"Doctors speak out about 'pronapping' addiction to propofol/divprivan on the job and at home" --MY TAKE

I have tried multiple times to post my comment to this article written here without success so I will just post it on my blog:

http://www.allvoices.com/contributed-news/3871392-doctors-speak-out-about-pronapping-addiction-to-propofoldivprivan-on-the-job-and-at-home#

Please understand this article is NOT credible (even though it claims to be at the bottom of the page).

Many medical professionals especially nurses would be livid to hear they are supposedly "napping on the job" when most nurses I know are not even allowed restroom breaks or to take a lunch. Meditation breaks? Seriously? Do you really think medical professionals have time to do that when they must tend to patients many times for more than 12 hours a day? Would that not constitute patient abandonment for a nurse to be meditating on the job?

To insinuate everyone who takes this medication receives a "high" is a gross mistake. Euphoria is not even listed as an adverse effect on LexiComp, nor is this medication scheduled (as all addictive/drugs of abuse are except anabolic steroids which are scheduled strictly to divert illegal use though not addictive). I do not even know if I believe the people who claim sexual inhibitions due to the drug (which can that not be a natural part of awakening after sleep, right?) because thousands of patient have received this drug and do not report such and even if someone has claimed it um, maybe it is not propofol? Unauthorized users do NOT have access to this drug. Have you ever worked in a hospital? It is not a pill you pop!

I do not have stats off the top of my head to point this out but the number of people who have died from propofol abuse or that abuse the drug is a tiny, tiny amount compared to the number who abuse pain killers, ALCOHOL, meth, etc. That point is actually clouded in your article as you mention a doctor here, a nurse there--that is not reflective of thousand of people with a problem, nor even hundreds. It is RARE.

You also failed to mention there is a severe shortage of the drug in hospitals nationwide.

http://www.ashp.org/DrugShortages/Current/

It is not available like candy bars.

People do NOT die from over-injecting 20 mg! People do not die from injecting 200 mg! One standard dosing regimen is 2-2.5 mg/kg. A patient weighs 50 kg. That means they could be given 100-125 mg. Whoops that is 25 mg too much? Hardly. The FEW that have died from propofol have died from injecting it too fast in which is causes cardiovascular collapse by lowering their blood pressure and stopping their breathing. This usually happens while they are alone and thus no one is there to render them sufficient aid. It has nothing to do with the dosage. I have seen a doctor debate on giving a patient 100-200 mg of propofol for a short-term procedure. He requested a bag-valve mask and oxygen on hand in case of a problem.

The elimination half-life is NOT 5 minutes. You are confusing half-life with duration of action. The half-life of propofol, from Lexicomp is:

Half-life elimination: Biphasic: Initial: 40 minutes; Terminal: 4-7 hours (after 10-day infusion, may be up to 1-3 days)

The above information is hard to explain but the drug works in different compartments of the body where it hangs out for different amounts of time. Main thing to notice is the first half-life is 40 minutes, not 5 minutes. This is not a difficult concept to understand for a medical professional. Half life does not correlate with duration of action.

I am embarrassed to say this but the number of residents abusing drugs being only 1-2% is not correct. It is higher than that (when considering all drugs). About 10% of the basic population abuses some substance. It is higher for medical professionals because they have easier access to the substances.

To discuss an article talking about opioid addiction is pathetic. Propofol is not in any way, shape or form related to opioids.

It's "YouTube" not uTube.

The only reason propofol is referred to as "milk of amnesia" is because it is white. A majority of people know this--it is no secret.

I do not believe it has ever been used regularly for the treatment of seizures. It is used safely for colonoscopies and dental procedures as well as numerous other short-term procedures like cardioversions, fluid withdrawal from the body like from the abdominal cavity or lung area, etc. When used in an appropriate setting propofol is very safe.

The information contained here has been grossly twisted as is not a reflection of the information at hand.

Just to make it clear, Michael Jackson if he did indeed ask for propofol, did not want it for euphoria or sexual hallucinations. He wanted it to go to sleep so he could try to pull off his comeback tour and provide for his children since so many had shoved him into a financial hole via horrifying defamation of his character and swindling. He died trying to live.

Nothing is Ever Right Concerning Michael Jackson

My reponse to this litte snippet listed here:

http://www.youtube.com/watch?v=8a5FKkNkjAg&feature=related

I think that translates into "Michael Jackson: Death of an Icon". This is from the "Celebrity Addiction" part.

I try not to watch any of these shows because they make me so angry I want to scream from the blatant errors they contain. I was asked to watch this by a friend and could not remain silent seeing all the flagrant errors. What makes me sad is thousand if not millions watched this. Not even 1% of them will read my corrections to this sham of a documentary. I could not bare to watch any other parts of it. This is from Ian Halperin's crapumentary, right? Correct me if I am wrong.


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I am hearing a lot of errors, my God. This is why I cannot watch things like this. Dr. Klein did not prescribe any drugs besides prednisone and a muscle relaxant (tizanidine) for insomnia. Tizanidine is NOT a narcotic, NOT a benzo, NOT a painkiller. NO painkillers were in Michael's body OR HOUSE--that is false, FALSE! It should NOT be that hard to understand this concept! ONE antidepressant was found in the house--trazadone, written by Metzger, it can be an antidepressant or sleep aid, but it was prescribed for insomnia, to take as needed, thus NOT for depression. He had a month's supply of trazadone, had it for 68 days and took ONLY 11 nights worth in that two-month period. SOUND LIKE ABUSE? NO!

Chopra needs to know that propofol does NOT give a "huge euphoria"--some euphoria has been reported as being experienced by some but this is usually in sub-therapeutic levels and is NOT experienced in all cases or even in the MAJORITY of cases. When looking on LexiComp it does not even state "euphoria" as being an adverse reaction for propofol but DOES list it for prednisone. Michael did NOT ask to get high--he did NOT ask to "feel good"--he asked for 8 hours of SLEEP. STOP shoving words into his mouth Chopra and go do some research. And, your tidbit about Michael wanting Oxycontin that you waved around shortly after his death, if he really did ask for it, that does NOT mean he was an addict. You cannot PROVE addiction through a patient's request. Instead of directly calling him an addict you should have first delved further and sought what was BEHIND the request--legitimate pain, doctors committing malpractice, a misunderstanding on Michael's part that Oxycontin when there are alternatives for pain relief or whatever ailment he had, etc.? Did you bother to sit down with your friend or did you jump to a conclusion like 99% of others out there? Michael may or may not have had his problems with drug use but like most out there--SOMETHING lies behind it. You call Michael an addict then accuse doctors of enabling him and shift blame onto them--you do understand that doctors have a responsibility to not mislead or harm their patients, right, as you are a doctor yourself? Did you report those doctors to the medical board and/or DEA? It is illegal to prescribe pain medications if not for pain even though Michael WAS in pain. I see how this blame game works now. People are blaming Michael because he is now dead and not "here" to hurt anymore when what lies behind the blame is GUILT. I would NEVER want to hurt someone by saying they should have any guilt in someone's death but I am SICK of seeing a man slandered who lies in a premature grave and has three children who if they heard this would be shattered. Behind EVERY action is a REASON. We hear of the actions, now it is time to figure out the reasons behind everything that happened, why certain choices were made, and discover what led to the death of a icon who deserved a much better in life than to be abused, humiliated and ridiculed every day of his life adult life and continues such in death. Who wouldn't at some point in time seek some sort of refuge out of the shitty life they were trapped in day and night? Michael's refuge was child wonderment, play and reaching out to children until that was ripped from him--he was left empty because of it. His life was ripped away from him years before 2009. How he survived as long as he did is a miracle itself though it took Murray, not Michael's, action to finally kill him.

The discussion on the propofol/lidocaine in Michael's stomach, OMG, insinuating Michael DRANK it? It is useless oral and Michael knew this or why would he have bothered having a doctor there to GIVE IT IV AND TO WATCH HIM? Why bother to mix it with lidocaine if you drink it? Dr. Calmes stated "(t)he levels of propofol found on the toxicology exam are similar to those found during general anesthesia for major surgery (intra-abdominal) with propofol infusions, after a bolus induction." Hence, the drug apparently goes through (intra) the abdominal (stomach) wall. That, or due to the bleeding from CPR--could be either one or both, I would imagine. Had Murray tried to shove it down Michael's throat he would have likely aspirated it into his lungs--no propofol was found in his lungs.

Doctors besides anesthesiologists prescribe/use Valium, Versed and Ativan. I know cardiologists use Versed on a regular basis, NOT for insomnia but for conscious sedation for cardiac catherizations. Cardiologists and others could use Ativan or even Valium, too. To insinuate a cardiologist does not know about these drugs is, to put it bluntly, retarded. Cardiologists may even use propofol for electric cardioversions though that is not common. Even if you "don't know the dosing" you can LOOK IT UP ON THE INTERNET. Murray KNEW the dosing. He KNEW they cause respiratory depression, all FOUR drugs he gave Michael that night. He is NOT a fool. He LIED and said he gave drip? Where were the drips Murray? No Ativan or Versed in the tubing, buddy. Why did you use IV drugs on Michael when if he was reeeeeeaaaally awake he could swallow the Valium and Ativan you wrote for him a few more times! No, you chose to STAB him intramuscularly to give it and I am sticking to that until I am proven otherwise.

People, do NOT be fooled into thinking Michael died another addict. Propofol is NOT established to be an addictive drug. It does NOT exhibit tolerance. It is NOT abused to "get high". It is used and even abused to be KNOCKED OUT. If you can't sleep and you are about to have to go on a rigorous tour that you CANNOT back out of, wouldn't you try anything to sleep? Sure, Michael's apparent theory of using propofol was wrong, but actually not far-fetched for a lay person to assume (especially one who had been given it before), but only a doctor could make it a reality for him. No doctor in their right mind would EVER do this to someone, ever give FOUR drugs that cause respiratory depression (without any means to give them oxygen, no less) to someone unless they WANT THEM DEAD. Media and others can harp all they want about Michael being an addict but the fact of the matter is Conrad Murray was in COMPLETE CONTROL during the hours of June 25th, 2010 and in the court of law THIS is the ONLY DAY, and all immediate events that leading to it, that matter. Use of painkillers is IRRELEVANT. Any previous addictions or dependences is IRRELEVANT. It will be difficult if not impossible to establish a dependence on benzodiazepines because according to the table of medications found in the residence there was no dependence or certainly no overuse of the medications provided--they were actually underutilized (he had Restoril capsules left over from 6 months before--what does that tell you?). The essential myth of Michael's addiction to propofol is not credible or factual, either. Murray made REPEATED bad choice after bad choice after FATAL choice. We are NOT talking about a lay man but a seasoned DOCTOR who did all of this. Of course the media will paint Michael to be that poor addict FOR RATINGS, and most others simply DO NOT UNDERSTAND WHAT WAS GOING ON and DO NOT UNDERSTAND THE COMPLEX NATURE OF MEDICINE. There is a reason people go to medical school, pharmacy school, nursing school, radiology school--because the field of medicine is intricate and complex. Do NOT be fooled by people who have NO idea what they are talking about which sadly is probably 95% of what you see on TV or read online. Most medical professional don't want to take the time to learn the intricate details of this case so they only follow up on what is fed to them--through the media. A vicious circle.

The media successfully painted Michael to be a pedophile though facts to the contrary exist. A majority of people still believe it. They will paint him to be responsible for his own death, too. Just look at the media still branding Michael with "painkillers" when they had absolutely nothing to do with his death. Don't fall prey to the ignorance. The truth will eventually come out.

In Case of Axident...

“Buprenex does the same as Demerol, the only difference is you cannot become an addict on Buprenex. Buprenex Synthetic Demerol. 2 viles (vials) I would feel safe. Have it in case of axident (accident).” (I love Michael's little misspellings here and there!)

This was supposedly picked up as evidence in the November 2003 raid that was spurned by the molestation charges that Jackson was later completely acquitted of (for more details on his acquittal please read Aphrodite Jones' book "Conspiracy" which contains actual material from court documents rather than from tabloid fodder). I am also currently seeking information regarding the "massive drug raid" that supposedly took place during this time, just FYI. I will mention that finding "IV bags containing a white, milky substance", as I have seen on some of these tabloid sites referring back to 2003 should in no way have been propofol as it comes only in glass bottles and should remain in those bottles only as it can become easily contaminated from being transferred. The only "white, milky substance" I have seen in a bag is pure lipids (fats). I am assuming that over time some originally clear substances could become white and somewhat milky, though propofol is indeed bright white. I will continue to get to the bottom of this at another time.

But, back to the note many say this note shows that Jackson was not actually a drug-seeking addict but rather someone apparently trying to look out for his health and avoid dependence on any medications, including pain medications like Demerol. I agree. A good friend of mine wrote a blog in detail about this view which can be found here:

http://www.mj-777.com/?p=4172

I agree with her view. This note, in my opinion, shows he valued his health and was attempting to look out for himself and he was trusting doctors. I want to now highlight on this actual medication Buprenex. I would think the doctor that gave him this information came from this link some time ago:




What irks me is this is one of the most unprofessional letters I have ever seen. This supposed doctor could not even spell Buprenex correctly, and the letter is riddled with other mistakes as well. Whomever told Michael that Buprenex was not addictive (and I assume a doctor or at least a doctor verified this to him or he would not have written it down)--was flat-out LYING to him and apparently poor Michael believed him as any normal lay person would.

A doctor telling him that it would not cause addiction (dependence/tolerance), which is evident or Michael would not have wrote it in his letter I am sure, is malpractice. Below I will quote some of what I wrote to Seven in the above mentioned blog so you can see how doctors were manipulating this man for some time and why it is evident to understand how he could thus accept that propofol was safe for treating insomnia as I firmly believe he believe he fell for this lie, too:

“I looked up Buprenex, generic name buprenorphine, because I was unfamiliar with it. I really wish I knew which doctor told him about this medicine because I personally would call him a quack for telling Michael that he would 'not become addicted'. It is a Schedule III, meaning it has some potential for addiction/dependence though not as bad as a Schedule II which is what Demerol and morphine are (Schedule IIs are the things you keep locked up in a pharmacy). So, yes, it is better than Demerol but not 'safe' or moreover not addictive. Michael was so misled. Michael wanted the IV/IM form which is indeed used for moderate-to-severe pain, and he did indeed only want 2 vials–-obviously in case he had some accident, not for chronic use/abuse. However, the tablet formation of this medicine is for opiate withdrawal, a yucky connotation. Granted, Michael didn’t ask for that one–-again not an addict needing more or seeking a fix. Sad thing is, Suboxone, which is a combo product of buprenophine and naloxone (the opioid reversal agent) is not a 'good' thing to me, either. It is only for opioid withdrawal. A lot of people think the naloxone is in there to keep you from becoming addicted. It isn’t. It is in there to keep people from getting high off the buprenophine if they decide to crush the tablets and shoot them IV. That makes me question this drug’s ability to cause dependence then, too. It is an opioid, too. Lexi-Comp also says that it is for short-term use as it has a 'ceiling effect', which then means of course if you use it for a while eventually the patient will plateau on pain relief and find themselves using more of it more often to try and get that relief again--legitimate pain relief, that is.

I know Michael’s intentions were good, and he so didn’t want to become 'dependent' but I see this as a doctor bullshitting him. I also see it as Michael not wanting to have had issues with Demerol, either. Poor Michael, he knew no better. He just wanted to live.”

Doctors (and pharmacists) are responsible for telling you the truth about medications, especially if one is concerned about addiction. Granted, I have been told that some things a patient is better off not being told, which I really cannot say I agree with that at all. My grandmother and her sister both died from taking medications that led to them developing a rare lung disease. If someone had warned them about this rare event--they could still be alive today or at least not died so young. Michael was obviously trying to help himself stay dependent-free-–but was being duped by doctors--not just left in the dark but lied to. Michael was simply a lay person and most lay people trust doctors. How many others did this to him? How many others lied to him?"

Now onto this:

http://abcnews.go.com/2020/MichaelJackson/michael-jackson-circle-address-rumors/story?id=11002573&page=2

Karen Faye, a beloved friend of Michael's said in a recent 20/20 special:

"Just before we went on tour for "Dangerous," he had an operation, in order to help the scarring. But he didn't have enough time to heal," said Faye. "So in order to keep going, he started using painkillers, because it is very painful when nerve endings are severed."

"Faye said painkillers "gave [Jackson] the ability to get through" the combination of the emotional pain brought about by the allegations and his already existing physical pain."

If he had to go on tour before healing and was using pain medications due to pain from a lack of healing, that to me doesn't justify him being an addict. It makes me feel he was a victim of the pharmacology of pain narcotics, as pain narcotics are addictive (I prefer to say they cause dependence and tolerance) in everyone. Thus, that does not mean someone suffers from the disease of addiction itself if they become "addicted" (dependent/tolerant) to opioid analgesics/pain narcotics while treating pain, especially if they are having to use them for any length of time. I want to again blame doctors in many situations as they need to be helping prevent this kind of dependence in patients and not looking to just stuff their wallets. Addiction is usually a disease, a genetic-based disease. No one in Michael's family apparently suffers from it and they were all in show business at one time or another--usually another reason (maybe not legit, though) to be an addict. He began using the pain medications for a legitimate reason if it was from pain to his scalp--and he was in fact wearing a lot of hats out in public during that time which to me would seem to maybe indicate he was having issues with the surgery and/or his scalp. So, it seems that a tolerance/dependence to pain medications was from real pain--not for his need to get high, escape, etc. though I am sure the stress of the allegations did not help as they likely made him depressed and depression can indeed cause physical pain as well.

Basically, if not all opioids/pain narcotics have a ceiling effect. This effect likely happened to Michael, while hopping from place to place on tour, and it is now coming back to haunt him with his death as he is now being deemed a drug addict who was responsible for his own demise. Never, ever will I believe he caused his own death. I will fight anyone who claims that, too. There is much more under the surface as to what really happened to Michael, concerning the allegations, the drug use, the law suits, the debt, the lies, and ultimately his unnecessary death of not only his body but of his soul while living, too.

Though off topic, I will firmly say that Michael never asked to be accused of child molestation. He never asked to be labeled as "Wacko Jacko". He never asked to be taken advantage of by so many slime-bags that saw him as an easy way to make money off the fact that he was naive, and once the allegations befell him, he was an easy target much like a wounded animal is to hungry predators. Once the problems began, more of them piled onto others, so many Michael was likely not even aware of many of the problems that surrounded him. There was no way to get out of it. He committed to "This Is It", a tour when he spoke of how tours nearly killed him, and that was the final straw--there was no way he could get out of this dilemma. He either had to die or die trying--he died (though I say was murdered) trying. He never gave up. I mean, look at this crap! He had so many law suits going against him, even one from a lady that claimed he messed with her food:

http://www.tmz.com/2006/06/15/jacko-tampered-with-my-food-suit-alleges/

This is what Michael had to face everyday. He couldn't escape it though he tried his best to live it as best he knew how. I think he tried to escape his life by being surrounded by children--innocence. He lived for his fans and for his children. I will stop now, though. This will lead into more blogs I hope to finish sometime soon...

I know some things in this post are kind of redundant, as I just noticed it while proofreading, but I hope that will only hit some of the major points home.

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.