“Our family sat together this morning with the Medical Examiner-Coroner’s Office and we were informed of their final analysis that Tom Petty passed away due to an accidental drug overdose as a result of taking a variety of medications.”
~ Wife Dana and daughter Andria Petty, on Tom Petty’s official website
On October 2, 2017, music legend Tom Petty passed away after earlier being found unconscious and unresponsive in his Malibu home. The original cause of death was listed as cardiac arrest. Petty was 66 years old.
In a more-than-40-year, career, and his bands sold over 80 million records, and received such honors as a star on the Hollywood Walk of Fame and an induction into the Rock and Roll Hall of Fame. But behind the scenes, Petty struggled with serious health problems, debilitating chronic pain, and heroin addiction.
Drug Abuse and Stardom: A Too-Frequent Combination
“In certain professions where there is high stress there is a greater proclivity to people using alcohol or drugs to get rid of that kind of stress. Part of what may be happening in some people is there is this sense of invulnerability, they have this high profile, visible profile and other people give them all this acclaim, and there is a sense that nothing bad can ever happen to me.”
~ Dr. Joseph Strand, Harvard Medical School
Unfortunately, however, Tom Petty’s tragic story is not at all unique in the entertainment industry. With depressing regularity, there are seemingly always new reports of yet another celebrity succumbing to the disease of addiction—whether by overdose, disease, fatal accident, or suicide.
But what makes successful celebrities so vulnerable to the hazards of alcohol and drug abuse?
After all, they seemingly have it all—wealth, fame, adulation, and glamorous lifestyles that make the rest of us jealous.
Yet despite the outward appearance and all the trappings of a successful “perfect” life, celebrities are just as susceptible to addiction as everyone else. In fact, their professional triumphs may even help contribute to the problem, especially when their money and influence gives them a false sense of entitlement and invulnerability.
As a result, many celebrities will surround themselves with people who will cater to their every whim -assistants, drivers, servants, and even their own personal physicians.
To illustrate this, let’s take a closer look at three music superstars whose deaths were all eerily similar -Tom Petty, Michael Jackson, and Prince.
Prescription Drug Abuse: Medically-Assisted Overdose?
“Tom had a history of heroin addiction. Unfortunately, it makes all the sense in the world. If someone has a history of opiate abuse and then they’re using fentanyl, you are dancing with the devil.”
~ Dr. Howard Samuels, expert on celebrity addiction
On January 19, 2018, the Los Angeles County Department of Medical Examiner-Coroner concluded that Petty had in fact died due to an accidental overdose of prescription medications, including:
- Despropionyl fentanyl
(These last two are illegal analogs of fentanyl)
- Alprazolam/Xanax—prescribed for anxiety
- Temazepam/Restoril—given to treat insomnia
- Citalopram/Celexa—an antidepressant
Of special relevance, 6 of these 7 drugs were central nervous system depressants. This means they negatively affected higher rate, blood pressure, and especially respiration. Individually, both opioids and benzodiazepines are dangerous, but combining the two types of medications can be deadly.
In fact, according to Dr. Larissa Loukianova, who serves as the Medical Director for the Mayo Clinic’s Comprehensive Pain Rehabilitation Center, “Patients taking both benzodiazepines and opioids have a 15-fold increase in risk of death, compared with those who are not taking those medications.”
Similarly, when Michael Jackson died of an overdose in 2009, he had a cocktail of drugs in his system:
- Propofol—a powerful surgical anesthetic
- Lidocaine—another anesthetic
- Midazolam/Versed—a benzodiazepine sedative typically given for insomnia
- Lorazapam/Ativan—another benzodiazepine given for insomnia and anxiety
- Diazepam/Valium—yet another anti-anxiety benzodiazepine
- Nordiazepam/Nordaz—still another anti-anxiety benzodiazepine
Prince died in 2016, and reports soon surfaced that the singer had been misusing prescription opioids for years, including:
- Percocet—Six days before his death, Prince overdosed on this oxycodone-based opioid and had to be revived with Narcan.
- U-47700—an opioid nearly 8 times stronger than morphine
The deadly combination of drugs is the common thread—98% of fatal overdoses involve more than one substance.
A Word About Fentanyl—The Deadliest Drug in America
“Fentanyl was designed for cancer patients who are going to die.”
~Dr. Drew Pinsky, national-recognized addiction specialist
Fentanyl is an extremely-potent synthetic opioid. It is typically prescribed as a surgical anesthetic or for patients in severe chronic pain—end-of-life cancer patients, for example.
Fentanyl may be the most dangerous drug in the United States. There were 21,405 fentanyl-related deaths in 2016, more than DOUBLE 2015’s total of 9945, and almost seven times 2013’s total.
Like other opioids, fentanyl kills by causing respiratory depression, but far longer and to a much greater degree than other similar drugs.
A tiny dose the size of six grains of salt can kill a 200-pound man, and people with low body fat are particularly at-risk. To give that number more perspective, Petty weighed about 150 pounds, and Prince was only 112 pounds when he died. Both had fentanyl in their systems.
What You Need to Know about Propofol
“At the end Michael’s problem was Propofol, and that problem affects everyone — doesn’t matter if you’re famous.”
~ Quincy Jones, music producer
The drug most responsible for Michael Jackson’s death was propofol, a general anesthetic. In Jackson’s case, however, it was used as a sleeping aid. This was not at all in line with its intended use.
Propofol has an extremely narrow safety margin. It acts in under 60 seconds and can affect breathing even before the patient is unconscious. Proper dosing is extremely difficult and requires constant monitoring of the patient. Like Prince and Petty, Jackson was very small-framed, weighing just 136 pounds at the time of his death.
Significantly, Conrad Murray, the doctor who administered the propofol used equipment that is explicitly not recommended for constant monitoring.
Not surprisingly, propofol misuse also results in pleasurable side-effects, including:
- Alcohol-like intoxication
- Reduced inhibition
In fact, propofol’s effects are so profound, it is nicknamed “milk of amnesia”.
About the dangers of using propofol for sleep, Dr. Beverly Philip, a anesthesia professor with Harvard Medical School, had this to say—
“I have heard nothing about how he (Murray) had training to use the drug… This had nothing to do with the medical care of a patient… This is not a sleeping aid… With this drug in unskilled hands, this sleep was permanent.”
Polydrug Abuse—A Deadly Combination
“You definitely should not be using benzos with opioids. They’re both overused, and the danger of both together is way worse than the danger of opioids alone.”
~Dr. Gary Franklin, Medical Director, Washington State Department of Labor and Industries
Each of these three singers died while under the influence of multiple depressants—opioids and/or benzodiazepines. While these substances are dangerous enough on their own, they are even more hazardous when taken together.
- Respiratory depression manifests sooner and lasts longer.
- Users of both medications are at tripled risk of psychiatric hospitalization.
- They are also twice as likely to be given a prescription for emotional issues.
There is another consideration—alone, opioids are highly addictive and are often abused for their pleasurable effects. But of concern, benzodiazepine tranquilizers enhance opioid highs. For example, 3 out of 4 methadone patients say that “benzos” boost the effects of their daily maintenance dose.
Chronic Pain and Opioid Abuse—Does One Lead to the Other?
“Many people who overdose begin with a legitimate injury or simply do not understand the potency and deadly nature of these medications.”
~ The Petty Family
Researchers at Columbia University report that people in severe or chronic pain are 41% more likely to become addicted to prescription opioids than people who are free from pain. It is worth noting that each of these singers struggled for years with agonizing pain.
- Severe scalp burns suffered in 1984 during the filming of a Pepsi commercial
- The lingering effects of numerous plastic surgeries
- Injuries and degenerative conditions resulting from decades of choreographed performances.
- A 1997 stage accident
- In 2013, Dr. Barney Van Valin testified that years before his death, Jackson had a bulging disc in his lower spine and exhibited the “classic symptoms of lower back pain”.
- Reported hip replacement in 2010
- Ankle problems
- Sheila E., Prince’s onetime fiancé, believes that years of performing in high-heeled shoes caused the damage, and says, “He was in pain all the time…”
- Knee problems
- A fractured hip—in their official statement, the Petty family said, “On the day he died, he was informed his hip had graduated to a full-on break, and it is our feeling that the pain was simply unbearable and was the cause for his overuse of medication.”
The common experience of severe chronic pain among these superstars relates to larger ongoing opioid epidemic. Dr. Nora Volkow, Director of the National Institute on Drug Abuse, writes that many doctors are not confident in their ability to:
- Safely prescribe opioids
- Detect opioid abuse
- Recognize an emerging addiction
- Talk to their patients about these issues
The Link Between Mental Illness and Addiction
“I honestly don’t think he is ready for this based on the continued physical weakening and deepening emotional state. There are strong signs of paranoia, anxiety, and obsessive-like behavior. I think the very best thing we can do is get a top Psychiatrist in to evaluate him ASAP.”
~ Kenny Ortega, Director of “This Is It”, in an email sent five days before Jackson’s death
At the time of their respective deaths, Tom Petty was taking both an anti-anxiety medication (Xanax) and an antidepressant (Celexa), while Michael Jackson was on three(!) different anti-anxiety benzodiazepines –Xanax, Valium, and Nordaz.
The relationship between anxiety and addiction is mutually problematic, because each disorder is partially caused by and partially causes the other. A third of all anxiety sufferers abuse drugs and/or alcohol, while a reciprocal third of all substance abusers suffer from anxiety.
Self-medication to alleviate anxiety symptoms is what typically leads to substance abuse and addiction. In at least 75% of cases, anxiety predates substance misuse.
Anxiety and depression are also intertwined. According to a 2001 study, up to 20% of Americans will see a doctor during a depressive or anxiety disorder. Even more significantly, approximately half of those patients also struggle with a comorbid secondary anxiety or depressive disorder.
In other words, if a person has one of these conditions, it is extremely likely that they have the other.
And there is also a strong connection between depression and addiction—having one disorder DOUBLES the likelihood of having the other.
How Insomnia Contributes to Substance Abuse
“He wasn’t looking to get high or feel good and sedated from drugs…This was a person who was seeking help, desperately, to get some sleep, to get some rest.”
~ Cherilyn Lee, a nurse-nutritionist who treated Michael Jackson
Both Jackson and Petty were taking benzodiazepine-class drugs for insomnia. In fact, an inability to sleep was supposedly the whole reason why Jackson was taking propofol.
But sleeping medications are extremely addictive and present a high risk of overdose, especially when combined with other drugs –95% of hospital admissions for a benzodiazepine overdose involve other substances. When you consider the amount of drugs that each singer was taking, the proof of that percentage becomes painfully obvious.
Apropos, the British Medical Journal published a study reporting a possible link between anti-anxiety or sleeping medications and early death.
According to the study, anyone taking three or more hypnotics a week has a risk of early death that is five times greater than someone who doesn’t use them. Even among people taking just 18 doses or less over an entire year, the risk of death is multiplied three-and-a-half times.
Professor of Psychiatry Scott Weich, of the University of Warwick, opines, “We have to do everything possible to minimize overreliance on anxiolytics and sleeping pills.”
Were the Warning Signs Ignored?
“I became increasingly more dependent on the painkillers to get me through the days of the tour.”
~ Michael Jackson in 1993, talking about his addiction to pain medication
One of the most glaring concerns about the deaths of Jackson, Petty, and Prince is the fact that they each exhibited warning signs of drug abuse but were still given dangerously-addictive medications, with little apparent supervision. Even with problematic personal histories, they were able to easily obtain more drugs.
- Jackson had an admitted history of painkiller addiction, and once even cancelled tour dates because of it.
- Petty battled heroin addiction in the 1990s.
- Just days before his death, Prince overdosed and had to be revived.
But each of them was still taking drugs with high potentials for abuse, addiction, and, tragically overdose.
Best Prescribing Practices
“A very close friendship between an addicted patient and a doctor is problematic. It makes it much easier for a patient to ask for drugs and it makes it more difficult for a provider to resist.”
~ Dr. Petros Levounis, drug addiction expert
Responsible prescribing practices dictate that patients with certain risk factors—personal/family history, mood disorders, lengthy prescriptions, etc.— be counseled and closely monitored. In such instances, alternative treatments should be explored.
For example, the Centers for Disease Control and Prevention recommends that opioid painkillers should only be given as a last resort, after other pain management options have proven ineffective. Even then, they should only be given at the lowest dose and for the shortest duration possible.
Likewise, sleeping medications are not recommended for long-term use. Doctors are advised to educate their patients about better sleep hygiene and practices that can alleviate what typically turns out to be short-term insomnia, rather than blithely writing prescription after prescription.
Worst Prescribing Practices
“Doctors can be attracted to giving special treatment to the stars… These are well-meaning doctors who don’t understand addiction.”
~ Dr. Pinsky
Dr. Murray is a perfect example of a problem prescriber. Among his errors:
- Treating Jackson’s insomnia with a medication that wasn’t approved for that purpose.
- Using propofol because Jackson requested it, not because it was medically necessary or appropriate.
- Administering the medication for which he had inadequate training.
- Failing to account for possible dangerous interactions between the different medications.
- Monitoring Jackson with improper equipment.
- Not calling 911 immediately
These deviations from the standard of care directly contributed to the death of Michael Jackson. Dr. Alon Steinberg, who was an expert witness at Dr. Murray’s involuntary manslaughter trial, says, “If any of those individual things would have been done, this would not have happened, but there were multiple mistakes made.”
There is supposition that Murray was afraid to tell Jackson no, because denying the singer his nightly dose of “milk” would mean the end of his lucrative $150,000 per month job.
Similarly, Prince was being seen by his own personal physician, rather than receiving needed services at a nearby premium treatment facility. That degree of separation and professional detachment may have made a lifesaving difference.
Even Petty, who died of “multisystem organ failure…due to mixed drug toxicity” was prescribed the medications that ultimately killed him.
Three people at extreme risk of prescription misuse, each prescribed potentially-dangerous drugs with few-to-no safeguards in place, and each dying an avoidable death.
Dr. Pinsky says, “…we need to expose doctors more to what addiction is. Clearly, that goes for those who treat addicts. Unfortunately, if you just focus on the pain and not the setting, it goes bad for the patient.”
What Can We Learn from The Overdose Deaths of Celebrities?
“I think you’re going to come off as a cautionary tale rather than a romantic tale.”
~ Biographer Warren Zales, speaking to Tom Petty about the revelation of heroin addiction
There are a few important takeaways from the overdose deaths of famous people.
FIRST—Addiction can happen to ANYONE, regardless of any outward signs of success.
NEXT—Prescription drug dependence, misuse, and addiction are involuntary. Even legitimately-obtained medications can hijack a person’s brain.
ALSO—Doctors should proactively and earnestly discuss the risks presented by the use of certain kinds of medications, especially for those who are particularly vulnerable to substance abuse. Whenever possible, alternatives should be explored.
FINALLY—NEVER ignore warning signs of substance abuse. Addiction is a disease that always worsens without intervention, even to the point of overdose and death. If you believe someone close to you is misusing drugs or alcohol, try to get help for them immediately. Don’t delay. Tomorrow may literally be too late.
Prince’s death highlights that sobering fact.