Heath Ledger and “Legal” Drugs

by MARK GABRISH CONLAN, Editor

Copyright © 2008 by Mark Gabrish Conlan for Zenger’s Newsmagazine • All rights reserved

Brokeback Mountain star Heath Ledger’s sudden, tragic death January 22 has evoked comparisons between him and James Dean: two young, hot movie stars with intense personalities that crossed sexual boundaries (though Dean was a real-life Bisexual while Ledger just played one in a movie), both of whom died in their 20’s and stuck the same company, Warner Bros., with the chancy task of selling epic movies (Dean’s Giant and Ledger’s The Dark Knight) that still had months of post-production left before they could be released.

But if the preliminary evidence on Ledger’s death checks out — particularly the fact that the New York loft where he died contained no illegal “recreational” drugs but at least six different prescription drugs, including the highly toxic sleep medication Ambien — the list of celebrity deaths Ledger’s belongs on is the one that includes Marilyn Monroe, Judy Garland and Elvis Presley. They didn’t get their drugs in glassine envelopes from grubby street pushers; they got theirs in little brown bottles with doctors’ names on them. Over time, they became so addicted to prescription drugs that they were able to tolerate quantities that would have killed a first-time user instantly — until one day a lethal combination of drugs finally did them in.

The technical term for what killed Elvis, and what probably killed Heath, is polypharmacy: the lethal interaction of several drugs taken at or near the same time. Drugs are chemical compounds, and when you take more than one at a time they have the potential to react with each other and create new compounds far more toxic than the initial drugs. Also, most of the commonly abused prescription drugs are either synthetic opiates (like Elvis’s favorite, Dilaudid; and Rush Limbaugh’s drug of choice, Oxycontin), sleeping pills or psychotropic drugs: all of which affect the brain and make it difficult for the person using them to keep track of just what he or she has already taken, when and how much.

For too long, prescription drug abuse has been America’s great hidden drug problem. According to the U.S. Centers for Disease Control (CDC), “unintentional poisoning deaths” — almost all of which are overdoses of either legal or illegal drugs — increased from 12,186 in 1999 to 20,950 in 2004. What’s more, according to CDC researcher Len Paulozzi, during that period prescription drugs became the leading causes of overdose deaths, more than cocaine and heroin combined. Overdose deaths from psychotropic drugs — including sleeping pills, antidepressants and tranquilizers — increased 84 percent from 1999 to 2004, according to Paulozzi’s study.

A survey by the National Center on Addiction and Substance Abuse at Columbia University in New York reported that the number of Americans admitting to using prescription drugs for non-medical reasons has almost doubled, from 7.8 million in 1992 to 15.1 million in 2003. Abuse among teenagers almost tripled, this study said. But the implication that prescription drugs are only dangerous if they’re sold illegally is wrong. Stars at the level of Marilyn, Judy, Elvis and Heath collect doctor-groupies just like they frequently collect other sorts of groupies — M.D.’s like two of the doctors implicated in Elvis’s death, George Nichopoulos and Elias Ghanem, perfectly willing to write unnecessary prescriptions (often in the names of members of the stars’ entourages as well as the stars themselves) in order to get celebrities as friendx.

The explosion in prescription drug-related deaths has tracked closely the explosion in prescription drug use, which has soared nearly 500 percent since 1990. That in turn has come about for two reasons: the increased use of drugs to treat conditions like ulcers that used to require surgery, and the government decision in the 1990’s to allow makers of prescription drugs to advertise directly to the public.

We’ve all seen those commercials: luscious pieces of filmmaking with good-looking people proudly proclaiming how these drugs have saved their lives, while in the background we hear treacly New Age music and see glorious landscapes in twilight (what cinematographers call “magic hour”). Often the ads are more informative about what the drugs look like than what they treat; the ads for Nexium make a big to-do about the purple color of the pill (the drug maker’s Web site for it is even called “thepurplepill.com”), while you have to listen very carefully to find out exactly what Nexium is supposed to do.

It’s true that, by law, the TV commercials for prescription drugs have to disclose the potential side effects — but those disclosures are usually delivered by an announcer suddenly accelerating his voice to near-warp speed in the auditory equivalent of fine print. What the commercials are all about is what all TV advertising is about: creating a warm, comfortable image for the product so you feel you just have to have it. Ambien, one of the most potentially lethal drugs in Heath Ledger’s personal pharmacopoeia (and one he was so addicted to at the end that, according to his own admission, two pills would only put him under for an hour or so), is advertised with a digitally animated butterfly against a deep blue background flying through an open window and bestowing the blessed gift of sleep on you.

What’s more, the pharmaceutical industry in general has followed a marketing strategy designed literally to create addicts. As Melody Petersen noted in an op-ed in the January 27 Los Angeles Times, “A Bitter Pill for Big Pharma,” “executives have shown less interest in medicines like antibiotics that actually cure disease than in those that only treat symptoms. Most blockbuster [drugs] are pills for conditions like anxiety, high cholesterol or constipation that must be taken daily, often for months or years. They are designed for rich Americans who can afford to buy them. Medicines for tropical diseases, including malaria, which is devastating the developing world and killing a child every 30 seconds, have never been an industry priority.”

That’s not only for the reason Melody Petersen cites in her article — “The poor can’t pay the high prices a blockbuster demands” — but also because drug companies have made the perfectly understandable decision that they don’t want to sell a “cure” for a disease. What they want is to put you on the hook for their product and keep you there. We saw this in the discourse around AIDS, which quietly shifted in the mid-1990’s from talk about a “cure” to talk about making AIDS “a chronic, manageable disease” — in other words, one you wouldn’t die from but only if you took three or more pills a day for the rest of your life.

In today’s mainstream medicine, “preventive care” doesn’t mean what it used to — educating people about diet, exercise and other nonpharmaceutical ways of maintaining good health. Instead, it means encouraging people to take “tests” for everything from cholesterol level to HIV status, then telling them that based on the results of these tests they’re going to get diseases unless they sign up and pay Big Pharma’s going rates for the latest drugs. Not coincidentally, these are the ones that have been developed and approved in the last 20 years and therefore are still under patent protection, meaning only one company can make it and therefore they can make you pay however much they think they can get.

“The marketing of pharmaceuticals that we’ve seen on television in the last 10 years — the whole ‘get some medicine for whatever you need’ attitude — has really increased the acceptability of prescription drugs,” said Richard A. Rawson, UCLA professor of psychiatry and associated director of its Integrated Substance Abuse Programs. “There’s a stigma that’s associated with illicit drugs that isn’t associated with legal drugs.” And yet the two industries are using similar marketing plans and targeting consumers at the same point of vulnerability.

Celebrities, with notoriously fragile egos and locked in a cutthroat business dependent on the good will of a fickle public that can be withdrawn at any moment, are infamously susceptible to the appeals of both legal and illegal drug pushers. The first drug-related death of a movie star, Wallace Reid’s, occurred in 1922. (Only 31 years old, Reid became addicted to medically prescribed morphine and was so weakened that he died of influenza in a sanitarium where he was trying to kick his habit.) Heath Ledger was no exception; at the end he was reportedly run down both by his breakup with actress Michelle Williams (who played the wife he cheats on in Brokeback Mountain and with whom he had a daughter, Matilda) and the intensity of playing the Joker, a psychopathic villain with no redeeming human qualities, in the Batman series film The Dark Knight — and instead of taking some time off for non-chemical rest and relaxation, he’d gone right into making another film.

In life, the solidly heterosexual Heath Ledger became an unexpected Gay icon with his performance as Bisexual cowboy/sheepherder Ennis del Mar in Brokeback Mountain. “Heath Ledger will forever be remembered for his groundbreaking role as Ennis del Mar,” said Gay and Lesbian Alliance Against Defamationi (GLAAD) president Neil Giuliano.. “His powerful portrayal changed hearts and minds in immeasurable ways. He will be greatly missed.” It would be nice if, in death, Ledger becomes an equally powerful silent advocate warning of the dangers of prescription drug abuse and the need to resist drug-company marketing strategies that seek to define every less than wonderful aspect of the human condition as a “disease” that can only be treated with a high-priced drug.