Anna Nicole Smith coroner predicts polypharmacy in Jackson case
Dr Joshua Perper, the Florida pathologist who performed the autopsy on the Playboy model Anna Nicole Smith, told E!News on Sunday that he thinks the Michael Jackson autopsy will show “a combination of drugs, where propofol will be present”. Similar remarks by Dr Perper were reported yesterday in the Mirror.
Dying from the combined effect of drugs in this way is often known as “polypharmacy”. In Jackson’s case it seems unlikely that propofol (Diprivan) was the only drug he had swimming around in his system, though it may well have been the last drug he took. It’s crucial to understand the risks of polypharmacy since it’s such an extremely common cause of accidental drug deaths. What happens is simply that the combined effect of taking several Central Nervous System (CNS) depressants at the same time is more potent and depresses the CNS more than any of the drugs taken singly would.
It’s common for drug users to die in this way because they don’t understand the risks. Or they’re intoxicated and don’t care. Not only that, but as any drugs worker can tell you, many supposed straight “heroin overdoses” are complicated by the fact that the street heroin had been adulterated with other drugs, typically benzodiazepines.
Anna Nicole Smith, you may recall, died as a result of ingesting a combination of drugs, principally chloral hydrate – the ingredient in the old “Mickey Finn”. (Added to which she had contracted a serious infection from injecting vitamins and weight-loss drugs into her buttocks.) Elvis Presley also died from polypharmacy, although in his case the toxicology revealed he had ingested several substances in doses that could have killed him if used individually.
This is how it works: a benzodiazepine tranquilliser, for example, like diazepam (Valium), is hard to overdose on fatally when taken on its own, but combine it with another CNS depressant such as, typically, alcohol, or opiate painkillers, and you could be in real trouble. The lesson is: the sedatives used for sleep and anxiety these days may be much safer than the old barbiturates they superceded, but they can still be lethal if combined with alcohol or other sedatives.
Incidentally, you can find interviews with kindly, Romanian-born Dr Perper on Youtube. He speaks with a pleasing eastern European accent and carries a pronounced bump on his bald head that’s said to be the result of being dropped as a child. Dr Perper has performed several autopsies on notables in the past few years and is not shy of publicity, with the result that he’s becoming something of a celebrity himself, like the LA “Coroner to the Stars” Dr Thomas Noguchi before him (model for TV’s Quincy).
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