Dr. Inaba talks about celebrities like Michael Jackson, and others who have died because of overuse and abuse of prescription drugs and alcohol … and the increasing international epidemic of prescription drug abuse.
Transcript of podcast (click to listen):
CNS: Looking under addiction and substance abuse today, and a lot of talk about Michael Jackson and a Purple Fall. Do you know much, much about that? Diprivan is the trade name, I guess.
Darryl: I think were looking at, lets start with your 2009 and the number of celebrities who have died to prescription drugs or overdose of prescription drugs, is pretty dramatic, but I dont know if its more greater or any less than, than previous years a, because this always seems to be an affliction of people in stardom, people in news – Keith Ledger, on top of his career like right in filming the end of batman ODs on prescription drugs and dies. And its not so much the specific drug thats involved, but the fact that there in every case a poly-drug situation that these celebrities are placed on just a huge array of different psychoactive drugs. The majority of them being some sort of depressant, something thats going to make you sleepy, drowsy or numb your senses to pain or cause an anesthetic effect and that, thats what usually kills people, is that people go into respiratory arrest or some sort of cardiac problem that then leads to just a whole collapse of the body and they die. I think I was more shocked to find out recently that a President John F Kennedy was on a whole huge cocktail of different drugs before he was assassinated so that, that really causes one to think what is it about being in the news or being a celebrity that first causes the need for human beings to alter their states of conscientiousness and so many ways to deal with it and what is it about celebrities that prescribers primarily their immediate primary care doctors are so willing to place them on such heavy and, and a variety of medications that you never see them do on somebody whos not a celebrity.
CNS: Right. So what is that all about and why is it happening?
Darryl: Michael Jackson was not on just that one drug, he was on a variety of drugs and the combination of these drugs are usually at a minimum addictive, meaning they work together to increase the sedating effects of each other in proportion to their individual effects are but lots of time, or most of the time when theres usually a death involved the persons who are taking super addictive or super or drugs that potentiate each other so when you add one on one the answer is six or eight or ten; its just much greater than what you would expect.
CNS: Right and of course alcohol is always, being that potent poison that it is, the body always tries to grapple with that and then, you put these other things on top and, like you say it multiplies.
Darryl: Well, thats the amazing thing Howard, because a lot of these medications were, were started to be developed were less toxic you know especially with celebrities dying, Marilyn Monroe and things like that they, prescribers came under heavy scrutiny as, as Im sure this one will with Michael Jackson.
So what were they doing, what were they thinking, why were they giving them these types of medication, so there was this whole development of this family of drugs called benzodiazepines: valium, librium, quanopin, xanax, ativan, tranxene, halcyon, resterol and maybe couple dozen more thats in clinical practice today and, the reason that they were promoted and they were used so widely at first is because they had whats called a huge therapeutic index. When you take the lethal dose and you put that in a ratio or as a mathematical divider so you divide the lethal dose by its therapeutic dose. So usually if you get a huge number from that division that means that the drug is really, really safe. It means that, if a one milligrams give you the effects of drowsiness and 10 milligrams is the amount thats going to kill you, then its therapeutic index is 10 and thats a relative measure of the safety of the drug.
Strychnine for instance, the therapeutic index of strychnine is a one, meaning thats why its used as a rat poison. The amount of strychnine it takes to make you feel like cocaine or stimulated high is exactly that amount that will kill you. So, its not to same with all drugs, but, when valium was tested and it was released it was immediately prescribed a lot because its therapeutic index was like 770 meaning you had to take 770 times a 5 or 10 milligram dose that makes you feel sedated to kill you. So was tremendously safe but nobody looked at what youre saying what, what happens if alcohol enters the equation or if Vicodin enters the equation or if Darvon enters the equation or any other barbiturate or other sedative drug. Well as it turned out although its safe if you only took Valium, if you combine them with alcohol it totally smashed up that therapeutic index so a much smaller amount could kill you and if thats a lot of the problem we are seeing also with these celebrities and their drugs.
CNS: And of course its not just celebrities too; another thing in the news here today is prescription drug abuse rising at an alarming rate in the U.S. and I read the same story in Canada yesterday.
Darryl: Ive done several papers on that because the fact is this, this has been happening for about ten years and not just in the United States and Canada its, its a world wide phenomena its just that its a massive turn to abusing prescription drugs. Right now I think the reports out of Washington is that prescription drug abuse represents 40% of all of our drug problems in our United States. Its represents 80% of our emergency room admissions, 30% of our emergency room deaths, so prescription drug abuse is the thing that you know whats interesting you look at the use surveys, you look at the modern trend of the future and what the young people views as the predictor of where we are going and right now the abuse of prescription drugs like Vicodin, Oxycontin, are much greater in youth than abuse in of methamphetamine, cocaine, heroin, theyre, theyre actually when you combine all the different prescription drugs theyre, theyre really approaching a marijuana, and knocking marijuana as the most abused illicit drug of you know of youth in America. So this thing is happening and the question is, what comes about is why you know is, is prescription Vicodin any better than illicit heroin or opium or anything like that? Is prescription Adderall or Concerta or Ritalin any better than street methamphetamine or cocaine, well, why would, I dont think they are.
CNS: Well is the perception that a because theyre a, they come essentially from a doctor and a pharmaceutical company that makes them more safe and more legitimate?
Darryl: I think thats it and I think that in a back-handed or roundabout way its sort of an indicator that prevention finally is being successful in this country because for the last 30, maybe a hundred years, but certainly within the last 20-30 years theres been a real focus of prevention of highlighting the consequences and the dangers of illicit drugs, that the adulteration and the misrepresentation and the gaffling, the rip-offs and everything you get and then you got a MRSA (staph) from some drugs and youve got a flesh-eating bacteria from some other drugs – that because they are tracked on the street, has raised the awareness, I think, of everybody – that street drugs are non-reliable, unsafe and much more dangerous whereas if youve got a prescription drug at least theres some degree of certainty that its been monitored and has the right dosage form and its got at least the ingredient that they claim it has to have that doesnt take into account to tell you the truth the, the evolving drug problem that nobody seems to be monitoring yet, that maybe we might start looking at first and thats counterfeiting – that manufacturers that are able to stamp out any drug that looks just like any prescription drugs so they are going to end up with the same thing.
CNS: And thats part of what we see in the phenomena of the availability of prescription drugs on the internet, coming either from legitimate sources being resold or coming from over seas where they might well be counterfeit.
Darryl: And when theyre counterfeit theres no guarantee that they have to contain anything, I mean with Quaalude was a big thing, when Quaalude was a big a popular drug and then banded made it a controlled substance and so on and no longer manufactured in the United States next thing you know you saw counterfeit 11-7-14 and borgs and all the different methods and makes of Quaaludes that looked just like the original tablet but in fact were totally counterfeit and contained things like benadryl, pcp and a whole bunch of other drugs, so its a phenomenon that I guess the understanding of the dangers of counterfeit drugs have not been portrayed as well as the dangers of illicit to regular street drugs and its going to take a while for the general public to realize that maybe these things arent as, prescription drugs arent any safer than a street drugs but right now whether its a safety factor, maybe its availability I dont know maybe theres just a lot of it around like you said on the internet, states like Oregon who places within the top five of all categories of abuse of prescription drugs and the young, whos in the top four and adults, and the type of drugs and things like that. One cant help but think part of reason might be this state has a compassionate position on treatment of pain. This states wants practioners and providers to err on the side of over treating pain instead of under-treating pain rather than trying to seek a good balance and what that leads to is manipulation, doctor shopping all kinds of ways that people can get prescription drugs in seemingly legitimate ways but inappropriately to take much more to take themselves or to sell.
CNS: And then mixing them themselves, if you have multiple doctors you dont necessarily know what the, what the counter, what the, the, the co-occurring phenomena are.
Darryl: Right, Oregon actually has moved in that direction. The legislature just passed in this state a high risk drug monitoring system so any drug that has a high profile to be diverted and abused, say soma, vicodin, oxycontin is going to be a national, I mean a state wide data back, data bank where pharmacists can look into doctors, can look into and try and weed out people who shows up the same week at ten doctors offices getting prescriptions for vicodin for the same leg pain or something like that.
CNS: And maybe even more scary, what we are finding especially, maybe with the younger people is simply going into their parents or their friends parents or their friends bathroom and just kind of picking and choosing pills just based on the name and the color or whatever.
Darryl: You know I, this, this is so amazing I grew up in an area where your parents said, Well we are go to, you know, the Smiths house down the street they invited our family over for dinner, and you go, oh no I got a sore throat, I got a heart pain, you know, I got a headache, wed everything in the world to avoid that kind of boring situation. But now days its the opposite, kids cant wait to be invited with their parents to go out to dinner at their friends parents friends home because they, they call it farming, or grazing, theres a bunch of names that the kids have for it you immediately go to the bathroom open the medicine cabinet, go through what ever theyve got and some of these kids actually grab pills when they dont know what they are and take them anyway. To discover they take a birth control or something like that so it is a very, very dangerous practice but farming parties also include kids grabbing what ever they can, and getting together with other kids and then exchanging or sharing those prescription drugs so we, were in an era, you know, we should be concerned about meth and meth is still a problem in Oregon and we should be concerned about the rise of cocaine, the rise of heroin right now, its happening but by in large the biggest drug problems we have and, and the largest growth of our problems we have of this state and other states is prescription drug abuse.
CNS: And not likely to end soon, this story will continue I’m sure. Thanks Darryl
Darryl: Sure.
That wraps our pod for today. Thanks for visiting the CNS pod cast. Please check back soon for the next in the series and visit our website www.cnsproductions.com
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