Actor Heath Ledger's accidental death from a combination of painkillers and tranquilizers serves as a tragic reminder that taking multiple prescription drugs at once can have lethal ramifications.
Doctors and pharmacists call it polypharmacy, which simply means the use of two or more drugs at the same time.
In some cases, especially in people with many ailments, polypharmacy is necessary and usually safe -- as long as prescribers are familiar with the entire contents of the patients' medicine cabinet. But an autopsy found that Ledger had taken two narcotic painkillers, three benzodiazepine tranquilizers and an over-the-counter sleep aid -- a deadly combination, even in low doses.
Narcotics and benzodiazepines are controlled substances, whose manufacture, possession and use are regulated by the U.S. Drug Enforcement Administration. Ledger's toxicology report has triggered an investigation by the DEA's New York office, DEA spokeswoman Rogene Waite says.
The DEA is looking at "all kinds of issues related to the drugs themselves and whether there were any violations of the Controlled Substances Act," Waite says. "We know it's extraordinarily dangerous for people to try to self-medicate and to mix drugs that they may have in their medicine chest. It's like having a loaded gun."
It's not too hard to get multiple prescriptions for narcotics and benzodiazepines, says Thomas Lackner, professor at the University of Minnesota College of Pharmacy. "Patients will see one physician, get a (prescription), and see another," he says. "He might have gone to a pain clinic. He might have gone to a primary care physician, he might have gone to a psychiatrist," and the doctors may not know about one another.
Says Duke University pharmacology professor Cindy Kuhn: "Certainly, there are less-scrupulous doctors who will prescribe in patterns not healthy for patients. But sometimes the left hand doesn't know what the right hand is doing."
Some of the drugs might have been in Ledger's medicine cabinet for a long time, Lackner says. Also, he says, "benzodiazepines, even in a relatively healthy person, can cause memory problems." Ledger had taken three of them: Valium and Xanax for anxiety, and Restoril for sleep. It's possible, Lackner says, that Ledger forgot he already had taken one or two of the drugs and took a second or a third.
Pharmacists can play an important role in preventing prescription drug abuse, says Lori Brown, manager of clinical services for the Kerr Drug chain. "Pharmacists can't change prescribing patterns themselves, but they can make recommendations and work collaboratively with patients and physicians." Some patients get prescriptions filled at different pharmacies, she says, and assume one store knows what the other is dispensing. "Even two stores in the same chain don't necessarily have access to the same prescription information."
Perhaps Ledger had an underground source for the drugs, says Kuhn, who, before the toxicology findings became available, had assigned her students to figure out what killed him. "Right now we have no knowledge of where he got them."
Because Ledger's death was ruled accidental, she says, he probably did not take large doses of the drugs.
To see more of USAToday.com, or to subscribe, go to http://www.usatoday.com
??? Copyright 2007 USA TODAY, a division of Gannett Co. Inc.