–something to be ashamed or embarrassed about.
The truth is that some people with chronic pain abuse drugs and others become addicted, usually inadvertently. No one starts using medications with the intent to become dependent or addicted–some people are “wired differently”–they take a medication, and without realizing, increase the dose in the face of increasing symptoms and decreasing function. The net effect is the drug works less well, life gets worse; they spin out of control and end up doing things that make matters worse. Combinations of drugs are added to treat the symptoms caused by the first drug. This is the spiral of addiction. The “loss of control” of the ingestion of mood altering substances defines the disease. It appears to be willful, but these drugs work in a part of the brain that ends up associating the drug with survival. People seek the drug with little regard for nourishment, relationships, and sleep. The drug takes over the “drive system” mediated by the chemical “dopamine” which is the main neurotransmitter in the brain’s reward system–and when it’s gone, the person craves the drug physically and emotionally.
We will never know exactly what happened to these folks leading to their deaths. We can speculate all day, but I think what’s much more important is that many more people are suffering from chronic pain, problematic drug use, and addiction. Because of the stigma associated with addiction, we are missing the chance to reach out and help them. I say, let’s devote our attention to the living.

Buty the Book! A Day Without Pain (Revised)

This blog post was written by Mel Pohl, MD, FASAM, author of the book, A Day Without Pain (Revised)