26 June 2009

Death on prescription

Michael Jackson's cardiac arrest may have been triggered by prescription medication abuse. Pill-popping addiction isn't confined to celebrities: it's a growing problem worldwide.

Rumours abound that Michael Jackson's fatal cardiac arrest was triggered by abuse of prescription medications. But pill-popping addiction isn't confined to celebrities: it's a growing health problem worldwide and in South Africa too.

Only hours after his death, a lawyer for Michael Jackson's family claimed the star was taking prescription drugs as he battled to get into shape for his gruelling concert comeback, and hinted this may have be the cause of the cardiac arrest which killed him.

Jackson allegedly fought long-running battles with prescription medication throughout his career, and was reportedly taking the drugs after suffering injuries during training for his comeback, attorney and spokesman Brian Oxman said. He told CNN he harboured concerns about Jackson's use of drugs, saying members of the star's entourage were "enablers" and comparing his case to the drug overdose death of Playboy centrefold Anna-Nicole Smith.

"This is not something that has been unexpected... because of the medications which Michael was under," Oxman said from the hospital where Jackson's family members had gathered. "I do not know the extent of the medications that he was taking but the reports we had been receiving in the family is that they were extensive," Oxman added. "When you warn people that this is what's going to happen and then it happens - where there's smoke there's fire."

Sadly, however, this abuse of prescription medication is not limited to celebrities and pop stars: it's something that is perceived to be a growing problem worldwide and even in South Africa. Many experts believe it is not given the attention it deserves, despite the fact that it seems to be a growing problem with celebrities - such as actor Heath Ledger who died from an overdose of prescription medication last year.

Between two and four percent of patients seen at specialist treatment centres (drug rehabs) between January and June 2007, had over-the-counter (OTC) or prescription medicines listed as their primary substances of abuse, according to the South African Community Epidemiology Network on Drug Use (Sacendu).

Middle-aged women most at risk
Their research also showed that the majority of these patients were female, and over the age of 40. In Gauteng women accounted for 68% of patients listing OTC drugs and prescription meds as their primary substances of substance. In the Western Cape this number grew to 72%. Research has shown that the average age of these women ranged from 39 to 44 years.

The researchers noted that these substances were also commonly used as a secondary drug of abuse.

The substances most abused included benzodiazepines, analgesics, codeine products and sleeping pills.

Commonly abused medications

Benzodiazepines, commonly referred to as tranquilisers, are often prescribed to people with anxiety disorders. Their effectiveness lies in the speed at which they work, but the downside is that sometimes a tolerance is built up by the patient, which means that the dose needs to be increased to deliver the desired effect. The risk of addiction is thus high.

Some of the more commonly used benzodiazepines include Valium, Librium and Xanor, which can be prescribed to treat anxiety, acute stress reactions, and panic attacks.

Side effects of the benzodiazepines are subtle and have been associated with mild cognitive impairment. Sudden discontinuation of benzodiazepines leads to marked symptoms of anxiety (in other words, they cause dependence).

Analgesics, also known as opioids, are often prescribed because of their effective analgesic, or pain-relieving, properties.

Some of the well-known drugs which fall into the analgesic category include morphine and codeine. These can be found in OTC/ prescription pain tablets and some cough medicines.

Opioid medications work by dulling the brain's perception to pain, and can produce drowsiness, cause constipation, and, in some cases, depending on the dose, slow down breathing. Taking too much of this form of medication can have dire consequences and even be fatal.

They should not be taken in conjunction with other substances such as alcohol, antihistamines, barbiturates, or benzodiazepines as these substances slow breathing. Their combined effects could lead to life-threatening respiratory depression.

How much of a problem is it in SA?

In a paper written for the South African Medical Journal, titled 'Over-the-counter and prescription medicine misuse in Cape Town – findings from specialist treatment centres', the prevalence and dangers associated with the abuse of such readily available medicines was discussed.

The study focused on 9 063 patients from 23 specialist substance abuse treatment centres in Cape Town between 1998 and 2000. It backed up the Sacendu finding that benzodiazepine medications were the most commonly abused and the drug for which most users required treatment. This was closely followed closely by analgesics.

This is in line with the global trend for abuse/ misuse of OTC/prescription medications.

OTC/prescription meds and alcohol
It was also reported that in 710 of the 9 063 cases recorded by specialist treatment centres in Cape Town, OTC/ prescription or unspecified medicines were listed as the primary or secondary substances of abuse.

Of these, 239 out of the 9 063 cases were primary cases of OTC/prescription misuse and in 471 of these cases, they were cited as secondary substances of abuse. In the latter group of patients, alcohol was found to be the primary substance of abuse with the OTC/prescription medication addiction secondary.

Researchers found this particularly worrying as 'the pattern of combining medicines with other substances is associated with serious health consequences such as coma and death'.

Why are OTC/prescription meds so popular?
As the statistics show, the use of OTC/ prescription medications is widely practised; possibly even more so than is reported at substance abuse treatment centres.

So what is the attraction? And why are benzodiazepines and analgesics so popular?

Apart from the fact that most OTC medications are relatively inexpensive, they are easy enough to obtain and are also not really perceived as an addictive drug – in other words, it is deemed more 'socially acceptable' than using say, heroin or dagga.

The fact that studies have shown that more women are prone to abuse OTC/prescription medication than men, may be explained by the type of drugs which are involved.

According to the SAMJ paper, benzodiazepines are most commonly used to treat anxiety and mood disorders – conditions which are particularly prevalent among women.

Benzodiazepines are also often used in conjunction with other drugs (such as alcohol) to enhance the effects of the primary substance, or to combat its effects by alleviating the withdrawal symptoms of the primary substance.

Analgesics, especially those containing codeine, are often used to relieve symptoms such as depression and anxiety, and induce a sleepy, relaxed feeling.

What's the harm?
Apart from the above-mentioned fact that excess use or blatant abuse of these medications can lead to addiction, there are many long-term side effects such as:

  • liver and kidney damage
  • heart and blood pressure problems
  • amnesia
  • irritability
  • confusion
  • increased aggression
  • cognitive difficulties
  • brain damage in severe cases.

What can be done?
There are a number of organisations equipped to deal with situations such as these and many of them also offer counselling to families and friends of the user.

LifeLine: or phone 0861-322-322

South African National Council on Alcoholism and Drug Dependence (SANCA):

Sources: Monitoring Alcohol and Drug Abuse Trends in South Africa, Alcohol and Drug Abuse Research Unit, Medical Research Council;
Over-the-counter and prescription medicine misuse in Cape Town- findings from specialist treatment centres, by Bronwyn Myers, Nandi Siegfried and Charles D H Parry;
National Institute on Drug Abuse, National Institutes of Health;

(Amy Henderson,, updated June 2009)

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Over-the-counter and prescription drugs


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