Sunday, June 20, 2010

Was Michael Jackson an addict?

Copyright 2010
Please do not reproduce this information without consent.

The capacity to become physically addicted to propofol has not been firmly established by any literature. Propofol is not structurally or pharmacologically related in any way to other common anesthetics such as opioids (narcotic pain killers), barbiturates (such as phenobarbital) or benzodiazepines. Propofol has no attraction to receptors that the above drugs commonly interact within the brain--meaning that potential for abuse and/or addiction should be limited. It is actually chemically similar to vitamin E and aspirin.

A case report titled Lethal Self-Administration of Propofol (Diprivan): A Case Report and Review of the Literature states, regarding dependency "there is no evidence of tolerance", which refers to the need to increase the amount of drug to maintain a given response. An article authored by Zacny, et al. discusses the possibility that propofol might be psychologically addictive at sub-therapeutic levels in healthy volunteers. However, Dr. J. Robert Sneyd blasted this study for its use of volunteers with a history of alcohol, soft and hard drug use. Sneyd also discussed the biased reporting of the statistics. Furthermore, Jackson was well into therapeutic range and was not using sub-therapeutic doses for recreational use. Jackson was also not self-administering propofol.

Valium (diazepam) is a long-acting benzodiazepine. Ativan (lorazepam) is an intermediate-acting benzodiazepine. Versed (midazolam) is a short-acting benzodiazepine. All the benzodiazepines administered to Jackson are acceptable for the treatment of insomnia. However, other kinds benzodiazepines are typically used for insomnia, such as Restoril (temazepam) which was found among Jackson's medications though this particular medication was not taken June 25th. Concerning insomnia, even though benzodiazepines may be used, IV benzodiazepines should not have been used to treat Jackson since he could take oral medications. There was no need for IV benzodiazepines for Jackson.

There have been rumors that Jackson had an addiction to various benzodiazepines. Rumors are simply that--rumors--and there is no current proof of such an addiction thus far. Jackson had one oral benzodiazepine prescribed to him by Dr. Metzger for insomnia. Jackson had three oral benzodiazepines prescribed to him by Murray, two for insomnia and one, written days before his death, was prescribed to take throughout the day. Information from Table 3A in the autopsy report shows that Jackson did not appear to be a compliant patient--he rarely finished or took his medications as prescribed, including antibiotics which should be finished in most situations. He underutilized almost every medication he had in his possession. For those medication bottles found empty, based on the date the medications were filled at the pharmacy, it is appropriate to have found them completely used. The amount of benzodiazepines remaining and the length of time since being filled/written do not correlate with an addiction. However, Murray's benzodiazepine-prescribing was more encouraging of establishing a tolerance in his patient (with no apparent tolerance) rather than trying to prevent one from occurring.

Even though benzodiazepines do pose a physical risk of tolerance and dependence, it is not common. An excellent article to read is "Benzodiazepine Use, Abuse and Dependence" by Charles P. O'Brien M.D. Ph.D. A link to this article can be found here:

http://www.psychiatrist.com/supplenet/v66s02/v66s0205.pdf

This article highlights the differences between tolerance, dependence and abuse. This article states that benzodiazepines are rarely a primary drug of abuse and that the actual percentage of people who abuse these drugs is very low. There is a major different between someone who intentionally chooses to abuse a drug and someone who accidentally becomes tolerant or dependent from regular use. Jackson did not appear to suffer from tolerance or dependence when he died though Murray was writing prescriptions which could have easily led to a tolerance or dependence to benzodiazepines. Physicians should be at the forefront of preventing tolerance and/or dependence from occurring. Physicians should be monitoring their patients regularly for signs or symptoms of tolerance or overuse and limiting the amount of medications they prescribe to their patients. Also, Murray never mentioned a fear of Jackson becoming addicted to benzodiazepines--Murray said he feared an addiction to propofol only. Jackson reportedly slept the entire night with the use of midazolam and lorazepam and without propofol on June 23rd. This notion could also indicate Jackson had no tolerance or addiction to benzodiazepines (nor a dependence on propofol as previously discussed).

Jackson did not have any organ damage that would indicate long-term drug abuse. For example, hearing loss from chronic narcotic analgesic (ex. Oxycontin) abuse is common. Liver damage is also a common find among drug abusers since the liver is responsible for metabolizing almost all medications. It appears that chronic propofol abusers (abuse over years) may develop hepatic steatosis or a "fatty liver", possibly from the triglyceride content of propofol. Valvular heart damage from bacterial infections and/or certain kinds of skin damage/demarcations may be seen if someone injects medications regularly with needles. Jackson had none of these theoretical or common signs of abuse. It is known that Jackson used narcotic pain relievers at times. Narcotic analgesics are known to cause accidental dependence and tolerance in many patients. Even if Jackson had a tolerance issue in the past, it is important to remember that no narcotic pain relievers were found in the residence or in Jackson's body. Every medication found in Jackson's system were administered to him by Murray, under his own admittance. Even if some dependency issues arose from the treatment of pain, as Jackson admitted to a pain medication dependency in 1993, this dependency seems to have been treated appropriately as all of his organ systems were in excellent condition other than some lung issues that were minimal and not due to any form of drug abuse. Jackson was determined to have had bronchiolitis and chronic interstitial pneumonitis along with scarring in his lungs. These were likely from autoimmunity issues.

Please realize that all of the information above concludes that Jackson was not the "drug addict" the media has painted him out to be--he ended up being a victim of someone else's actions, not from personal misuse of medications. Everyone in their lifetime has at some point misused a medication, perhaps shared a medication they should not, taken a medication that may not have been necessary for an ailment, etc. That does not mean someone is an addict. In fact, Jackson was at intermittent times on very high doses of prednisone, presumably to treat his discoid lupus. This steroid critical in the treatment of immune diseases could have caused him to have appeared unusually euphoric or "high" at times. Individuals without a substantial medical background may not be aware of such effects with a medication like prednisone. Many people do not understand the basis behind drug addiction, what may lead to it, how the physical components of a drug may actually induce addiction/tolerance/dependence or how many find themselves relying on a medication just to have some sort of livelihood. By far, many who take medications in excess usually do so either from accidental tolerance/dependence formation or from inappropriate self-medication of an ailment. Perhaps they are depressed or suffering from an ailment such as fibromyalgia which then is treated with inappropriate medications or substances. Many people who find themselves using drugs and/or alcohol do so from something a physician cannot see--emotional pain. People in general should be more sympathetic to others who may or may not have a drug problem instead of seeing them as below one's self. Jackson may or may not have had some issues in the past, but it is important to remember he, too, was human. He does not appear to have any long-term damage from any sort of abuse of medications and certainly did not have any issues when he died--other than Murray being in his life.

20 comments:

  1. More medical details here: http://xscapemj.blogspot.com/

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  2. i just posted on there, too...thanks! :-)

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  3. ur posts (i consider them work) is invaluable! i appreciate it so much!

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  4. @ Nikki
    Darling you've got a great blog going here & thanks very much for the comment you made on my blog regarding Propofol found in stomach content. I'm still studying the issue. I've work with Propofol before, but haven't seen it being absorbed by stomach tissue this way, unless the patient has been down for more than 6 hrs straight. I'm going to consult a professor at my university who happens to be a Gastrologist, maybe he can shed some light on this issue.
    much love 2 u :)

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  5. Hello "Hot Ice"! I am looking for your comment on here but do not see it (I still have it via my email, though). Hopefully it will show up soon. Please do let me know what you find out re: the propofol. This is something perplexing me (even though I wrote angrily about it tonight, haha). Thank you for your lovely comment. Much <3 to you!

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  6. Now I look like a dork! Now I see your comment, hehe. Oh well...:-)

    I have posted on several blogs lately, can you tell me which is yours again? I want to make sure I am a follower.

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  7. I am fed up of all these comments on supposed addiction of Michael of drugs. He was NOT an addict, he had to take these drugs for illness, not for pleasure. Every body must understand this and stop to make supposition

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  8. Would it be okay if I share this information on the Michael Jackson forum. There are some fans who think once an addict always an addict. So because Michael had problems in the past which he admitted it to that must mean he was a drug addict. Your blog is really insightful and written very well. I think others need to read this. If is okay with you, I will post this blog on the website and the blog link.

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  9. Do you mind if I post this article on facebook?

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  10. Anon, don't mind at all, please do! Thank you.

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  11. 2.

    Benoquin: Monobenzone is used to treat the uneven appearance of the skin due to a loss of skin color (vitiligo). It works by permanently removing color from normal skin located around skin with vitiligo. This will help to make the appearance of the skin more even


    Propofol and Lidocaine are used together. Lidocaine is not medication it is used in conjunction with Propofol because Propofol burns when it's being injected. So right there you can cross Lidocaine off the list. They're trying to make it sound like it was something separate when it wasn't.

    Then there's Lorazepam. The Lorazepam was prescribed on April 28, 2009 and contained 30 pills. On June 25, 2009-two months later- there will still 9 pills remaining. So Michael took 21 pills of this in a two month time span.

    Then there's Diazepam. It was issued on June 20, 2009 (the same day Michael was told he was going to lose everything if he backed out of the concerts) One thing Diazepam treats is anxiety. What person wouldn't have anxiety after being treated the way Michael was at the meeting. I think for someone to tell you they are going to take your children away would cause anyone to have anxiety. Anyway...there were 60 pills of Diazepam prescribed on June 20, 2009 and on June 25, 2009 there were 57 remaining. That means he only took three within the span of 5-6 days.

    Then there's Temazepam. This was prescribed in December of 2008 and on June 25, 2009 there were still 3 pills left. This was something he had stopped taking a while ago and Temazepam did not show up in the toxicology report.

    Then there's Trazodone. This was issued to him in April of 2009. It was a prescription for 60 pills and on June 25 there were still 38 pills left. This was also something he stopped taking quite some time ago. Trazodone did not show up in the toxicology report.

    Then there's Flomax. Flomax has nothing to do with any of this. I don't even know why they mentioned it.

    Then there's Clonazepam. This was issued in April with 30 pills and on June 25 there were still 8 remaining. Once again, something he was no longer taking. This was not found in his toxicology report either.

    Then there's Tizanidine. A prescription for ten pills was issued on June 7, 2009 and on June 25, 2009 there were 8 left. So in the span of more than two weeks, he took two of these pills. Tizanidine was also not found in the toxicology report.

    Last but not least there's Hydrocodone and Benoquin. I have no idea why these are even listed. They are not medication. They are creams and lotions that Michael used for his skin.

    So, out of all of that BS what they found in Michael was: Propofol, Lorazepam, Diazepam, and Tizanidine. And guess who gave him ALL of that in the early morning of June 25, 2009...Dr. Murray.

    If you were to go inside a random person's house and look at the medication they have, I guarantee you that you would find close to the same amount of prescriptions as Michael had. It's clear to see he was not taking this day in and day out. When people have medication that doesn't work or that they don't feel is right for them, they usually stop taking it. Which is EXACTLY what Michael did. My cabinet is full of old prescriptions.

    This just makes me crazy! I don't understand why the general public can't see the TRUTH here and what the media is trying to do!”

    http://www.facebook.com/l.php?u=http%3A%2F%2Fwww.twitlonger.com%2Fshow%2F808jng&h=78ee8

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  12. 1.

    Resend to all followers

    On Saturday 8th January 2011, @Cotton_Sea said:
    Please RT this to all of your followers. This was posted on TMZ's site in the comments.

    "A pharmacy of drugs" such BS! This is how the media likes to spin everything.

    **So this is what was found at the house:**

    Propofol Propofol and Lidocaine are used together. Lidocaine is not medication

    Lidocaine: Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery. Propofol and Lidocaine are used together. Lidocaine is not medication

    Lorazepam: Lorazepam is used for the management of anxiety disorders, the short-term relief of symptoms of anxiety or anxiety associated with depression.

    Diazepam Diazepam is used for the management of anxiety disorders or for the short-term relief of symptoms of anxiety.

    Temazepam: Temazepam is used to treat insomnia symptoms, such as trouble falling or staying asleep. Temazepam may also be used for other purposes not listed in this medication guide.

    Trazodone: Trialodine (Trazodone), an antidepressant -mood elevator, is used to treat depression. Trazodone is a psychoactive compound with sedative and anti-depressant properties. Trazodone may also be used for relief of an anxiety disorder (e.g., sleeplessness, tension) and chronic pain.

    Flomax - Flomax is used to improve urination in men with benign prostatic hyperplasia (enlarged prostate). Flomax may also be used for other purposes not listed in this medication guide.

    Clonazepam: An anti-anxiety medication
    Tizanidine: Tizanidine is used to relax certain muscles of the body. Spasticity Management of spasticity associated with cerebral or spinal injury, alone or in conjunction with other standard therapies


    Hydrocodone: Hydrocodone is a narcotic analgesic and antitussive used in concurrence with other drugs to relieve acute pain or cough. Hydrocodone works by acting on the central nervous system and alters the way the brain communicates sensations of pain. It is the most widely prescribed opiate in the U.S. and is most commonly combined with acetaminophen to form drugs such as Vicodin, Lortab and Lorcet. The effects of hydrocodone are similar to those of morphine.



    Contd:

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  13. I need to add some things to your report Anon:

    Diazepam--this can be used for anxiety (and apparently was written for such by Murray) but it actually appears that Michael may have been using it at night as a sleep aid. 10 mg of diazepam is equal to about 2 mg of lorazepam (oral lorazepam not IV). This was filled on June 20th--not sure if Michael had ever had it before (doesn't seem like he did recently at least, as in the past 6 months, there was no spare bottles or anything but without pharmacy records I cannot promise he had not had it prior) but for sure Michael was apparently not taking this medication as it was prescribed, to take about every 6 hours (4 times a day) and given these were 10 mg tablets that is the max dose that someone should take of this medicine. Why Murray wrote for this, not sure, but Michael certainly was not taking four a day, he only took three tablets within 4 days, as if he took it at night or something.

    Trazadone is an antidepressant but can also be used for just about anything. I suspect in this case it was being used for insomnia, which is an appropriate use of the medication.

    One error is hydrocodone--hydrocodone is a pain medication that comes as a combination drug either with acetaminophen/paracetamol or ibuprofen. I want people to hear me out

    ****there was no hydrocodone (a pain narcotic) in the house or in Michael's body****.

    There was a skin lightening cream called hydroquinone that was found. There has been some name confusion with these two drugs. Again, no hydrocodone, I don't care what someone thinks they heard, trust me, these drugs names are too similar even to newly trained ears. There is no hydrocodone or pain medications (besides aspirin) listed in autopsy report in any form.

    Michael did not test positive for tizanidine/Zanaflex. That script was actually from Klein and my guess it was used to cut down spasicity maybe from some procedures he had done to his face, I am not sure, but it was for temporary use, not for pain or insomnia.

    The key to understanding the medications found are comparing Michael's meds to that of Murray's meds. The drugs Murray brought in and gave to an unconscious Michael are the problem--nothing else found was problematic. The drugs found are nothing I would be worried about--besides what Murray brought in to use on an unconscious Michael, drugs to only be used in a hospital or clinic and never used for insomnia. Another key thing people need to realize is Michael had leftover medications from months prior. Temazepam from December? Someone with a drug problem typically does not have leftover medications from a script from months prior. That just isn't how addiction to these drugs work. Granted, I know Murray was giving him drugs at night but we have yet to know when he gave what and when. Michael himself, what he had control of, what he took with his own hands does not harbor any form of any abuse or addiction. In fact, one would call Michael non-compliant--he did not take medications like Flomax (which IMO a cardiologist should not have written for, either, but I wouldn't flip out over it) or his antibiotics as he should.

    Oh, and lidocaine is a medication. It was used to decrease the burn here but can be used for local anesthesia as well as cardiac disturbances.

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  14. Girl, I never get tired of reading this entry! I hope you don't mind I keep retweeting, facebooking, & post this with your link of course to every MJ board! I get frustrated when even MJ fans question this about MJ, you entry is superb & very very helpful in dealing with this! I hope you can do an entry on the 1993 dependency. I personally believe MJ became dependent but not necessarily addicted in 93. He had to accomplish a 12 step program which he never did, & it just seemed like it was not as serious or as dependent as it is now being considered. i hope with your medical background you could look into this?

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  15. Excuse me but may I ask permission that I pot this on tumblr?

    This article needs to be seen.

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  16. Thanks Elena! Someone just asked me to do an entry on the 1993 issue so I should as I have a lot of information to share about it--I have not wanted to do it because I am afraid people will fight me on the subject without listening to me. Thing is, I am not looking to glorify or exonerate Michael from anything negative--I see what I see and say it like it is and thus far I just do not see any evidence of this addiction and abuse like some people are claiming. Sources STILL try to claim he died from painkillers when the only "painkiller" in his house was a bottle of aspirin, so what does that tell us about "sources"? I tend to agree with you, though, that he was either dependent or simply using the medications for pain. The big difference between dependency and being called an "addict" is *why* someone is using the medication (or many times for an addict it is medications in the plural). If someone is using a pain medication for pain they can become dependent, if they use it for recreational purposes (to get high or experience anything but pain relief) that would be considered abuse and addiction, e.i. finding themselves craving it, needing it and possibly withdrawing from it, etc. I do not believe Michael began using these drugs to get "high" and he had real issues with pain during this time stemming from things such as scalp surgery, migraines, back pain and right before he left for London he had had an abscessed tooth extracted. Those all sound painful and would warrant pain medication. I will not say too much else here since I will save it all for another blog (hopefully a recent one but I may be MIA here shortly as I will be having to relocate). Stay tuned!

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  17. I'd like to post this information on an MJ forum with your permission, some fans keep insisting that he was an addict.

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