MJ 's death: Role of pain killers

The recent shocking death of the pop icon Michael Jackson at just 52 years , has drawn attention to the dangers of pain killer drugs. The autopsy report, just out, ruled out blockage of the arteries of his heart, and pointed to consumption of excess amounts of pain killer and other medications as the cause of his collapse. Reports suggest that he was on to as many as 7 drugs, comprising painkillers, muscle relaxants and anti-depressants, that made a deadly cocktail.

                 Pain killers or analgesics, are of 2 broad groups:

·         Narcotic: such as morphine, extracted from opium a product of the Poppy plant, or its “cousins” such as Pethidine (Demerol*), Hydromorphone (Dilaudid*, considered 8 times more potent than pethidine), codeine (Vicodine*), oxycodone, tramadol, pentazocine and others.  These are strong analgesics used for severe pain and have potentially serious side effects such as drowsiness, coma, respiratory failure, circulatory failure, shock and heart failure, apart from the strong potential for addiction and dependence. Many , such as pethidine, can be taken only as injections.

·         Non-narcotics: such as pracetamol (as in Crocin or Tylenol), aspirin, ibuprofen (as in Brufen), piroxicam (as in Pirox), and nimesulide (withdrawn from most countries). The commonest problem with these drugs is irritation and bleeding from the stomach.  They can also affect the liver and kidneys, but are not addictive and do not suppress breathing.

Apart from these side effects, pain killers can cross react with each other as well as with a large number of other medications. Hence “cocktails” are hazardous, as was with MJ.

                In addition, MJ was on alprazolam (a sleeping pill as in Alprax, Trika etc), chlorpheniramine (anti-allergic, that can also cause drowsiness), and on 2 anti-depressants, sertraline (as in Serta, Daxid) and paroxitine (Paxil), that added to the toxicity.  What probably precipitated his collapse was an injection of propofol, a drug that is used for general anesthesia; it causes total loss of consciousness and depresses breathing, and hence is supposed to be used only by anesthestists in a hospital set-up where artificial ventilatory support is available.

                Most of the narcotic analgesics are not available “over the counter”. How MJ had access to 3 of them (marked*) is not clear. What is most intriguing is how he managed to get his doctor to administer an intravenous dose of propofol, at his home!

                Irrational decisions are often taken by a depressed and confused mind. MJ was undoubtedly suffereing from depression and anxiety for which he was on medications. His financial losses and loneliness must have added to his frustration.  He was probably addicted to narcotics for quite some time, as the several injection marks on his body would suggest.  While the electrifying music of this musical genius will live on for many years, the story of his death should alert and remind us of the hazards of indiscrimate use of painkillers.

 As published inHT City Hindustan Times dated 5 july , 2009.