The eulogies for pop superstar Whitney Houston have been delivered and she was laid to rest Sunday near her late father. The round-the-clock coverage of the 48-year-old singer following her Feb. 11 death will subside.
But Houston’s passing has already sparked widespread discussion on the dangers of mixing prescription pills, especially mixing medications with alcohol. Bottles of prescription pills were found inside Houston’s hotel room and are said to have included the anti-anxiety medication Xanax, the antibiotic amoxicillin for an upper respiratory infection, and the pain medication Ibuprofen. She was drinking champagne in the days leading up to her death, including at a pre-Grammy party in which she was photographed looking disheveled.
Official results from toxicology tests on Houston’s body are expected to take a month or more to release.
Whatever the report states, the message that emerged is clear: mixing drugs and alcohol can be deadly.
Nationwide, one person dies every 19 minutes of prescription drug overdoses, which works out to about 27,000 annually, a rate that now outnumbers deaths involving cocaine and heroin combined, reports the Centers for Disease Control and Prevention.
That’s an increase from 2008, when one or more prescription drugs were responsible for about 20,000 deaths. That year, opiate pain relievers like Vicodin, OxyContin and Percocet accounted for 14,800 deaths, an almost fourfold increase from 1999.
About half of the prescription painkiller deaths involved at least one other drug, including anti-anxiety drugs such as the popular Xanax and Alprazolam. Cocaine, heroin and alcohol also figure in the mix.
For instance, the stimulant cocaine, which raises blood pressure and can lead to stroke, heart attack and artery damage, often is chased with a Xanax tablet, a depressant, after a night of partying to come down from the high to coax sleep. Alcohol, also a depressant, is another popular counter to the jittery effect of coke.
“Someone who abuses cocaine and brings themselves down with the use of alcohol or Xanax have this additive effect of two depressants on the brain center that makes us breathe. You go into a coma and stop breathing and die,” warns Dr. Ihsan Salloum, director of the alcohol and drug abuse treatment program at the University of Miami Miller School of Medicine.
In 2010, more than 12 million Americans aged 12 and older used prescription drugs — whether prescribed directly or obtained via someone else’s prescription — for nonmedical reasons to attain a high many of these drugs can cause, not unlike cocaine. Sales of prescription drugs have tripled from 2000 to 2009, leading to the higher death rates. An average of seven people die every day in Florida as a result of prescription drug abuse, according to the Florida Department of Law Enforcement.
Dr. Sanjay Gupta, CNN chief medical correspondent, attributes the number of deaths to a perception that legal drugs are safe and the increased availability of prescribed medications.
“One is a perception issue. The perception is if you are prescribed medication given by a doctor, while it might not be a great idea to misuse it, it’s not going to kill you. Doctors say, ‘Don’t drink if you are taking this medication’ and it seems a courtesy warning. Whereas, a warning that a person dies every 19 minutes would be a stronger warning,” Gupta said in a telephone interview
“And the second is the number of medications being prescribed,” Gupta continued. “If you just look at the category of opioids, pain medications, given in a year, it’s enough that every adult could take one of these every four hours a day for a month. It’s staggering the number of medications out there. If you look at the data by the CDC, that’s gone up significantly between 2000 and 2009 — triple in that time. The population hasn’t tripled but the medications have.”
Dr. Charles Nemeroff, chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami, believes the problem exists on both ends.
“I think we under prescribe and over prescribe,” he said. “There are a lot of people who have chronic pain who don’t get the medications they need. On the other hand, sometimes these drugs are prescribed by physicians without giving it a lot of thought.”
Gupta and other medical experts say better precautions need to be put in place, such as an electronic monitoring system of pills for patients at all pharmacies. Doctors also need to better screen their patients and to look for signs of alcoholism before prescribing pills that mix improperly with drink or have an addicting nature.
“The checks and balances on the pharmacy side of things is woefully inadequate,” Gupta said soon after he conducted an investigative report in which he was able to fill multiple prescriptions for oxycodones. “I showed in 15 minutes I was able to get four different oxycodone prescriptions filled. If I could do it, a lot of patients can as well.”
The problem hits all age ranges. Adolescents often engage in drug parties by raiding their parent’s medicine cabinets for the high prescription drugs can give.
“Part of this education is parents need to know this can happen to you and to be cautious of what you have in the medicine chest and who your children’s friends are,” said Nemeroff.
Another risk group are the elderly, who often take multiple drugs prescribed by many doctors who don’t communicate with one another, warns Nemeroff.
“The elderly are not immune to alcohol abuse. They can still get the same phenomenon, a bit more accidentally, but it still happens. The elderly are more fragile and don’t have a lot of reserve. It’s a perfect storm,” Nemeroff said.
Effect on the body
The problem with misusing a depressant like Xanax, even when taken in isolation, is that it depresses the central nervous system and affects your heart rate, blood pressure and your drive to breathe.
“Alcohol is a central nervous system depressant on the higher critical functions. As you know, from recent hazing episodes, if you drink enough you can be so poisoned you stop breathing. It affects the respiratory centers of the brain that controls breathing. Certain medications have a similar effect, oxycodones or opiates for treating pain when used inappropriately,” said Nemeroff.
Ditto sedatives like Xanax, Valium or Klonopin.
When you combine the pills and mix in alcohol, Gupta said, the outcome is not a simple one-plus-one-equals-two situation but what’s known as an additive effect because of its physiological effect on the central nervous system. The particularly fast-acting Xanax boosts alcohol’s potency in the bloodstream. The major depressive impact of Xanax and alcohol can put a halt to respiration, coordination and mental processes. The breathing becomes so shallow the victim can pass out, or lapse into a coma, which could explain what happened to Houston when she was found submerged in the hotel’s bathtub.
“Another problem is that there are vast differences among individuals in how they metabolize and this is genetically determined,” Nemeroff said. “If you are a slow metabolizer the levels of the drugs you take end up being higher than someone who is a moderate or fast metabolizer. If, by some chance, you are unlucky enough to be a slow metabolizer and take two or three prescriptions and build up a high level in the blood and then drink alcohol, the combination could be lethal.”
Due to its fast-acting nature, Xanax is considered the most addictive of the anti-anxiety drugs.
“Addiction is considered a disease of the brain. It’s a complex sort of behavior and manifestation if you are using a drug for a long enough time and with a quantity — and it depends on the kind of drugs — it changes the brain in a fundamental way,” said Salloum. “Physically, these changes make people vulnerable to continued use.”
Think of this region of the brain, the medial forebrain bundle, as the reward target of the body that is activated whenever we engage in an activity that we perceive as pleasurable, such as eating and sex.
“We enjoy it, we’d like to do it again, it helps us survive and procreate,” Salloum said. “We enjoy the food and will eat it again. Enjoyable activity centers in the brain’s reward circuits. Addictive substances affect these substances and release dopamine. When we take a drug it makes the brain release dopamine in a disproportional quantity than any regular pleasurable activity. The brain is not built for this overstimulation so when people talk about drugs hijacking the pleasure centers of the brain, the natural reward doesn’t work anymore and people require super doses to feel any pleasure.”
But you don’t have to be an addict to make one mistake and have a problem. Many nervous flyers or those who like to sleep during flight mix a Xanax and a drink to calm down.
“Most of the people we are taking about are not addicts. Some of the people watching TV and reading columns think that’s a problem of addicts. ‘I take a drink and an Ambien but I’m not an addict.’ Most of the people who die are not addicts,” Gupta said.
Celebrities and mortals
Still, recent celebrity deaths involving prescription drugs like Playboy model Anna Nicole Smith, who died at the Seminole Hard Rock Hotel & Casino near Hollywood five years ago, actors Heath Ledger in 2008 and Brittany Murphy in 2009, and singer Michael Jackson in 2009, have raised the profile to a fever pitch. Jackson’s doctor, Conrad Murray, was recently sentenced to jail for his role in the Thriller star’s death.
But celebrity deaths as a result of prescription pill misuse date back decades, and include actresses Marilyn Monroe, Dorothy Dandridge, Dana Plato, and musicians Jimi Hendrix, Elvis Presley and Keith Moon.
Buck Winthrop, now an author in Los Angeles, was a publicist in South Florida in the 1990s who became addicted to prescription drugs after using street drugs. He says he finally was able to break free from all drugs in 2005.
“You get off ‘drugs’ like I did — Crystal, X, GHB, everything —and you are so mentally drained you need anti-depressants,” Winthrop said. “Then I had surgery after an accident so you get Vicoden from a doctor. You feel amazing, so, after the pain stops you say, ‘I’ll just take a half to get me through this event, with wine, just a touch.’ But then another half will make you feel even better. Then you need more.
“The point is you build up a little medicine chest of happy pills and it’s so alluring,” he continued. “I am off drugs, I made it,” Winthrop said.
“People just don’t understand that ‘medicine’ is actually more dangerous that street drugs because there is a casual feeling about their use. A doctor gave them to me so it’s OK so you take more. They are cheaper than street drugs. You shrug it off because it’s medicine and your doctor becomes your dealer
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