Ledger's Death Ruled Accidental

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Ledger's Death Ruled Accidental

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(CNN) -- Heath Ledger died from an accidental overdose of prescription medications including painkillers, anti-anxiety drugs and sleeping pills, the New York City medical examiner's office said Tuesday.

"Mr. Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine," the office said in a short statement.

"We have concluded that the manner of death is accident, resulting from the abuse of prescription medications."

Hydrocodone and oxycodone are painkillers. Diazepam is an anti-anxiety drug commonly sold under the brand name Valium; alprazolam is also an anti-anxiety drug, sold under such names as Xanax. Temazepam, sold under such names as Restoril and Euhypnos, is a sleeping agent, as is doxylamine.

Ledger died January 22 at an apartment in Lower Manhattan. The Oscar-nominated Australian actor, best known for his role as a stoic, closeted cowboy in the 2005 film "Brokeback Mountain," was 28.

An autopsy done on the actor January 23 was inconclusive.

In a statement released through Ledger's publicist, Ledger's father, Kim, said Wednesday: "While no medications were taken in excess, we learned today the combination of doctor-prescribed drugs proved lethal for our boy. Heath's accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage."


"Families rarely experience the uplifting, warm and massive outpouring of grief and support as have we, from every corner of the planet," his family added in the statement. "This has deeply and profoundly touched our hearts and lives. We are eternally grateful."

Ledger's family returned to Perth, Australia, Tuesday for the actor's funeral, according to The Associated Press. Arrangements were private.

Ledger had talked about his difficulty sleeping after back-to-back roles as a Bob Dylan persona in "I'm Not There" and the Joker in "The Dark Knight," the latter of which is due out this summer.

"Last week I probably slept an average of two hours a night," Ledger told The New York Times in November. "I couldn't stop thinking. My body was exhausted, and my mind was still going."

In the hours leading up to Ledger's death two weeks ago, a housekeeper, identified as Teresa Solomon, arrived at the apartment about 12:30 p.m., a police source with knowledge of the investigation said.

She saw Ledger lying on a bed face down with a sheet pulled up around his shoulders and heard him snoring, the source said.

Masseuse Diana Wolozin arrived at the apartment about 2:45 p.m. to give Ledger a massage, according to the police source. About 15 minutes later, when he had not come out of the bedroom and the door remained closed, she went in, saw him lying in bed and set up a massage table.

She shook Ledger, but he did not respond, so she used his cell phone to call actress Mary-Kate Olsen, a friend of Ledger's, in California, the source said.

Wolozin told Olsen that Ledger was unconscious, according to the police source.

Olsen reportedly told her that she would call private security people in New York.

At 3:26 p.m., Wolozin called 911 and told authorities Ledger was not breathing. While on the phone with dispatchers, Wolozin tried to perform cardiopulmonary resuscitation on Ledger, but he was unresponsive.

Emergency personnel arrived seven minutes later, according to the police source, at about the same time as a private security person summoned by Olsen.

The medical technicians performed CPR on Ledger and used a cardiac defibrillator, but their efforts were in vain and he was pronounced dead at 3:36 p.m. By then, two other private security people summoned by Olsen had arrived as well as police.

His former fiancée, actress Michelle Williams, has asked the public to respect the need for her, the couple's 2-year-old daughter, Matilda, and others "to grieve privately."

"My heart is broken," Williams said in a statement issued last week via her publicist. "I am the mother of the most tender-hearted, high-spirited, beautiful little girl who is the spitting image of her father. All that I can cling to is his presence inside her that reveals itself every day. His family and I watch Matilda as she whispers to trees, hugs animals, and takes steps two at a time, and we know that he is with us still. She will be brought up in the best memories of him."

Condolences poured in from Ledger's friends and co-stars.

"He was a wonderful guy, he was a wonderful actor, he had a wonderful future ahead of him, and I liked him," said actor Eric Roberts, who worked with Ledger in "The Dark Knight," the latest installment in the "Batman" series set to open in July.

Colleagues on Terry Gilliam's film "The Imaginarium of Doctor Parnassus," which Ledger had been shooting in England, said the actor apparently had been suffering from a respiratory ailment in the days before he died.

Christopher Plummer told Entertainment Weekly that Ledger had a "terrible, lingering bug in London, and he couldn't sleep at all. We all -- I thought he'd probably got walking pneumonia."
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Ledger's first American film was the teen comedy "10 Things I Hate About You" in 1999. He passed up several scripts before taking a role in the Revolutionary War drama "The Patriot" in 2000 and "A Knight's Tale" in 2001. He also played a supporting role in "Monster's Ball."

But Ledger was perhaps best known for his portrayal of Ennis Del Mar in "Brokeback Mountain," Ang Lee's film about two cowboys who had a secret romantic relationship. The role earned Ledger a best actor Oscar nomination.
link to cnn article

What's not clear to me is: Was he prescribed too many different meds, or did he take too much of them? Was this a mistake on the part of his doctor in prescribing stuff that can have different side effects, or did he just mix-and-match too many different meds?
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Post by Flagg »

Idiot.

Though he was sick, so that may have clouded his judgment.

Still... Idiot.
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Post by Broomstick »

Damn! How come this thread didn't show up when I searched for Health Ledger?
What's not clear to me is: Was he prescribed too many different meds, or did he take too much of them? Was this a mistake on the part of his doctor in prescribing stuff that can have different side effects, or did he just mix-and-match too many different meds?
A couple of different things could have happened.

1) He went to more than one doctor without fully disclosing everything he was taking and/or how much.

2) He went to one doc, who simply made a mistake and either didn't record medications/dosages properly, or failed to double-check records that were accurate.

3) While it is possible that someone might need such a cocktail of medications, Heath Ledger seemed awful young and healthy for such. Such mixtures must be very careful considered, measured, dosed, and monitored because, as in this case, while no one dose may be hazardous the combination may be lethal.

My Other Half, who is on multiple medications, frequently dumps the bottles into a bag, takes them to the doc, and says "here, this is what I'm taking". We do this for new doctors, as well as once a year to his usual doc as a review. Regular doc double checks his records as well, to make sure this is all adequately recorded and that incompatible things are not simultaneously prescribed. We include vitamins, supplements, and OTC's in that bag as well. We try, as much as possible, to have all prescriptions filled at just one location - that way, there is a complete medication list for the pharmacist to refer to. Doing that is part of the job of a pharmacist. We happen to have some excellent ones at the site we go to, all of whom know us by name, and who also double-check medications for compatibility and do not hesitate to phone the doctor for clarification or confirmation of anything. They are also very good at answering our questions and at issuing proper cautions - even those we may have heard before. The Other Half is subjected to blood tests every 3 months, as well as a doctor visit to monitor his health and medications. Done properly, multiple medications can optimize his health and maximize his comfort (although it never entirely eliminates his pain). Done properly. Done improperly it can kill you or make things much worse. I somehow doubt the young, less experienced (my husband has had health issues for 50 years), continent-hopping Mr. Ledger enjoyed such continuity of care. If it had, this might not have happened.

I also have to wonder while he was on multiple anti-anxiety meds, multiple pain killers, and multiple sleeping agents. Again, while it is possible for that to be an optimum strategy (my Other Half does have several painkillers, some for long-term pain and one for "breakthrough") it's very rare, particularly in the young and able-bodied. It makes me more inclined to think this was a case of multiple doctors that weren't fully aware of his medication load.
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Post by Spin Echo »

Broomstick wrote:Damn! How come this thread didn't show up when I searched for Health Ledger?
Heath, not Health ;)
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Post by Superman »

Elvis' heart failure in the 1970's was also probably due to what's called polypharmacy. This is what happens to addicts, and I wouldn't be surprised if Ledger had a history of daily substance use or has spent some time in rehab.
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Post by Broomstick »

Supposedly, Ledger had troubles in high school with "substance abuse". He might have had a relapse. It is a definite possibility.

I will also note that polypharmacy can occur with people who are NOT addicts. Particularly with some of the sleep aids, it is not unknown for people to take multiple doses or to combine drugs without being fully aware of what they're doing.

Performers are under enormous pressure to keep performing. World-class performers, which Ledger was rapidly becoming if he wasn't one already, frequently have a lot of money and, because of extended travel, more than one doctor prescribing for them. This is a dangerous combination whether addiction is involved or not.
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Post by MKSheppard »

Ha
Mr. Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine," the office said in a short statement.
Idiot.

Yes, lets medicate all our problems away!
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Post by Illuminatus Primus »

Anyone of those drugs are heavy, highly-addictive, easy-to-OD street drugs. All of them at once is madness.
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Post by Superman »

Broomstick wrote:I will also note that polypharmacy can occur with people who are NOT addicts. Particularly with some of the sleep aids, it is not unknown for people to take multiple doses or to combine drugs without being fully aware of what they're doing.
Anyone with common sense could see that I wasn't implying some type of absolute truth. And yes, accidental deaths from drug mixing happen, but are usually much more common among geriatric populations. When you have a younger guy like Ledger who dies suddenly, and drugs are involved, the odds of him being an addict or alcoholic increase significantly. That was my point.
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Post by Flagg »

MKSheppard wrote:Ha
Mr. Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine," the office said in a short statement.
Idiot.

Yes, lets medicate all our problems away!
It's the American way!

And I misspoke earlier:

Dead[i/] idiot. The best kind.

Now let's find out how he got them.
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Post by aerius »

Oxy & hydrocodone, 3 types of Benzodiazepines, and another drug which I'm not familiar with, yeah, that's some pretty heavy duty drugs there.
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Post by Flagg »

Superman wrote:
Broomstick wrote:I will also note that polypharmacy can occur with people who are NOT addicts. Particularly with some of the sleep aids, it is not unknown for people to take multiple doses or to combine drugs without being fully aware of what they're doing.
Anyone with common sense could see that I wasn't implying some type of absolute truth. And yes, accidental deaths from drug mixing happen, but are usually much more common among geriatric populations. When you have a younger guy like Ledger who dies suddenly, and drugs are involved, the odds of him being an addict or alcoholic increase significantly. That was my point.
To be fair, he was apparently quite sick at the time. I'm sure that didn't help any. Of course I have a hard time believing a doctor who isn't running an RX drug ring would prescribe all of those to one person. So it's either a case of a crooked MD or he went doctor shopping. He was clearly abusing RX drugs.

Each of those drugs listed is fucking powerful. I've been on a few of them, and I wouldn't dream of taking 2 of those in a combo, let alone those 6.
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Post by Superman »

aerius wrote:Oxy & hydrocodone, 3 types of Benzodiazepines, and another drug which I'm not familiar with, yeah, that's some pretty heavy duty drugs there.
Since benzos are basically downers, just mixing those is a really bad idea.
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Post by aerius »

Superman wrote:Since benzos are basically downers, just mixing those is a really bad idea.
No kidding, and taking hydro & oxycodone at the same time is not exactly good for you either. That's a hell of a lot of opiates.
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Post by Broomstick »

Superman wrote:
Broomstick wrote:I will also note that polypharmacy can occur with people who are NOT addicts. Particularly with some of the sleep aids, it is not unknown for people to take multiple doses or to combine drugs without being fully aware of what they're doing.
Anyone with common sense could see that I wasn't implying some type of absolute truth. And yes, accidental deaths from drug mixing happen, but are usually much more common among geriatric populations. When you have a younger guy like Ledger who dies suddenly, and drugs are involved, the odds of him being an addict or alcoholic increase significantly. That was my point.
Understood.

Which is why I pointed out that among the young and able-bodied it's an unlikely scenario. He was supposedly sick at the time, but "walking pneumonia" would not be treated with that cocktail. He didn't seem to have had a chronic illness to account for all those pharmaceuticals.

It could be addiction, incompetent doctoring, or more likely, both. It wouldn't be the first time a doctor or doctors helped someone down the merry road to addiction hell. These were, according to the reports, prescriptions - he didn't buy them off the street. SOMEBODY wrote those scripts.
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Post by Broomstick »

aerius wrote:Oxy & hydrocodone, 3 types of Benzodiazepines, and another drug which I'm not familiar with, yeah, that's some pretty heavy duty drugs there.
• Oxycodone -- narcotic/pain killer; trade names: OxyContin, Percodan
• Hydrocodone -- narcotic/pain killer; trade name (combined with acetaminophen): Vicodin
• Diazepam -- anti-anxiety drug; trade name: Valium
• Alprazolam -- anti-anxiety drug; trade name: Xanax
• Doxylamine -- sleep medication; trade name: Unisom
• Temazepam -- sleep medication; trade name: Restoril
Oxycodone and hydrocodone are both, as I assume most here know already, opiates. Oxycodone is a long-acting formulation which may be given for chronic pain, with hydrocodone used for "breakthrough" pain but that combination is normally only for people with chronic, debilitating conditions or something like cancer. My Other Half has, on occasion, been on multiple opiates but only with close monitoring and only temporarily (so far - hope it stays that way). I have seen nothing to indicate that Ledger suffered from anything that would justify these two drugs and if he had an addiction I suspect this was the core of it.

Diazepam and Alprazolam are benzos - both are, indeed, anti-anxiety drugs and both are definitely potentially addictive. They CAN be used with opiates, but again, only under very controlled conditions (one reason to do so would be to aid someone with chronic pain in getting to sleep without increasing the dosage of narcotics - obviously there are risks to either approach)

Temazepam is also a benzo. However, it tends to suppress respiration a little more than some others (according to my admittedly limited information). In which case, combining it with other drugs AND a possible lung infection/pneumonia makes it a definite risk. Opiates definitely increase this respiratory-suppression effect. Why a doctor would prescribe this for a patient taking two other benzos and opiates is beyond me - there are other sleep aids that probably do not pose as great a risk, especially in people with a history of substance abuse and/or emotional instability.

Doxylamine is actually an anti-histamine - but like many antihistamines it has significant sedative effects and so it is often used as a sleep aid as well as an anti-histamine (so is diphenhydramine, which is less sedating and more effective as an anti-histamine). It is an ingredient in OTC remedies such as NyQuil, and may be used for upper respiratory/lung infecitons. However, it shouldn't be mixed lightly with some of the other drugs he was taking.

So... he's taking two opiates, two benzos, a benzo that may be either anti-anxiety or sleep aid, and an anti-histamine used frequently as a sleep aid...? That sounds like two different doctors prescribing for a patient, or possibility more than two, and unaware of what the others are prescribing. That looks like an addict's doctor shopping to me.
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Post by Superman »

Broomstick wrote:It could be addiction, incompetent doctoring, or more likely, both. It wouldn't be the first time a doctor or doctors helped someone down the merry road to addiction hell. These were, according to the reports, prescriptions - he didn't buy them off the street. SOMEBODY wrote those scripts.
Right. Almost all of the opiate rehab patients I've worked with were easily getting prescriptions from multiple doctors. They're not hard to get; all one usually has to do is complain of chronic pain. Most internists and family practitioners aren't very well trained when it comes to screening for potential abuse; they see someone in pain and try to help. I don't blame them personally, I think it's really just time to implement better education on addiction for all physicians. Addictionology is a relatively new field after all.
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Post by Illuminatus Primus »

Another thing is an addict is not necessarily lying; they may also have chronic disease or pain, to say nothing of the result of their withdrawals. And opiates can entertain an addiction in many for a long time without dramatic and apparent effects; it isn't redneck-cooked crystal meth.
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Post by Superman »

Illuminatus Primus wrote:Another thing is an addict is not necessarily lying; they may also have chronic disease or pain, to say nothing of the result of their withdrawals. And opiates can entertain an addiction in many for a long time without dramatic and apparent effects; it isn't redneck-cooked crystal meth.
As odd as this sounds, I've yet to meet an opiate addict who doesn't have chronic back pain. The reasons aren't exactly clear, but one doc I've worked with explained that he believes it to be a specific withdrawal symptom. So, you're probably onto something there...
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Post by Broomstick »

My experience with opiate addicts is that during withdrawal they have exaggerated pain perception - stimulus that to a normal person is not painful or not consequential is interpreted by the opiate addict as extreme pain. We used to express it as "these people take heroin to kill the pain of a papercut". I would guess it's because the addiction messes up the pain perception/control system of the brain and nervous system. They didn't just complain of back pain, they complained of all sorts of pain in any location you care to name.
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Post by Knife »

Superman wrote:
Broomstick wrote:It could be addiction, incompetent doctoring, or more likely, both. It wouldn't be the first time a doctor or doctors helped someone down the merry road to addiction hell. These were, according to the reports, prescriptions - he didn't buy them off the street. SOMEBODY wrote those scripts.
Right. Almost all of the opiate rehab patients I've worked with were easily getting prescriptions from multiple doctors. They're not hard to get; all one usually has to do is complain of chronic pain. Most internists and family practitioners aren't very well trained when it comes to screening for potential abuse; they see someone in pain and try to help. I don't blame them personally, I think it's really just time to implement better education on addiction for all physicians. Addictionology is a relatively new field after all.
The only thing that will be a problem with that is the total subjectiveness of pain. While the lortab will work for some one with a toothache, another will be screaming in paing by the same affliction and will need percs.

I agree, Docs should be more aware of addiction of what are normal meds, but.......as long as a lot of pain is subjective and doctors try to manage pain; you'll have plenty of wiggle room for addicts to play with.
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Post by Superman »

Knife wrote:The only thing that will be a problem with that is the total subjectiveness of pain. While the lortab will work for some one with a toothache, another will be screaming in paing by the same affliction and will need percs.

I agree, Docs should be more aware of addiction of what are normal meds, but.......as long as a lot of pain is subjective and doctors try to manage pain; you'll have plenty of wiggle room for addicts to play with.
That's true, not to mention your average addict has a level of tolerance that requires amounts that could literally kill others.

To some extent, a screening process exists now. It's a matter of taking family history, recognizing high levels of tolerance, screening urine for amounts, paying closer attention to prescriptions (for example, having the patient come in for each one instead of sending him or her home with 3 pre filled scripts)... there are ways to determine who is at an increased risk for becoming an addict. But you're basically correct.
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Post by Broomstick »

Pain is not totally subjective - there are physiological changes such as elevated heart rate and blood pressure, changes in breathing pattern, changes in movement...

We are also just beginning to understand the genetic variations that lead to some people processing certain drugs - including painkillers - faster or slower than average. Then there are the kappa-opiates, which work in women but not in men for the most part.

However - since we all experience pain we are also all aware when a given person's perceptions are way out of whack, too. Getting a routine teeth cleaning, for example, should not require morphine.

My current doc will provide pain medication for chronic conditions, but makes drug testing a requirement. If there's too much, something he didn't prescribe, or not enough of what he did prescribe those are all warning flags.

Back at the clinic, we had addicts with legit medical problems that really did require medication. Such people had to be VERY carefully monitored, it would be cruel to deny an addict in pain relief from that pain but it is also quite obvious that there is enormous potential for abuse.
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KlavoHunter
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Post by KlavoHunter »

Illuminatus Primus wrote:Anyone of those drugs are heavy, highly-addictive, easy-to-OD street drugs. All of them at once is madness.
Madness?

This is Hollywood!

Seriously, why is anyone surprised when one of these stars dies from overdosing on too many drugs at once?
Superman wrote:As odd as this sounds, I've yet to meet an opiate addict who doesn't have chronic back pain. The reasons aren't exactly clear, but one doc I've worked with explained that he believes it to be a specific withdrawal symptom. So, you're probably onto something there...
Now that's the strangest thing, I have this friend who likes to abuse drugs, and he has a messed-up back after a car accident. and he especially likes opiates...



Anyways, this blows my "Sleeping pill accidental OD" theory out of the water. Granted, they ruled it an accidental OD, and sleeping pills WERE a major part, but my theory was that they were the only reason.
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Superman
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Post by Superman »

KlavoHunter wrote:Now that's the strangest thing, I have this friend who likes to abuse drugs, and he has a messed-up back after a car accident. and he especially likes opiates...
Surprise, surprise... and that's how he'll keep getting his refills.
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