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 busy doctors and pharmacists, and drug company advertising.
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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?

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