The Drug Enforcement Agency is going to investigate how Heath Ledger obtained the four prescription drugs that ended up killing him. Yesterday the Medical Examiner announced that his death was an accident caused by “acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine.” People reports that the DEA has confirmed that an investigation is underway, and their spokesman said that “We are working with the NYPD to identify any illegally prescribed drugs that may have been prescribed to [Ledger].”

It seems clear that the Medical Examiner is saying he died from a fatal drug interaction and not from too much of any of those single drugs. The autopsy confirmed that he had pneumonia and he probably felt awful right before he died. He took two different painkillers, two different anti-anxiety medications and two different sleeping pills. That seems excessive, but who knows at which point he took which medication, and it’s possible he forgot that he took one and groggy, took another one. Maybe it was hours apart, we don’t have enough information to know if he took them all at one time.

Ledger’s co-star in the movie he was working on in London just prior to his death, The Imaginarium of Doctor Parnassus, talked about how grueling the work was for that film, all of which took place outside in the cold. Christopher Plummer, who plays Dr. Parnassus, said: “We all caught colds because we were shooting outside on horrible, damp nights. But Heath’s went on and I don’t think he dealt with it immediately, even when he was taking antibiotics. I think what he had was the walking pneumonia. We had to shoot every second we were out there. There was hardly any time to keep warm. He was saying all the time, ‘Damn it, I can’t sleep’, and he was taking all these pills to help him.”

It sounds to me like he was very sick and thinking it would help he took a different painkiller or a different sleeping aid, maybe one or two more pills than he normally did, and they all suppressed his central nervous system. The AP has a very good explanation of this, and they quote an expert who says “This was not rock star wretched excess” and that it’s possible the drugs built up in his system over days and not hours:

Doctors not connected with the case said it would be unlikely for one doctor to order all the drugs. However, they said it’s not unusual for people to be prescribed both painkillers and sedatives, and overdoses are not uncommon.

“This is not rock star wretched excess,” said Cindy Kuhn, a pharmacology professor at Duke University. “This is a situation that could happen to plenty of people with prescriptions for these kind of drugs.”

Kuhn said some of the drugs are long-lasting and Ledger could have taken them over a period of several days. The medical examiner’s office wouldn’t say what concentrations of each drug were found in Ledger’s blood.

“What you’re looking at here is the cumulative effects of these medications together,” said the spokeswoman, Ellen Borakove.

‘This was an accident’
Police had said they found six bottles of anti-anxiety medicines, sleeping pills and other medicine in his Manhattan apartment after the Oscar-nominated actor was discovered dead in his bed last month.

“This was not a deliberate attempt to kill himself. This was an accident,” said Lawrence Kobilinsky, head of forensic science at John Jay College in New York. He had no role in the investigation. “He just took too many drugs having similar effects on the central nervous system.”

Experts said the combination of sedatives and the other medicines likely combined to suppress his brain function and his breathing. They said that Ledger probably had been prescribed the medicine by a number of different doctors, because several of them were from the same class of drugs and used to treat similar symptoms.

“It doesn’t make sense” that one doctor would prescribe all those, said Dr. William Lee, an internal medicine specialist at the University of Texas-Southwestern in Dallas. “It’s more likely that he got them from different prescribers.”

Jane Prosser, a medical toxicologist from New York University School of Medicine, said patients can often end up with similar medications prescribed by different doctors, who are unaware of what they’re already taking.

[From MSNBC, thanks to reader headache for the link]

Some of Heath’s medications were prescribed overseas, and people are pointing that out as if it’s a bad thing, but he was in England working right before he died, and he was very sick and couldn’t sleep. Even if he told the doctor what he was already taking, he may have given him a prescription for another medication saying “try this” without advising him not to take those two drugs together. This very scenario has happened to me.

A lot of us have horror stories about prescription drugs causing extreme debilitation for us and people we know. Instead of all the flashy advertisements about how a condition can be treated by some miracle cure, resulting in sun-filled days frolicking with our loved ones, the drug companies need to step back. Their marketing methods and the way they push drugs on doctors need to be highly regulated. Maybe drug ads should be banned from television like cigarette ads are, and it’s about time that someone imposed more stringent standards on the pharmaceutical industry overall. I have had a doctor recommend a specific drug to me over another I asked for, and then gone out into the waiting room to see the pharmaceutical rep for that very drug giving the secretary samples. Just because a doctor prescribes a drug doesn’t mean it’s safe. It’s not the patient’s fault, either. Many people trust their doctors and will do what they say and many doctors barely glance over the medications the patient is currently taking before giving a new script.

Heath may have known that it wasn’t safe to take that many drugs, but it’s doubtful that he realized they could kill him.