The news yesterday that actor Heath Ledger died from a lethal combination of six different medications has raised new concerns about the hazards of overdoses among Americans with increasingly well-stocked medicine cabinets.
The New York City medical examiner ruled yesterday that Ledger's death last month was accidental, the result of "acute intoxication" from two prescription painkillers (oxycodone and hydrocodone); two prescribed anti-anxiety drugs (diazepam and alprazolam); and two sleep aids - one of them available over the counter.
As Americans turn increasingly to pharmaceuticals to treat their physical and emotional complaints, medical experts say, more of those drugs are being diverted and abused. Pharmacy experts say that is placing many more people at risk of death or injury due to accidental overdoses or potentially fatal drug interactions.
"It's a growing problem," said Steve Robertson, special agent for special affairs with the Drug Enforcement Administration.
"People seem to think that because prescription drugs are made in a lab, that they can't hurt you. Misuse of pharmaceuticals can be just as dangerous as so-called harder drugs. This case [Ledger's] is an example. ... It can cost you your life."
The DEA has joined the New York Police Department in investigating Ledger's death, to see if there was an illegal diversion of prescription drugs, Robertson said.
Ledger's death at age 28 has been deemed accidental by the medical examiner. But the combination of drugs he ingested evidently went far beyond any medical direction he might have received.
"A person would never be prescribed all these drugs at the same time. An opioid [painkiller] and benzodiazepine could have medical use, but never this number," said Dr. Andrew Coop, chairman of the Department of Pharmacy Sciences at the University of Maryland School of Pharmacy.
Such misuse of prescription medicines has been increasing in recent years, experts say, and the number of accidental poisonings and overdoses has grown apace.
The rising death rate has been driven mostly by narcotic painkillers and psychotherapeutic drugs, according to a 2006 study by the National Center for Injury Prevention and Control.
Researchers led by Dr. Leonard Paulozzi, a medical epidemiologist at the Centers for Disease Control and Prevention, found almost 20,000 people died in the United States in 2004 due to inadvertent drug overdoses and poisonings. That was a 68 percent increase from the 11,000 who died in 1999.
The misuse or abuse of prescription medicines is a huge problem in the U.S. The DEA estimates that nearly 7 million Americans are abusing prescription drugs - "more than the number who are abusing cocaine, heroin, hallucinogens, Ecstasy, and inhalants, combined. That 7 million was just 3.8 million in 2000, an 80 percent increase in just 6 years," according to a DEA fact sheet.
The drug agency says opioid painkillers cause more overdose deaths than cocaine and heroin combined. And nearly one in 10 high school seniors admit to abusing powerful prescription painkillers.
Yet many Americans don't see the hazard for what it is. Forty percent of teens and an almost equal number of their parents think abusing prescription painkillers is safer than abusing "street" drugs, the DEA says.
In Paulozzi's study, the sharpest increase in overdose deaths were those involving anti-anxiety and anti-depressive medicines, up 84 percent between 1999 and 2004.
But the category responsible for the most deaths was narcotic painkillers, legal and illegal. That category increased 55 percent. The DEA says hydrocodone is the most commonly diverted and abused controlled pharmaceutical in the U.S.
Abusers acquire the drugs by "doctor shopping," from illicit Internet pharmacies, by theft from stores, friends and family, or from drug dealers.
Both painkillers and the psychotherapeutic medicines can act to depress brain activity, suppress heart rate and respiration. In large enough doses, or in combination with alcohol or other drugs, they kill.
Certain drug interactions can do the same, or damage vital organs such as the liver or kidneys.
Paulozzi found that poisoning deaths - 95 percent of them due to drugs - are now the second-most-common cause of unintentional injury in the U.S., after motor vehicle accidents.
The death toll has climbed in tandem with an increased number of legitimate prescriptions being written for these drugs, he said.
"There has been a dramatic increase across the country in the use of painkillers to address pain," Paulozzi said. "And along with that there has been substantial abuse."
People with prescription drugs in their cabinets can get into trouble even without intentionally abusing their medications, Coop said.
"With modern pharmaceuticals there are numerous drug-drug interactions that can and do occur," he said. These incompatibilities are well-studied, and physicians and pharmacists can help protect people from them, but only if they're aware of everything the patient is taking.
Most pharmacies can tap into computer databases to flag potentially harmful drug interactions. And pharmacists are trained to ask patients what other medicines they're taking.
"They try and dig a little deeper and advise customers of potential dangers," said Jamie Miller, spokesman for Giant Food supermarkets, with 165 pharmacies in Maryland, Virginia, Washington and Delaware.
People who resume taking leftover medications without telling their doctor, for instance, may suffer a drug interaction with a new prescription, Coop said. Old drugs may also deteriorate.
"When taking a combination of drugs, it's essential to consult either your physician or your pharmacist," Coop said.
He also warned against importing drugs. "There's obviously a problem with counterfeit drugs," Coop said. "But if even if the drugs are legit, you don't know whether there will be drug-drug interactions with drugs you are currently taking."
Giving a child drugs prescribed for an adult is also risky. "Many of these drugs, their safety and efficacy isn't known in children," Coop said. "The way a drug biologically affects a child can be very different from the way it affects an adult. You need to talk to your pharmacist."
Alcohol, too, can have unexpected interactions with medicines.
"It can be a huge factor," Coop said. "Alcohol should not be taken with the benzodiazepines. That would increase the sedative properties ... [with] potentially dangerous effects."
Ditto for prescription painkillers. "You should not take alcohol with any medication," Coop said. "It's difficult, I know. But you can significantly impair ... the efficacy of the drug, or put yourself in danger of unintended consequences."
Over-the-counter medicines and certain foods can cause dangerous interactions with prescription drugs.
Antacids, for example, can have adverse interactions with oral asthma drugs or blood thinners, according to the Food and Drug Administration. Anti-nausea medicines, sleep aids, cough medicines and antihistamines can interact badly with prescription sedatives and tranquilizers.
frank.roylance@baltsun.com
meredith.cohn@baltsun.com