By CCHR International
Mental Health Industry Watchdog
June 8, 2017

Responding to Heath Ledger’s father’s recent call for government prescription drug oversight as well as the untimely death of singer Chris Cornell, the mental health industry watchdog, Citizens Commission on Human Rights, offers a free online psychiatric drug side effects search engine to better educate consumers and families about psychotropic drug risks.

The father of the late actor Heath Ledger, who died from an accidental overdose, has called for tighter rules on prescription drugs. Speaking at a scholarship fundraiser in his son’s name in Los Angeles on June 1, Kim Ledger said: “I think from a government point of view it would be great to see real-time monitoring systems in each country.”[1] This and the family of Soundgarden singer, Chris Cornell, recently questioning whether the anti-anxiety (or benzodiazepine) drug, lorazepam, contributed to his suicide on May 18,[2] prompted CCHR to strongly urge consumers, their families and primary care physicians to access its free online psychiatric drug side effects search engine as well as their executive summaries on psychiatric drugs risks.  The summaries and drug side effects database provide easily understood overviews of the most common adverse effects of powerful psychotropic drugs as reported to the Food and Drug Administration (FDA), as well as studies and international drug regulatory agency warnings about the drugs.

Heath Ledger (28) died of an accidental overdose on January 22, 2008, as a result of taking a lethal combination of prescription drugs that included three benzodiazepines: diazepam, temazepam and alprazolam. He was also taking two painkillers.[3] Ledger wasn’t taking the drugs for “psychiatric” reasons—like many, he used them to help him sleep and to handle a busy schedule. The night before he died, his sister Kate warned him, “You can’t mix drugs that you don’t know anything about.”[4]

As a mental health industry watchdog, CCHR says the public has a right to know all of the documented risks, including drug regulatory agency warnings, associated with psychiatric drugs, as too many are unaware of the risks until it is too late.  As Health Ledger’s father,  Mr. Kim Ledger stated, “The Government, health professionals and support services all need to realize that this isn’t something that happened to my son—it is happening to thousands of families across the country.”[5]

A toxicology test determined that lorazepam was in Cornell’s system at the time of his death. His wife, Vicky, said she spoke with him shortly before his death and said, “When he told me he may have taken an extra Ativan [lorazepam] or two, I contacted security and asked that they check on him.”[6] At his final stage performance, Cornell (52)  seemed “high” and “out of character from note 1,” lead sound engineer Ted Keedick stated and adding: “I’d never heard his voice that way before. He was having serious control problems.” However, Keedick said Cornell did not appear depressed.[7]

While the Medical Examiner said the “drugs did not contribute to the cause of death,” CCHR says that coroners are looking for physical causes of death and can’t determine the impact of the benzodiazepines, especially combined with other prescription drugs, on Cornell’s state of mind.

Lorazepam’s drug information warns of adverse reactions that include suicidal ideation/attempt, anxiety, agitation, confusion, disorientation, disinhibition and slurred speech, to name a few.[8] Dependence or tolerance can occur within just a few weeks of being prescribed a benzodiazepine. Cornell also had the barbiturate butalbital in his system.[9] Butalbital is most commonly found in combination with acetaminophen (e.g., Tylenol) in a drug called Axocet or in combination with both acetaminophen and caffeine (Fioricet). Both may be prescribed to relieve tension headaches. It is unknown which drug Cornell took that contained butalbital. However, even when combined with other drugs, butalbital can cause a “high” at certain dosages.[10] Barbiturates can be habit forming and adverse effects of butalbital and acetaminophen include agitation, fatigue, confusion, mental or mood changes, and a feeling of intoxication. Patients with a history of drug abuse require close monitoring while on the drug.[11] It is contraindicated among those who regularly ingest benzodiazepines.[12] Both butalbital type drugs can enhance the effects of sedative-hypnotics, which includes benzodiazepines or other central nervous system depressants.

For more information on Anti-Anxiety Drugs (Benzodiazepines)

CCHR also points to actor and comedian Robin Williams (63) who tragically committed suicide on August 11, 2014. The medical examiner found the antidepressant, mirtazapine and levodopa, a drug used to treat Parkinson’s disease, in his system.[13] Mirtazapine may cause mood or mental changes, including abnormal thinking, agitation, anxiety, confusion, feelings of not caring, suicidal ideation, and suicidal behavior among many other common and rare effects.[14] More common side effects of levodopa include “Abnormal thinking: holding false beliefs that cannot be changed by fact,” agitation, anxiety, and confusion.[15]

For more information on Antidepressant Drugs

The psychotropic drug industry in the U.S. alone represents an average of $31 billion a year. Between 2012 and 2016, non-discount spending on mental health drugs (antipsychotics and antidepressants) in the U.S. was nearly $102 billion, according to a Quintiles IMS Institute report. Add psychostimulant drugs and the figure is around $155.4 billion—or an average of $31 billion a year.[17]

CCHR is also concerned by how often prescription psychiatric drugs are abused and sold illicitly. In February 2016, researchers from the Albert Einstein College of Medicine in New York warned that benzodiazepine abuse is a growing problem in the U.S., with overdoses on the drugs increasing at a faster rate than prescriptions of them, suggesting people are using them in a riskier way over time. “Benzodiazepines have several known safety risks: in addition to overdose, they are conclusively linked to falls, fractures, motor vehicle accidents, and can lead to misuse and addiction,” Dr. Marcus Bachhuber, lead author of the study, told Reuters. Benzodiazepines typically used to treat anxiety or depression includes alprazolam, chlordiazepoxide, diazepam and lorazepam. The benzodiazepine clonazepam is also used for seizures, while oxazepam and temazepam are also used for insomnia.[18]

The Medical Examiners Commission of the Florida Department of Law Enforcement published a report in May 2017 on “Drugs Identified in Deceased Persons” in the state for the first half of 2016 (January through June). Benzodiazepines caused 632 deaths (including 355 alprazolam deaths).[19] In the benzodiazepines category, alprazolam and nordiazepam dominated. Occurrences of alprazolam increased by 26.1 percent (176 more) and nordiazepam increased in by 2.8 percent (9 more) compared to the first half of 2015. Alprazolam and nordiazepam were common as contributing to the cause of multi-drug deaths.[20]

In May 2017, IMS Health released the 2016 drug sales and prescriptions data for the U.S., showing “mental health” drugs (antipsychotics and antidepressants) were the third highest “therapeutic class” in prescriptions at 395 million prescriptions in 2016 (up five percent from 376 million in 2015). Sales of antidepressants and antipsychotics alone were $17.2 billion in 2016.[21] Between 1999 and 2013, U.S. psychiatric drug prescriptions, including sedatives, antidepressants, psychostimulants and antipsychotics, increased 117 percent from 197,247,557 to 427,837,506. During that same period, death rates from overdose of prescription psychiatric drugs climbed an astonishing 240 percent.[22]

For more information on Antipsychotic Drugs

The National Institute on Drug Abuse warns that people often think that prescription drugs are safer than illicit drugs, “but they can be as addictive and dangerous and put users at risk for other adverse health effects, including overdose….”[23] CCHR adds that without being fully informed of the adverse effects, a person may not even be aware of the mind-altering properties these drugs may have, citing other celebrity experiences.

Stevie Nicks went public about how after beating a cocaine habit a psychiatrist prescribed her a benzodiazepine. In a 2011 interview Nicks was asked about her “greatest regret,” and said: ““The only thing I’d change [in my life] is walking into the office of that psychiatrist who prescribed me Klonopin. That ruined my life for eight years,” she said. “God knows, maybe I would have met someone, maybe I would have had a baby.”   It took her 47 days in rehab to get off the prescription drug, which she said was harder than kicking cocaine.[25]

Rock star legend Ozzy Osbourne had been fighting substance abuse for decades when a physician prescribed 13,000 doses of 32 different drugs that included opiates, tranquilizers, amphetamines, antidepressants and antipsychotics during one year, which turned Osbourne into an incoherent, stumbling wreck. “I was wiped out on pills,” said Osbourne. “I couldn’t talk. I couldn’t walk. I could barely stand up. I was lumbering about like the Hunchback of Notre Dame.” The pills cost $58,000 and the doctor’s services $650,000, according to a Los Angeles Times interview with Osbourne in 2003.[26]

CCHR supports the need for greater prescription drug oversight and as a mental health industry watchdog is concerned about widespread psychotropic drug use is in the U.S. with 79 million Americans now taking some form of psychiatric drug.[27] They also want to see an expansion of toxicology testing for psychiatric drugs in suicide and death cases to include violent crimes where the perpetrator may have been influenced by the mind-altering properties of these drugs.

References:

[1] “Heath Ledger’s family call for tighter rules on prescription drugs,” Sky News, 2 June 2017, http://news.sky.com/story/heath-ledgers-family-call-for-tighter-rules-on-prescription-drugs-10901826

[2] http://www.rollingstone.com/music/news/chris-cornells-wife-issues-statement-w483179

[3] “Ledger’s death caused by accidental overdose,” CNN, 6 Feb 2008, http://www.cnn.com/2008/SHOWBIZ/Movies/02/06/heath.ledger/

[4] Karen Mizoguchi, “Last, Ominous Conversation with Him: ‘He Was Warned’ About Prescription Drugs,” People, 28 July, 2016, http://people.com/celebrity/heath-ledgers-father-opens-up-about-actors-death-from-prescription-drugs/

[5] “Heath Ledger’s dad brings talk on prescription medication misuse to Geelong,” Geelong Advertiser, 29 Mar. 2017, http://www.geelongadvertiser.com.au/news/geelong/heath-ledgers-dad-brings-talk-on-prescription-medication-misuse-to-geelong/news-story/404fb233be9af93b22164ba1ed9c2e2b

[6] “Chris Cornell’s Family: Prescription Drugs May Have Influenced Suicide,” Variety, 19 May 2017, http://variety.com/2017/music/news/chris-cornells-family-prescription-drugs-may-have-influenced-suicide-1202436611/; “CHRIS CORNELL TOXICOLOGY REPORT Rx Drugs in System,” TMZ, 2 June 2017, http://www.tmz.com/2017/06/02/chris-cornell-toxicology-report-overdose-drugs-suicide/

[7] http://www.latimes.com/entertainment/la-et-entertainment-news-updates-may-chris-cornell-s-body-1495642732-htmlstory.html

[8] http://www.rxlist.com/ativan-side-effects-drug-center.htm

[9] https://www.yahoo.com/celebrity/chris-cornell-toxicology-report-reveals-194531479.html

[10] http://mentalhealthdaily.com/2016/03/08/fioricet-high-intoxication-from-butalbital-containing-agents/

[11] http://www.medicalook.com/reviews/Butalbital_APAP.html; https://www.drugs.com/sfx/axocet-side-effects.html

[12] http://mentalhealthdaily.com/2016/03/08/fioricet-high-intoxication-from-butalbital-containing-agents/

[13] “Williams had antidepressants, caffeine and Parkinson’s drugs in his system,” Hollywood Reporter, 1 July 2014, http://www.hollywoodreporter.com/news/robin-williams-autopsy-confirms-death-746194; Robin Williams Autopsy and Toxicology Report, http://www.autopsyfiles.org/reports/Celebs/williams,%20robin_report.pdf, pg. 33

[14] https://www.drugs.com/sfx/mirtazapine-side-effects.html

[15] https://medlineplus.gov/druginfo/meds/a601068.html; https://www.drugs.com/sfx/levodopa-side-effects.html

[16] “10 Facts You May Not Know About Electroshock (ECT),” https://www.cchrint.org/2017/05/12/10-facts-about-electroshock/; “Ban Electroshock (ECT) Device Being Used on Children, the Elderly and Vulnerable Patients,” https://www.change.org/p/ban-electroshock-ect-device-being-used-on-children-the-elderly-and-vulnerable-patients

[17] “Medicines Use and Spending in the U.S., A Review of 2016 and Outlook to 2021,” QuintilesIMS Institute, pg. 38, May 2017, https://structurecms-staging-psyclone.netdna-ssl.com/client_assets/dwonk/media/attachments/590c/6aa0/6970/2d2d/4182/
0000/590c6aa069702d2d41820000.pdf?1493985952.

[18] Madeline Kennedy, “Benzodiazepine prescriptions, overdose deaths on the rise in U.S.,” Reuters, 26 Feb. 2016, http://www.reuters.com/article/us-health-rxdrugs-benzodiazepine-overdos-idUSKCN0VZ2TU

[19] “Drugs Identified in Deceased Persons by Florida Medical Examiners,” Medical Examiners Commission of the Florida Department of Law Enforcement, May 2017, p. ii

[20] Ibid., p. iii

[21] “Medicines Use and Spending in the U.S., A Review of 2016 and Outlook to 2021,” QuintilesIMS Institute, May 2017, https://structurecms-staging-psyclone.netdna-ssl.com/client_assets/dwonk/media/attachments/590c/6aa0/6970/2d2d/4182/
0000/590c6aa069702d2d41820000.pdf?1493985952

[22] “Psychiatric Medications Kill More Americans than Heroin” Rehabs.com,  5 Jan., 2016, http://www.rehabs.com/pro-talk-articles/psychiatric-medications-kill-more-americans-than-heroin/, citing: MEPS (Medical Expenditure Panel Survey) database, http://meps.ahrq.gov/mepsweb/data_stats/download_data_files_results.jsp?cboDataYear=All&cboDataTypeY=2%2CHousehold+Event+File&buttonYearandData
Type=Search&cboPufNumber=All&SearchTitle=Prescribed+Medicines

[23] https://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications

[24] “EXCLUSIVE: Stevie Nicks Says Doc Almost Killed Her, Ruined Chance of Becoming a Mom,” Fox News Entertainment, 4 May 2011, http://www.foxnews.com/entertainment/2011/05/04/exclusive-stevie-nicks-says-doc-killed-ruined-chance-mom.html

[25] “Stevie Nicks: a survivor’s story,” The Telegraph, 8 Sept. 2007, http://www.telegraph.co.uk/culture/3667803/Stevie-Nicks-a-survivors-story.html;  “Stevie Nicks’ $1million cocaine habit, fueled by her wild affair with married Mick Fleetwood, burned a hole in her nose so big,” The Daily Mail, 5 Feb. 2015, http://www.dailymail.co.uk/news/article-2941749/Stevie-Nicks-1million-cocaine-habit-fueled-wild-affair-married-Mick-Fleetwood-burned-hole-nose-big-took-drug-private-parts-reveals-new-book.html#ixzz4itAiHqtq

[26] “Harsh Reality of ‘Osbournes’ No Laughing Matter,” Los Angeles Times, 7 Dec. 2003, http://articles.latimes.com/2003/dec/07/entertainment/ca-ozzy7; Julian Coman, “Ozzy ‘prescribed 13,000 doses of drugs in a year’ by doctor,” The Telegraph, 14 Dec. 2003, http://www.telegraph.co.uk/news/worldnews/northamerica/usa/1449437/Ozzy-prescribed-13000-doses-of-drugs-in-a-year-by-doctor.html

[27] IMS, Vector One: National (VONA) and Total Patient Tracker (TPT) Database, Year 2013, Extracted April 2014, https://www.cchrint.org/psychiatric-drugs/people-taking-psychiatric-drugs/