About Time We Talked About Michael Jackson, Don't You Think?

It’s a safe bet that some of our readers here at T&T wonder why we haven’t really jumped on the Michael Jackson bandwagon. Imagine if T&T had been in existence during Jackson’s 2005 child molestation trial? What a field day that would have been!

It’s my belief that when Michael Jackson is the topic of conversation, no one is really on the fence where he’s concerned. You are either a fan of his music or you are not (I have never been, even when I was a kid. Back then I was more of a Led Zeppelin, Bachman Turner Overdrive, Eagles type of kid). You either believe he molested those boys or that he didn’t, and there’s no talking you out of it. 

(I believe he did, but I think what he did was what kids do—they “play doctor”—“I’ll show you mine if you show me yours” kind of thing. He probably knew what he was doing was not age-appropriate but because his childhood was far from normal, he was acting out childhood fantasies he was not allowed to fulfill when he was a primary and elementary school-aged kid. Perhaps in his developmentally-immature mind, he was protecting those kids from what he perceived as an abusive situation and wanted them to simply “be kids” when they were with him.)

However, most everyone can agree that something happened to him when he was just a child, and the fingers pretty much point to his father as being the source of the abuse, and the source of much of the dysfunction in Michael Jackson’s life.

So when I heard the news that he’d died on the afternoon of June 25, after I'd spent the afternoon at the movies watching “The Proposal,” the first thing I thought was “another Anna Nicole.” Like all of you, I’d read tabloid rumors about his having lupus, and I know that in its most severe form, it can kill you. We all know about the vitiligo, a skin disorder that can cause much mental pain but itself has few systemic negative health effects. But Michael Jackson was going through some vigorous physical activity in preparing for his London appearances, so who knew how his health really was or how his body was holding up with long hours of rehearsals.

We also have a man who tried to “call in sick” for his molestation trial because of severe back pain—pain so severe he essentially shut down an emergency room when he and his entourage stopped by early one morning. He’d also done time in rehab for an addiction to pain pills that started when he was severely burned while filming a Pepsi commercial many years ago at the height of his popularity.

I remember saying “It was drugs, a cumulative overdose” right off the bat. I had no idea it was really as bad as it seems to be turning out to be.

I believe it was the day after Jackson died that the reports of a “shot of Demerol” started coming up. Demerol is a commonly used narcotic—most everyone’s received it at one time or another. And usually it’s not a harmful drug, used sparingly—but it has a very dark side too, something I know a bit about.

There is a move by medical practitioners to use Demerol less frequently because of its negative pharmalogic effects.

The metabolite of Demerol, normeperidine (the generic name for Demerol is meperidine) is highly neurotoxic. The drug’s half-live is fairly long (15 to 20 hours) and normeperidine’s effects are felt long after the meperidine has metabolized. In other words, a person feels pain and his or her nervous system can be going haywire over the effects of the normeperidine. A person with normeperidine toxicity can experience irritability and nervousness; agitation, twitching and tremors (that’s what happens to me); myoclonus jerking and grand mal seizures

I have specifically been told to never have even a single dose of Demerol ever by several anesthesiologists. I might be fine, but I might just have a grand mal seizure. No one can be sure.

Grand mal seizures can kill a person, and that’s what I envisioned could have happened, or Jackson still had enough active meperidine in his system that he could have gone into respiratory arrest with “just one more pill/shot.”

Meperidine is poorly absorbed through the digestive tract, so a doctor will prescribe a slightly higher dose. Problem is, a person can still get the same amount of normeperidine jerking your central nervous system around. Fifty milligrams of oral Demerol may work as well as 25 milligrams when given into a muscle, but those 50 milligrams are broken down in the same manner, so you get the same “dose” of toxic metabolite.

Then word came out about the Deprivan (propofol). First I thought “no way.” This is a medication that has absolutely no place in outpatient care. (By outpatient care I mean at home. This medication is frequently used in outpatient surgery centers for diagnostic procedures such as colonoscopy or bronchoscopies.) It might not be a highly controlled substance, but it’s also not something that the pharmacy in your neighborhood has any reason to keep in stock!

This is another medication many of us have had—while undergoing general anesthesia. It’s a milky white drug, and it stings like no one’s business when given through an IV. But you won’t care about the pain, because as you get ready to say “ouch,” you go out like a light!

Generally speaking, your body clears this drug pretty quickly, so if an anesthesiologist elects to use this in combination with other drugs to keep you unconscious during surgery, you may get a continuous infusion. It’s also used to sedate ICU patients. HOWEVER, whenever this drug is used, there must be ONE medical professional monitoring the patient for low blood pressure and apnea (lack of breathing), and that person must be able to initiate symptomatic treatment—which means a person using this drug is usually intubated and ventilated.

With prolonged use, a propofol abuser could experience propofol infusion syndrome. Signs and symptoms can include cardiac failure, metabolic acidosis, and rhabdomyolysis (damage to muscle tissue that results in breakdown products flooding the bloodstream, causing a fluid shift that can lead to low blood pressure, electrolyte imbalances, or disseminated intravascular coagulation [DIC]).

One simple shot does not reverse propofol overdose or propofol infusion syndrome. Treatment is supportive, but propofol infusion syndrome is still often fatal.

Any doctor who is dumb enough to prescribe that medication in an outpatient home care setting is negligent. Any nurse who injected that medication into Jackson in a home care setting is negligent. Any lay person who learned how to do an IV injection for Jackson to give him the propofol is a murderer.

I’ve not read any media reports that intubation equipment or a ventilator was sitting around Jackson’s home. As a matter of fact, had it been, that should have been the initial treatment initiated by the doctor at the home, non-board certified cardiologist Conrad Murray. Had that equipment been on hand, Jackson might be alive today.

 

Even more reports state that the only things found in Jackson’s stomach were pills. I’ve read those pills were oxycontin. The active ingredient in oxycontin is oxycodone, more commonly known as Percodan (oxycodone and aspirin) or Percocet (oxycodone and acetaminophen). Oxycontin differs from the “percos” in that it’s a timed-release drug. 

The worst-case possibility is that Jackson had oxycontin on board that wasn’t working quickly enough, so he was given (or took) a quicker-acting narcotic (Demerol) for faster relief. Not feeling sedated enough, a well-meaning (but utterly stupid) person gave Jackson the propofol injection. Voila!

An injection of Narcan wouldn’t have been enough to revive him if there had been normeperidine in his system—as a matter of fact, Narcan would have made things far worse. A treatment (obviously not readily available) for normeperidine toxicity is hemodialysis.

So what kinds of “medical devices” did Dr. Murray have anyway? Why didn’t he have something as simple as a CPR mask? What is the use of having a doctor on staff if the only equipment he has is a stethoscope and blood pressure cuff? And why this particular doctor? Jackson would have been better off with Dr. Drew than what he ended up with.

Many of us are simply gobsmacked that nobody stepped forward and made Michael quit taking so much medication. No doubt he had the money to buy the best medical care available. There are other ways to treat back pain, if that was his primary complaint. Unless you have lived with an addict, you have no idea how hard they are to deal with—especially one who doesn’t have to steal money from his mother to go buy his fix from his friendly neighborhood drug dealer!

Michael Jackson was surrounded by “yes” people, and anyone who dared say “no” was banished from a lucrative meal ticket. Watch an episode of “Intervention” on A&E. Everyone sees the train wreck, but no one has the power to stop it from happening. How many times did Jackson “hit bottom?” 

Perhaps he was clever enough to have multiple “treating” physicians, none of whom knew about the other. Prescribing Oxycontin or Demerol (oral or injectable) is perfectly legal. Those drugs are commonly available at a pharmacy. The propofol is another thing entirely and the physician who prescribed that drug is guilty of the worst kind of malpractice.

But I suspect he was paid very well to prescribe that drug. 

I don’t believe that he intended to die. From all accounts, he loved his children, regardless of their biology. He would not purposely harm them in any way, the ultimate harm being abandoning them through death. I firmly believe Michael Jackson was as salvageable as Anna Nicole Smith was—with the right people getting them on track through rehab and ongoing treatment. Each were meal tickets for less-than-scrutable people, and it was easier to feed their addictions (and keep the money coming) rather than risk being tossed from the inner circle. 

What do you think happened? What do you think the consequences will be? Who is at fault? Will dispensing laws change? Will pharmacists be held responsible for prescribing drugs they know have no place in outpatient home care?

And can this sort of behavior be prevented from happening to Michael’s kids?

CNN: Diprivan risk well known to doctors