The results from Heath Ledger's autopsy came out today. Though the doses of the drugs have not been released, it appears that he died from combining drugs with similar effects rather than an overdose of a single drug:
Among the drugs found in Mr. Ledger's system were two widely prescribed narcotics: oxycodone, the main ingredient in the prescription drug OxyContin, and hydrocodone, the principal pain reliever in the prescription drug Vicodin.
Also in Mr. Ledger's system were three anti-anxiety medications: diazepam, the generic name for Valium; alprazolam, commonly known as Xanax; and temazepam, which is sold under the brand name Restoril and is often prescribed as a sleep medication.
The drug doxylamine was also found in his system. It is an ingredient in some over-the-counter sleeping pills, and is also marketed in some nonprescription cold medicines that contain decongestants.The medical examiner's office provided only the generic names of the drugs found in Mr. Ledger's bloodstream, so it was not known what forms of the drugs he took before he died. In a telephone interview, Ms. Borakove would not say how much of each drug turned up in Mr. Ledger's bloodstream. She said such concentrations were not normally made public, although the amounts are included in the information given to a person's family after an autopsy.
She also would not say whether any one drug had contributed more than the others to his death.
"It's the combination of the drugs that caused the problem, not necessarily too much of any particular drug," she said in the interview. "All these drugs have a cumulative effect on the body."
Mr. Ledger's father, Kim, released a statement through Mr. Ledger's publicist that said "no medications were taken in excess," echoing Ms. Borakove's comments about the medications' being taken together.
"We learned today the combination of doctor-prescribed drugs proved lethal for our boy," Mr. Ledger said. "Heath's accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage."
So let's take everyone's statements here at face value and assume that Ledger was taking each of these drugs as directed -- i.e. at the recommended dose.
Then there are only three explanations for Ledger's death as I see it:
- All of the prescriptions were given to Mr. Ledger by a single physician. If this is the case, there is some doctor out there who behaved with criminal negligence. I am not a physician yet, but I seem to remember a cautionary discussion in pharmacology about not mixing drugs with similar mechanisms of action. Ledger had not one but three benzodiazepine anxiolytics and two narcotics! All six of these drugs can be respiratory suppressants. I shudder to think of the physician who thought this mixture would be peachy-keen.
- The more likely situation -- at least I think -- is that these drugs were prescribed by multiple physicians. In that case, it is likely that the physicians involved didn't know he was taking the other drugs. This does not free those physicians from responsibility -- you are supposed to probe deeply into any patient's medication history, and this goes double for potential addicts who are likely to lie about poly-pharmacy -- but it does make it easier to understand how he could get drugs with the same actions. You can argue back and forth about whether the doctors involved could have reasonably known whether Ledger was an addict. It also is a cautionary tale for anyone who plans on lying to their doctor. Be honest with your doctor about your medications, because mixing them can kill you.
- Ledger could have gotten one or all of these drugs by illicit means. This is another cautionary note: just because some drugs come from a drug dealer and some come from a pharmacist doesn't mean they can't interact dangerously.
Basically it boils down to whether you think it was one doctor who was wildly negligent or several who were misled -- or whether you think he was buying all this stuff on the street.
What is clear though is that all the mechanisms in medicine intended to prevent mixing potentially harmful medications broke down in this case. If I were the NY district attorney, I would want to find out who prescribed those medications.
Kevin, MD has a similar take.
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It doesn't take a brain surgeon to know you shouldn't mix prescription drugs and/or alcohol, especially if you don't know your tolerance level. If he was going to multiple physicians, he certainly knew enough not to disclose the other drugs he was taking. He was just another idiot, maybe with a death wish. As for all the hoopla, for God's sake he was just an actor, one without a long track record at that.
Ledger could not have been so dumb as to not guess that all the drugs he was taking could be dangerous. It is not hard to figure out that two drugs with similar effects could cause a summative effect or worse. He probably doctor shopped and perhaps even lied to get what he wanted. A doctor may even have specifically warned him not to mix his narcotics (they usually do). I think what is most likely is that his combination of drugs affected his judgement and, drowsey and confused, he forgot exactly what he had taken when.
Considering Heath works on various sets in differing cities on a regular basis, it's very likely that these were acquired from doctors in London, Australia, New York or Los Angeles. As I recall, Plummer, one of the actors working with Heath on his last film shoot in London, commented that Heath had seen a doctor on set, as recently as a week before his death, who gave Heath anti-biotics. Perhaps that doctor gave him something in addition to anti-biotics?
Patrick...why are you talking about mixing rx drugs and alcohol? Nowhere in his toxicology report does it indicate that they found cocaine, heroin or alcohol in his body. As a matter of fact, the police also confirmed that they did not find any illegal drugs OR ALCOHOL in Heath's apartment.
Sorry, have I missed something here? Where did it say that he was addicted to anything? I have known of people who get themselves in trouble by taking a prescribed drug, complaining to a friend that it's not working, and then accepting some of whatever the friend says is working for them. Sometimes they only find out that you shouldn't take X with Y when they return to consciousness in hospital. I'd like to know more before I decide whose fault this is (if indeed it's anyone's 'fault').
@Farne His wife said that he has struggled with addiction problems (that was why they broke up). Anyone struggling with insomnia who tries to solve it pharmacologically can get become dependent on (ie., addicted to) sleep aids -- especially people with a history of addiction.
Considering the whims of tolerance, it's possible that Ledger has taken this amount of stuff in the past and been fine. He was taking the drugs in a novel setting (someone else's apt.) which would lower his tolerance, and he may have been off the drugs for a little while, also lowering his tolerance.
Two narcotics, three benzos and doxylamine? This was a suicide attempt, and worked only too well.
I strongly disagree. I don't think it was a suicide attempt at all. The man had a beautiful daughter that he thought the world of and I don't think for a second that he would be so selfish as to leave her fatherless. As for any thoughts of him being an addict of any sort I haven't heard anything like that. From the research I have come across the medications were prescribed to him because he was having anxiety problems and nightmares from the filming of the new Batman movie where he played the joker. He states in an interview that playing that part had given him nightmares during filming and afterward. It seems that everyone is speculating and trying to make Ledger seem like the party-boy, drug addict, that everyone loves to watch in Hollywood. In reality he seems to be far from that. He seems to be a down-to-earth man who had his feet firmly on the ground. Not just another Lindsay Lohan. He loved his family and loved his job. He seems to be one of the few celebrities who acts because it is his passion, not for fame or fortune. If you ask me, he was just a normal man, a father, son, friend, and extremely talented actor, who was just trying to get some rest. Why do you think sleep aids are so popular? In this day in age, many people need help getting to sleep at night, whether it be stress or whatever, his reason was just a very intense movie role that was plaguing him. He just happened to take the wrong combination of pills and it had toxic results and because he is famous everyone wants to try and make it a big dramatic Hollywood crazy party story, or a grief-stricken suicide. If he was just some Joe Blow no one would think twice about it. It would just be another death due to medications. It happens all the time. I think he at least deserves the respect for people to not try and make him the bad guy in death just because it was unexpected. So for the sake of his daughter, his family, and his memory, QUIT SPECULATING!! Remember him for the talented man he was and not the deranged suicidal drug addict that SOCIETY is trying to make him out to be. The truth is, no one really knows the whole story. So why does it have to reflect badly on him? He was a great and very talented man, he died too soon in a tragic ACCIDENT, and left everyone heartbroken. End of story.
Sad part is, there are handfuls of people each day who die because of pharmacutical guidance or lack thereof. I dont see the media hussling and bustling out there best cameras and fancy paper spreads for the hard working every day man, woman, child. Its sad that he is dead and no one will EVER know as to why he took what he took in the manner in which he took it but there are worse things to be looped into rather than mourning for the loss of a heroin addicted, sleep aid needed, man who knew how to entertain us.
He is dead now but even more so famous than before. Give me a break!
A person has passed...let them to rest.