Combined Drug Intoxication
Encyclopedia
Combined drug intoxication (CDI), also known as multiple drug intake (MDI) or lethal polydrug/polypharmacy
intoxication, is an unnatural
cause of human
death
. While it is sometimes reported as a simple "overdose
", it is distinct in that it is due to the simultaneous use of multiple drug
s, whether the drugs are prescription
, over-the-counter
, recreational, or some other combination. The reasons for toxicity
vary depending on the mixture of drugs.
CDI can occur with numerous drug combinations, including mixtures of over-the-counter (OTC) drugs, legally or illegally obtained prescription drugs, herbal
mixtures, and home remedies
. Ingestion of alcoholic beverage
s, in combination with other drugs, increases the risk of CDI.
The CDI/MDI phenomenon seems to be becoming more common in recent years. In December 2007, according to Dr. John Mendelson
, a pharmacologist
at the California Pacific Medical Center Research Institute
, deaths by combined drug intoxication were relatively "rare" ("one in several million"), though they appeared then to be "on the rise". In July 2008, the Associated Press
and CNN
reported on a medical study showing that over two decades, from 1983 to 2004, such deaths have soared. It has also become a prevalent risk for older patients.
and other hypochondriac behaviors are at an elevated risk of death from CDI. Elderly people are at the highest risk of CDI, due to having many age-related health problems requiring many medications combined with age-impaired judgment, leading to confusion in taking medications.
Recent veterans back from war and suffering from Post Traumatic Stress Disorder (PTSD) in combat are at risk of dying from CDI/MDI. Nine Veteran PTSD patients died from CDI/MDI in America in 2007. There are anecdotal reports of veterans dying from combinations of antidepressants, antipsychotics, and tranquilizers used in combination with OTC medicines like diphenhydramine
. While still a U.S. senator from Illinois, United States
President
Barack Obama
asked the U.S. Congress
to inquire about the safety of these drugs. There is an ongoing investigation of the matter.
and licensed medical doctor
, either an M.D. or D.O.
. Close association between prescribing physicians and pharmacies, along with the computerization of prescription
s and patients' medical histories, aim to avoid the occurrence of dangerous drug interactions. Lists of contraindications for a drug are usually provided with it, either in monographs, package inserts (accompanying prescribed medications), or in warning labels (for over-the-counter (OTC) drugs). CDI/MDI might also be avoided by physicians requiring their patients to return any unused prescriptions. Patients should ask their doctors and pharmacists if there are any interactions between the drugs they are taking.
and another painkiller, Percocet
, be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with paracetamol overdose and liver damage. These two drugs, in combination with other drugs like Nyquil
and Theraflu
, can cause death by multiple drug intake and/or drug overdose
. Another solution would be to not include Acetaminophen with Vicodin
or Percocet
.
was found dead from CDI with methadone
, sertraline
, and escitalopram
in his system, Anna Nicole Smith
also died from CDI/MDI, an autopsy detecting 11 drugs in her bloodstream. On March 12, 2009 California
State authorities under State Attorney General
Jerry Brown
indicted Smith's legal companion Howard K. Stern
and two physicians, Sandeep Kapoor and Khristine Eroshevich, for conspiracy to provide the drugs that led to her death. All three were released on bond. Stern was charged with conspiring to give mind altering drugs to a known drug addict (Smith). Both physicians faced loss of their licenses to practice medicine and may be fined or imprisoned. On October 28, 2010, Stern and Dr. Eroshevich were found guilty, but Kapoor was acquitted. Both convictions are on appeal.
n actor Heath Ledger
was found unconscious and died on January 22, 2008, in his SoHo
, New York City
, apartment; the toxicology
report concluded that the cause of death was "acute intoxication" resulting from "the combined effects of oxycodone
, hydrocodone
, diazepam
, temazepam
, alprazolam
, and doxylamine
" and "that the manner of [his] death" was "accident, resulting from the abuse of prescription medications or combine drug intoxication(CDI)
."
, which is completely different phenomena. The following list is for speedball
CDI/MDI deaths only. Victims must be using cocaine and heroin in combination or amphetamine with demerol. An upper and a downer combination can be called speedball death.
case of then-comatose Karen Ann Quinlan
(March 29, 1954 - June 11, 1985) made legal history in 1975 and 1976, stimulating public scrutiny of ethical and moral implications of her case. In 1975, after drinking gin and tonic
s at a party and then taking Diazepam
, Quinlan collapsed, suffered respiratory failure
and irreversible brain damage, and, after being taken to the hospital, lapsed into a persistent vegetative state
. After she had been kept alive on a ventilator for several months without improvement, her parents requested that the hospital discontinue such active care and allow her to die. The hospital refused, and the subsequent legal battles made newspaper headlines and set significant precedents. After the New Jersey Supreme Court
ruled in her parents' favor, Quinlan spent nine more years comatose in the hospital, before dying from pneumonia
in 1985.
Polypharmacy
Polypharmacy is the use of multiple medications by a patient, especially when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ....
intoxication, is an unnatural
Unnatural death
Unnatural death is a category used by coroners and vital statistics specialists for classifying all human deaths not properly describable as death by natural causes...
cause of human
Human
Humans are the only living species in the Homo genus...
death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
. While it is sometimes reported as a simple "overdose
Drug overdose
The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced...
", it is distinct in that it is due to the simultaneous use of multiple drug
Drug
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...
s, whether the drugs are prescription
Prescription drug
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...
, over-the-counter
Over-the-counter drug
Over-the-counter drugs are medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription...
, recreational, or some other combination. The reasons for toxicity
Toxicity
Toxicity is the degree to which a substance can damage a living or non-living organisms. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a substructure of the organism, such as a cell or an organ , such as the liver...
vary depending on the mixture of drugs.
CDI can occur with numerous drug combinations, including mixtures of over-the-counter (OTC) drugs, legally or illegally obtained prescription drugs, herbal
Herbal
AThe use of a or an depends on whether or not herbal is pronounced with a silent h. herbal is "a collection of descriptions of plants put together for medicinal purposes." Expressed more elaborately — it is a book containing the names and descriptions of plants, usually with information on their...
mixtures, and home remedies
Home remedy
A home remedy is a treatment to cure a disease or ailment that employs certain spices, vegetables, or other common items. Home remedies may or may not have medicinal properties that treat or cure the disease or ailment in question, as they are typically passed along by laypersons...
. Ingestion of alcoholic beverage
Alcoholic beverage
An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
s, in combination with other drugs, increases the risk of CDI.
The CDI/MDI phenomenon seems to be becoming more common in recent years. In December 2007, according to Dr. John Mendelson
John Mendelson
John Jakob Mendelson was a British Labour Party politician.Mendelson was educated at the University of London and became a university lecturer in political science...
, a pharmacologist
Pharmacology
Pharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
at the California Pacific Medical Center Research Institute
California Pacific Medical Center
California Pacific Medical Center is one of the largest private, non-profit, academic medical centers in Northern California. The Medical Center is a combination of four of San Francisco's oldest medical institutions: Pacific Presbyterian Hospital, Children's Hospital of San Francisco, Davies...
, deaths by combined drug intoxication were relatively "rare" ("one in several million"), though they appeared then to be "on the rise". In July 2008, the Associated Press
Associated Press
The Associated Press is an American news agency. The AP is a cooperative owned by its contributing newspapers, radio and television stations in the United States, which both contribute stories to the AP and use material written by its staff journalists...
and CNN
CNN
Cable News Network is a U.S. cable news channel founded in 1980 by Ted Turner. Upon its launch, CNN was the first channel to provide 24-hour television news coverage, and the first all-news television channel in the United States...
reported on a medical study showing that over two decades, from 1983 to 2004, such deaths have soared. It has also become a prevalent risk for older patients.
Risk factors
People who engage in polypharmacyPolypharmacy
Polypharmacy is the use of multiple medications by a patient, especially when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ....
and other hypochondriac behaviors are at an elevated risk of death from CDI. Elderly people are at the highest risk of CDI, due to having many age-related health problems requiring many medications combined with age-impaired judgment, leading to confusion in taking medications.
Recent veterans back from war and suffering from Post Traumatic Stress Disorder (PTSD) in combat are at risk of dying from CDI/MDI. Nine Veteran PTSD patients died from CDI/MDI in America in 2007. There are anecdotal reports of veterans dying from combinations of antidepressants, antipsychotics, and tranquilizers used in combination with OTC medicines like diphenhydramine
Diphenhydramine
Diphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
. While still a U.S. senator from Illinois, United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
President
President
A president is a leader of an organization, company, trade union, university, or country.Etymologically, a president is one who presides, who sits in leadership...
Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
asked the U.S. Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
to inquire about the safety of these drugs. There is an ongoing investigation of the matter.
Prevention
In general, the simultaneous use of multiple drugs should be carefully monitored by a qualified individual such as board certifiedBoard certified
Board certification may refer to:* Board certification, for physicians in an area of medical specialization.* Nursing board certification, for nurses who obtain additional specialty training....
and licensed medical doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
, either an M.D. or D.O.
Osteopathic medicine
Osteopathic medicine is a branch of the medical profession in the United States. Osteopathic physicians, known as DOs, are licensed to practice medicine and surgery in all 50 states and are recognized in forty-seven other countries, including most Canadian provinces.Frontier physician Andrew Taylor...
. Close association between prescribing physicians and pharmacies, along with the computerization of prescription
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
s and patients' medical histories, aim to avoid the occurrence of dangerous drug interactions. Lists of contraindications for a drug are usually provided with it, either in monographs, package inserts (accompanying prescribed medications), or in warning labels (for over-the-counter (OTC) drugs). CDI/MDI might also be avoided by physicians requiring their patients to return any unused prescriptions. Patients should ask their doctors and pharmacists if there are any interactions between the drugs they are taking.
Paracetamol / Acetaminophen deaths
On June 30, 2009 an FDA advisory panel recommended that VicodinVicodin
Hydrocodone/paracetamol is a combination of two analgesic products hydrocodone and paracetamol used to relieve moderate to severe pain...
and another painkiller, Percocet
Percocet
The combination oxycodone/paracetamol is a narcotic pain reliever used to treat moderate to severe acute pain, marketed by Endo Pharmaceuticals.-History:The U.S...
, be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with paracetamol overdose and liver damage. These two drugs, in combination with other drugs like Nyquil
NyQuil
NyQuil is a brand of over the counter medication which is intended to relieve various symptoms of the common cold. Because all of the medications within the NyQuil imprint contain sedating antihistamines, hypnotics, and/or alcohol, they are intended to be taken before sleep...
and Theraflu
Theraflu
Theraflu is a brand of over-the-counter cold and flu medicines from Novartis that contain different groupings of various cold and flu symptom medications. The original version of Theraflu contained Acetaminophen , Chlorpheniramine maleate , Dextromethorphan hydrobromide , and Pseudoephedrine...
, can cause death by multiple drug intake and/or drug overdose
Drug overdose
The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced...
. Another solution would be to not include Acetaminophen with Vicodin
Vicodin
Hydrocodone/paracetamol is a combination of two analgesic products hydrocodone and paracetamol used to relieve moderate to severe pain...
or Percocet
Percocet
The combination oxycodone/paracetamol is a narcotic pain reliever used to treat moderate to severe acute pain, marketed by Endo Pharmaceuticals.-History:The U.S...
.
Celebrity deaths due to CDI (or MDI)
Many celebrities have died from CDI/MDI, including:- Writer/actor/comedian Freddy SotoFreddy SotoAlfred Soto, Jr. was an American comedian, writer and actor. His stand-up comedy act focused primarily on his upbringing in a Mexican American household...
from fentanyl, alprazolamAlprazolamAlprazolam is a short-acting anxiolytic of the benzodiazepine class of psychoactive drugs. Alprazolam, like other benzodiazepines, binds to specific sites on the GABAA gamma-amino-butyric acid receptor...
and alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
; - Pro westling manager Elizabeth Ann Hulette aka Miss Elizabeth from alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
, temazepamTemazepamTemazepam is an intermediate-acting 3-hydroxy benzodiazepine. It is mostly prescribed for the short-term treatment of sleeplessness in patients who have difficulty maintaining sleep...
, oxycodoneOxycodoneOxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...
, hydrocodoneHydrocodoneHydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
and anabolic steroidAnabolic steroidAnabolic steroids, technically known as anabolic-androgen steroids or colloquially simply as "steroids", are drugs that mimic the effects of testosterone and dihydrotestosterone in the body. They increase protein synthesis within cells, which results in the buildup of cellular tissue ,...
s; - Child actress Anissa JonesAnissa JonesMary Anissa Jones was an American child actress known for her role as Buffy on the CBS sitcom Family Affair. She died from combined drug intoxication at the age of 18.-Early years:...
from cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, PCPPhencyclidinePhencyclidine , commonly initialized as PCP and known colloquially as angel dust, is a recreational dissociative drug...
, methaqualoneMethaqualoneMethaqualone is a sedative-hypnotic drug that is similar in effect to barbiturates, a general central nervous system depressant. The sedative-hypnotic activity was first noted by Indian researchers in the 1950s and in 1962 methaqualone itself was patented in the US by Wallace and Tiernan...
and secobarbitalSecobarbitalSecobarbital sodium is a barbiturate derivative drug that was first synthesized in 1928 in Germany. It possesses anaesthetic, anticonvulsant, sedative and hypnotic properties...
; - Pro wrestler Louie SpicolliLouie SpicolliLouis Mucciolo, Jr. was an American professional wrestler. He performed in Mexico under the ring name Madonna's Boyfriend, for the World Wrestling Federation as Rad Radford, and in Extreme Championship Wrestling and World Championship Wrestling in the 1990s as Louie Spicolli...
from carisoprodolCarisoprodolCarisoprodol is a centrally-acting skeletal muscle relaxant. Carisoprodol is slightly soluble in water and freely soluble in alcohol, chloroform and acetone. The drug's solubility is practically independent of pH. Carisoprodol is manufactured and marketed in the United States by Meda Pharmaceuticals...
, alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
, painkillers and lorazepamLorazepamLorazepam is a high-potency short-to-intermediate-acting 3-hydroxy benzodiazepine drug that has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant, antiemetic and muscle relaxant...
; - Hawthorne HeightsHawthorne HeightsHawthorne Heights is an American rock band from Dayton, Ohio, formed in 2001. Their line-up currently consists of lead-singer and rhythm guitarist JT Woodruff, lead-guitarist and vocalist Micah Carli, bassist and backing vocalist Matt Ridenour, and drummer Eron Bucciarelli...
guitarist Casey Calvert from citalopramCitalopramCitalopram brand names: Celexa, Cipramil) is an antidepressant drug of the selective serotonin reuptake inhibitor class. It has U.S...
, clonazepamClonazepamClonazepamis a benzodiazepine drug having anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties. It is marketed by Roche under the trade name Klonopin in the United States and Rivotril in Australia, Brazil, Canada and Europe...
and hydrocodoneHydrocodoneHydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
; - Actor Nick Adams from paraldehydeParaldehydeParaldehyde is the cyclic trimer of acetaldehyde molecules. Formally, it is a derivative of 1,3,5-trioxane. The corresponding tetramer is metaldehyde. A colourless liquid, it is sparingly soluble in water and highly soluble in alcohol. Paraldehyde slowly oxidizes in air, turning brown and producing...
and promazinePromazinePromazine is a medication that belongs to the phenothiazine class of antipsychotics. An older medication used to treat schizophrenia, it is still prescribed, alongside newer agents such as olanzapine and quetiapine...
; - Acid rockAcid rockAcid rock is a form of psychedelic rock, which is characterized with long instrumental solos, few lyrics and musical improvisation. Tom Wolfe describes the LSD-influenced music of The Jimi Hendrix Experience, Pink Floyd, The Doors, Iron Butterfly, Big Brother & The Holding Company, Cream,...
guitarist Jimi HendrixJimi HendrixJames Marshall "Jimi" Hendrix was an American guitarist and singer-songwriter...
from alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
and barbiturateBarbiturateBarbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
s; - Singer Elvis PresleyElvis PresleyElvis Aaron Presley was one of the most popular American singers of the 20th century. A cultural icon, he is widely known by the single name Elvis. He is often referred to as the "King of Rock and Roll" or simply "the King"....
had over 10 drugs in his system when he died. (The license of his physician, Dr. George C. NichopoulosGeorge C. NichopoulosGeorge Constantine Nichopoulos also known as "Dr. Nick" is a former American doctor, of Greek descent. He is best known as Elvis Presley's personal physician, and controversial due to the singer's longstanding and ultimately fatal abuse of prescription drugs.- Career :Born in Pittsburgh,...
was later suspended and then revoked after press reports from then-ABCAmerican Broadcasting CompanyThe American Broadcasting Company is an American commercial broadcasting television network. Created in 1943 from the former NBC Blue radio network, ABC is owned by The Walt Disney Company and is part of Disney-ABC Television Group. Its first broadcast on television was in 1948...
News reporter Geraldo RiveraGeraldo RiveraGeraldo Rivera is an American attorney, journalist, author, reporter, and former talk show host...
on 20/20.); - Lester BangsLester BangsLeslie Conway "Lester" Bangs was an American music journalist, author and musician. He wrote for Creem and Rolling Stone magazines, and was known for his leading influence in rock 'n' roll criticism....
from diazepamDiazepamDiazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
and propoxyphene; - Deep PurpleDeep PurpleDeep Purple are an English rock band formed in Hertford in 1968. Along with Led Zeppelin and Black Sabbath, they are considered to be among the pioneers of heavy metal and modern hard rock, although some band members believe that their music cannot be categorised as belonging to any one genre...
's Tommy BolinTommy BolinThomas Richard "Tommy" Bolin was an American-born guitarist who played with Zephyr , The James Gang , and Deep Purple , in addition to doing solo work...
from alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
and prescription drugPrescription drugA prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...
s and illegal drugs in combination; - David Anthony Kennedy, son of Senator Robert Francis Kennedy, from cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, pethidinePethidinePethidine or meperidine Pethidine (INN) or meperidine (USAN) Pethidine (INN) or meperidine (USAN) (commonly referred to as Demerol but also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil; Alodan; Centralgin; Dispadol; Dolantin; Mialgin (in Indonesia); Petidin Dolargan (in Poland);...
and thioridazineThioridazineThioridazine is a piperidine typical antipsychotic drug belonging to the phenothiazine drug group and was previously widely used in the treatment of schizophrenia and psychosis...
; - Singer Johnny O'KeefeJohnny O'KeefeJohn Michael O'Keefe, known as Johnny O'Keefe was an Australian rock and roll singer whose career began in the 1950s. Some of his hits include "Wild One" , "Shout!" and "She's My Baby"...
from combining several prescription drugs; - Steve ClarkSteve ClarkStephen Maynard Clark was an English musician, co-lead guitarist for the British hard rock band Def Leppard up until his death in 1991 due to a combination of alcohol and multiple prescription drugs...
of rock group Def LeppardDef LeppardDef Leppard are an English rock band formed in 1977 in Sheffield as part of the New Wave of British Heavy Metal movement. Since 1992, the band have consisted of Joe Elliott , Rick Savage , Rick Allen , Phil Collen , and Vivian Campbell...
from combining antidepressantAntidepressantAn antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
s, tranquilizerSedativeA sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
s and alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
; - Actor Lani O'GradyLani O'GradyLani O'Grady was an American actress and the sister of actor/musician Don Grady. O'Grady is best-remembered for her role as Mary Bradford, the eldest sister from Eight Is Enough.-Career:...
of Eight is EnoughEight Is EnoughEight Is Enough is an American television comedy-drama series which ran on ABC from March 15, 1977 until August 29, 1981. The show was modeled after syndicated newspaper columnist Thomas Braden, a real-life parent with eight children, who wrote a book with the same name...
from hydrocodoneHydrocodoneHydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
and fluoxetineFluoxetineFluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
; - Bridgette AndersenBridgette AndersenBridgette Andersen was an American child actress best known for her part in the title role of the 1982 comedy Savannah Smiles.-Early life and career:...
from alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
and multiple drugs; - Edie SedgwickEdie SedgwickEdith Minturn "Edie" Sedgwick was an American actress, socialite, model and heiress. She is best known for being one of Andy Warhol's superstars. Sedgwick became known as "The Girl of the Year" in 1965 after starring in several of Warhol's short films in the 1960s...
from barbiturateBarbiturateBarbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
s and alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
; - Dana PlatoDana PlatoDana Michelle Plato was an American actress notable for playing the role of Kimberly Drummond in the U.S. television sitcom Diff'rent Strokes.Plato appeared in over 100 television commercials as a young girl...
from carisoprodolCarisoprodolCarisoprodol is a centrally-acting skeletal muscle relaxant. Carisoprodol is slightly soluble in water and freely soluble in alcohol, chloroform and acetone. The drug's solubility is practically independent of pH. Carisoprodol is manufactured and marketed in the United States by Meda Pharmaceuticals...
and hydrocodoneHydrocodoneHydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
; - Actor/comedian Eric DouglasEric DouglasEric Anthony Douglas was an American actor who appeared in several movies and television shows and was also a stand-up comedian.-Early life and career:...
from alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
, hydrocodoneHydrocodoneHydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
and temazepamTemazepamTemazepam is an intermediate-acting 3-hydroxy benzodiazepine. It is mostly prescribed for the short-term treatment of sleeplessness in patients who have difficulty maintaining sleep...
; - Actor Heath LedgerHeath LedgerHeath Andrew Ledger was an Australian television and film actor. After performing roles in Australian television and film during the 1990s, Ledger moved to the United States in 1998 to develop his film career...
from toxic combination of prescribed drugs; - Michael JacksonMichael JacksonMichael Joseph Jackson was an American recording artist, entertainer, and businessman. Referred to as the King of Pop, or by his initials MJ, Jackson is recognized as the most successful entertainer of all time by Guinness World Records...
from propofolPropofolPropofol is a short-acting, intravenously administered hypnotic agent. Its uses include the induction and maintenance of general anesthesia, sedation for mechanically ventilated adults, and procedural sedation. Propofol is also commonly used in veterinary medicine...
and two other sedativeSedativeA sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
s; - Brittany MurphyBrittany MurphyBrittany Anne Murphy-Monjack , known professionally as Brittany Murphy, was an American actress and singer. She starred in films such as Clueless, Just Married, Girl Interrupted, Spun, 8 Mile, Uptown Girls, Sin City, Happy Feet, and Riding in Cars with Boys...
from multiple prescription drugs; - The RevThe RevJames Owen Sullivan , more commonly known by his stage name The Reverend Tholomew Plague, often shortened to The Rev, was an American musician, best known as the drummer for the American heavy metal band Avenged Sevenfold...
of Avenged SevenfoldAvenged SevenfoldAvenged Sevenfold is an American heavy metal band from Huntington Beach, California. Formed in 1999, the group consists of vocalist M. Shadows, lead guitarist Synyster Gates, rhythm guitarist Zacky Vengeance, bassist Johnny Christ....
from oxycodone, oxymorphone, diazepam, nordiazepam and alcohol. - SlipknotSlipknot (band)Slipknot is an American heavy metal band from Des Moines, Iowa. Formed in 1995, the group was founded by percussionist Shawn Crahan and bassist Paul Gray...
bassist Paul Gray from morphineMorphineMorphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
and fentanyl - New York RangersNew York RangersThe New York Rangers are a professional ice hockey team based in the borough of Manhattan in New York, New York, USA. They are members of the Atlantic Division of the Eastern Conference of the National Hockey League . Playing their home games at Madison Square Garden, the Rangers are one of the...
forward Derek BoogaardDerek BoogaardDerek Leendert Boogaard was a Canadian professional ice hockey left winger who played for the Minnesota Wild and the New York Rangers of the National Hockey League . He was of Flemish descent. Known primarily as a fighter and enforcer, his nicknames included "Boogeyman" and "The Mountie"...
from oxycodone and alcohol.
Anna Nicole Smith and Daniel Wayne Smith
In February 2007, five months after her son Daniel Wayne SmithDaniel Wayne Smith
Daniel Wayne Smith was the son of the model and actress Anna Nicole and Billy Smith. He infrequently appeared in his mother's E! Network reality TV show, The Anna Nicole Show...
was found dead from CDI with methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...
, sertraline
Sertraline
Sertraline hydrochloride is an antidepressant of the selective serotonin reuptake inhibitor class. It was introduced to the market by Pfizer in 1991. Sertraline is primarily used to treat major depression in adult outpatients as well as obsessive–compulsive, panic, and social anxiety disorders in...
, and escitalopram
Escitalopram
Escitalopram is an antidepressant of the selective serotonin reuptake inhibitor class. It is approved by the U.S...
in his system, Anna Nicole Smith
Anna Nicole Smith
In 1992 Smith was chosen by Hugh Hefner to appear on the cover of the March issue of Playboy, where she was listed as Vickie Smith, wearing a low-cut evening gown. The centerfold was photographed by Stephen Wayda. Smith said she planned to be "the next Marilyn Monroe". Becoming one of Playboys...
also died from CDI/MDI, an autopsy detecting 11 drugs in her bloodstream. On March 12, 2009 California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
State authorities under State Attorney General
State Attorney General
The state attorney general in each of the 50 U.S. states and territories is the chief legal advisor to the state government and the state's chief law enforcement officer. In some states, the attorney general serves as the head of a state department of justice, with responsibilities similar to those...
Jerry Brown
Jerry Brown
Edmund Gerald "Jerry" Brown, Jr. is an American politician. Brown served as the 34th Governor of California , and is currently serving as the 39th California Governor...
indicted Smith's legal companion Howard K. Stern
Howard K. Stern
Howard Kevin Stern is an American attorney, and a former domestic partner of the late Anna Nicole Smith. On September 28, 2006. Stern and Smith exchanged vows in a legally nonbinding ceremony in Nassau, Bahamas...
and two physicians, Sandeep Kapoor and Khristine Eroshevich, for conspiracy to provide the drugs that led to her death. All three were released on bond. Stern was charged with conspiring to give mind altering drugs to a known drug addict (Smith). Both physicians faced loss of their licenses to practice medicine and may be fined or imprisoned. On October 28, 2010, Stern and Dr. Eroshevich were found guilty, but Kapoor was acquitted. Both convictions are on appeal.
Heath Ledger
AustraliaAustralia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
n actor Heath Ledger
Heath Ledger
Heath Andrew Ledger was an Australian television and film actor. After performing roles in Australian television and film during the 1990s, Ledger moved to the United States in 1998 to develop his film career...
was found unconscious and died on January 22, 2008, in his SoHo
SoHo
SoHo is a neighborhood in Lower Manhattan, New York City, notable for being the location of many artists' lofts and art galleries, and also, more recently, for the wide variety of stores and shops ranging from trendy boutiques to outlets of upscale national and international chain stores...
, New York City
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...
, apartment; the toxicology
Toxicology
Toxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms...
report concluded that the cause of death was "acute intoxication" resulting from "the combined effects of oxycodone
Oxycodone
Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...
, hydrocodone
Hydrocodone
Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
, diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
, temazepam
Temazepam
Temazepam is an intermediate-acting 3-hydroxy benzodiazepine. It is mostly prescribed for the short-term treatment of sleeplessness in patients who have difficulty maintaining sleep...
, alprazolam
Alprazolam
Alprazolam is a short-acting anxiolytic of the benzodiazepine class of psychoactive drugs. Alprazolam, like other benzodiazepines, binds to specific sites on the GABAA gamma-amino-butyric acid receptor...
, and doxylamine
Doxylamine
Doxylamine is one of the many sedating antihistamines used by itself as a short-term sedative, and in combination with other drugs as a night-time cold and allergy relief drug...
" and "that the manner of [his] death" was "accident, resulting from the abuse of prescription medications or combine drug intoxication(CDI)
Drug abuse
Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts...
."
Speedball deaths
Some controversially think speedball deaths are MDI/CDI when they might simply be drug overdoseDrug overdose
The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced...
, which is completely different phenomena. The following list is for speedball
Speedball (drug)
Speedball is a term commonly referring to the hazardous intravenous use of heroin or morphine and cocaine together in the same syringe. The speedball can also be taken by insufflation. The original speedball used cocaine hydrochloride mixed with morphine sulfate, as opposed to heroin...
CDI/MDI deaths only. Victims must be using cocaine and heroin in combination or amphetamine with demerol. An upper and a downer combination can be called speedball death.
- Layne StaleyLayne StaleyLayne Thomas Staley was an American musician who served as the lead singer and co-lyricist of the rock group Alice in Chains, which was formed in Seattle, Washington in 1987 by Staley and guitarist Jerry Cantrell. Alice in Chains rose to international fame as part of the grunge movement of the...
of Alice in ChainsAlice in ChainsAlice in Chains is an American rock band formed in Seattle, Washington, in 1987 by guitarist and songwriter Jerry Cantrell and original lead vocalist Layne Staley. The initial lineup was rounded out by drummer Sean Kinney, and bassist Mike Starr...
from cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
and heroin. - Baseball athlete Ken CaminitiKen CaminitiKenneth Gene Caminiti was an American third baseman in Major League Baseball and the 1996 National League Most Valuable Player. He was born in Hanford, California, and attended San Jose State University...
from cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
and opioidOpioidAn opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
painkillers; - Actor Trevor GoddardTrevor GoddardTrevor Goddard was an English actor. He played Kano in the first Mortal Kombat movie and Lieutenant Commander Mic Brumby on JAG.-Career:Goddard was born in Croydon, Surrey, England, in 1962...
from cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, heroin and temazepamTemazepamTemazepam is an intermediate-acting 3-hydroxy benzodiazepine. It is mostly prescribed for the short-term treatment of sleeplessness in patients who have difficulty maintaining sleep...
; - Actor/comedian John BelushiJohn BelushiJohn Adam Belushi was an American comedian, actor, and musician, best known as one of the original cast members of the NBC sketch comedy show Saturday Night Live, The Star of the Films National Lampoon's Animal House and the The Blues Brothers and for fronting the American blues and soul...
from cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
and heroin 'speedballSpeedball (drug)Speedball is a term commonly referring to the hazardous intravenous use of heroin or morphine and cocaine together in the same syringe. The speedball can also be taken by insufflation. The original speedball used cocaine hydrochloride mixed with morphine sulfate, as opposed to heroin...
' - Stand up comedian Mitch HedbergMitch HedbergMitchell Lee "Mitch" Hedberg was an American stand-up comedian known for his surreal humor and unconventional comedic delivery. His comedy typically featured short, sometimes one-line jokes, mixed with absurd elements and non sequiturs...
, also from 'speedballSpeedball (drug)Speedball is a term commonly referring to the hazardous intravenous use of heroin or morphine and cocaine together in the same syringe. The speedball can also be taken by insufflation. The original speedball used cocaine hydrochloride mixed with morphine sulfate, as opposed to heroin...
'; - Actor River PhoenixRiver PhoenixRiver Jude Phoenix was an American film actor, musician, and teen icon. He was the oldest brother of fellow actors Rain, Joaquin, Liberty, and Summer Phoenix.Phoenix began acting at age 10 in television commercials...
from heroin, cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
and methamphetamineMethamphetamineMethamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
; - Elisa BridgesElisa BridgesElisa Rebeca Bridges was an American model and actress. She was Playboy magazine's Playmate of the Month for December 1994, and Playboy's Video Playmate of the Month for September 1996. She appeared in several video productions from Playboy Home Video from 1996 to 2000. She also appeared as a...
from heroin, methamphetamineMethamphetamineMethamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
, pethidinePethidinePethidine or meperidine Pethidine (INN) or meperidine (USAN) Pethidine (INN) or meperidine (USAN) (commonly referred to as Demerol but also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil; Alodan; Centralgin; Dispadol; Dolantin; Mialgin (in Indonesia); Petidin Dolargan (in Poland);...
and alprazolamAlprazolamAlprazolam is a short-acting anxiolytic of the benzodiazepine class of psychoactive drugs. Alprazolam, like other benzodiazepines, binds to specific sites on the GABAA gamma-amino-butyric acid receptor...
; - Zac Foley of EMFEMF (band)EMF were an indie dance band from the United Kingdom. The band, from the Forest of Dean in Gloucestershire, came to prominence at the beginning of the 1990s. During its initial eight year run , EMF had released three studio albums and had gone on hiatus and reformed twice...
from multiple illegal drugs; - John KahnJohn KahnJohn Kahn was an American rock bass player. For a period of about twenty five years Kahn was Jerry Garcia's principal collaborator outside of the Grateful Dead.-Biography:...
, a Jerry Garcia collaborator and member of the Jerry Garcia BandJerry Garcia BandThe Jerry Garcia Band was a San Francisco Bay Area rock band led by Jerry Garcia of the Grateful Dead. Garcia founded the band in 1975; it remained the most important of his various side-projects until his death in 1995...
, from heroin, cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
and fluoxetineFluoxetineFluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
;
Karen Ann Quinlan
The Right to DieRight to die
The right to die is the ethical or institutional entitlement of the individual to commit suicide or to undergo voluntary euthanasia. Possession of this right is often understood to mean that a person with a terminal illness should be allowed to commit suicide or assisted suicide or to decline...
case of then-comatose Karen Ann Quinlan
Karen Ann Quinlan
Karen Ann Quinlan was an important figure in the history of the right to die controversy in the United States....
(March 29, 1954 - June 11, 1985) made legal history in 1975 and 1976, stimulating public scrutiny of ethical and moral implications of her case. In 1975, after drinking gin and tonic
Gin and tonic
A gin and tonic is a highball cocktail made with gin and tonic water poured over ice. It is usually garnished with a slice or wedge of lime, or lemon. The amount of gin varies according to taste...
s at a party and then taking Diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
, Quinlan collapsed, suffered respiratory failure
Respiratory failure
The term respiratory failure, in medicine, is used to describe inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation is known as hypoxemia; a rise in arterial...
and irreversible brain damage, and, after being taken to the hospital, lapsed into a persistent vegetative state
Persistent vegetative state
A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is...
. After she had been kept alive on a ventilator for several months without improvement, her parents requested that the hospital discontinue such active care and allow her to die. The hospital refused, and the subsequent legal battles made newspaper headlines and set significant precedents. After the New Jersey Supreme Court
New Jersey Supreme Court
The New Jersey Supreme Court is the highest court in the U.S. state of New Jersey. It has existed in three different forms under the three different state constitutions since the independence of the state in 1776...
ruled in her parents' favor, Quinlan spent nine more years comatose in the hospital, before dying from pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
in 1985.
See also
- Poly drug usePoly drug usePolydrug use refers to the use of two or more psychoactive drugs in combination to achieve a particular effect. In many cases one drug is used as a base or primary drug, with additional drugs to leaven or compensate for the side effects of the primary drug and make the experience more enjoyable...
- Drug interactionDrug interactionA drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind...
- Adverse drug reactionAdverse drug reactionAn adverse drug reaction is an expression that describes harm associated with the use of given medications at a normal dosage. ADRs may occur following a single dose or prolonged administration of a drug or result from the combination of two or more drugs...
- List of drug-related deaths
- PharmacovigilancePharmacovigilancePharmacovigilance is the pharmacological science relating to the detection, assessment, understanding and prevention of adverse effects, particularly long term and short term side effects of medicines...
External links
- Drug Interactions Checker at Drugs.com: Drug Information Online.
- Drug Interaction Checker at MedscapeMedscapeMedscape is a web resource for physicians and other health professionals. It features peer-reviewed original medical journal articles, CME , a customized version of the National Library of Medicine's MEDLINE database, daily medical news, major conference coverage, and drug information—including a...
(registration required).