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Combined Drug Intoxication or CDI, also known as Multiple Drug Intake (MDI), is an unnatural cause of human death. While it is sometimes reported as a simple "overdose", it is distinct in that it is due to the simultaneous use of multiple drugs, whether the drugs are prescription, over-the-counter, recreational, or some combination. The reasons for toxicity vary depending on the mixture of drugs.

CDI can occur with numerous drug combinations, including mixtures of over-the-counter (OTC) drugs, illegally obtained prescription drugs, herbal mixtures, and home remedies. Ingestion of alcoholic beverages, in combination with other drugs, increases the risk of CDI. Drugs which may fatally interact with one another need not be pharmacologically similar.

The CDI/MDI phenomenon seems to be becoming more common in recent years. In December 2007, according to Dr. John Mendelson, a pharmacologist at the California Pacific Medical Center Research Institute, deaths by Combined Drug Intoxication were relatively "rare" ("one in several million") though they appeared then to be "on the rise".^[1] In July 2008, the Associated Press and CNN reported on a medical study showing that over two decades from 1983 to 2004, such deaths have soared.^[2]

Physicians whose patients die from CDI may face malpractice lawsuits and consequences from state licensing boards.

Contents 1 Risk factors 2 Prevention 3 Direct causes of death 4 Celebrity deaths due to CDI (or MDI) 5 Karen Ann Quinlan case 6 See also 7 Notes 8 External links

Risk factors

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People who engage in polypharmacy and other hypochondriac behaviors are at an elevated risk of death from CDI. Elderly people are at the highest risk of CDI, due to having many age related health problems requiring many medications and due to impaired judgment leading to confusion in taking their medications.^[2] Wealthy and or professional people and their families, especially their children, are at high risk, simply due to their ability to buy expensive drugs. Entertainers seem to have the highest risk of dying from CDI/MDI. Physicians are pressured by their celebrity patients, who claim they cannot perform their livelihood, without prescription narcotic painkillers or claim that their life is so stressful, that they need tranquilizers to cope with their fast paced hectic lifestyle.^{citation needed}

Prevention

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In general, the simultaneous use of multiple drugs should be carefully monitored by a qualified individual. Close association between prescribing physicians and pharmacies, along with the computerization of prescriptions and patients' medical histories, aim to avoid the occurrence of dangerous drug interactions. Lists of contraindications for a drug are usually provided with it, either in monographs or package inserts (accompanying prescribed medications) or in warning labels (for over-the-counter (OTC) drugs). CDI/MDI might also be avoided by physicians requiring their patients to return any unused prescriptions. Patients should ask their doctors and pharmacists if there are any interactions between the drugs they are taking.

Direct causes of death

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Combined Drug Intoxication can be caused by interactions between many different drugs.

CDI/MDI deaths often involve multiple CNS depressants, such as benzodiazepines and narcotic analgesics. Interactions between depressants may lead to severely depressed breathing or slowed heartbeat (bradycardia), causing the victim to become unconscious or comatose. While unconscious, the victim may regurgitate and die from asphyxia, in effect, drowning in vomit.^{citation needed}

Certain drugs potentiate or amplify the effects of another drug. This can lead to much stronger effects than either drug taken alone would produce. Alcohol, a depressant, will potentiate the effects of other depressants. This can cause respiratory depression and bradycardia. Because alcohol is legal, easy to obtain, and commonly used, it may figure in about half of all MDI/CDI cases.^{citation needed}

A CDI victim may have a drug-induced heart attack or heart failure. Multiple drug usage may weaken the human heart, which may fail during bowel movements. Many victims are found dead in their toilets. Some drugs may weaken the human immune system, making the patient susceptible to infections. It has been speculated that Howard Hughes may have died in such a manner.^{citation needed}

The combination of OTC and prescription analgesics like NSAIDs and acetaminophen can (potentially fatally) damage organs including the kidney, liver, and pancreas. Certain drug combinations can cause a mechanical interaction with blood, leading to excessive clotting. Clots may then travel into the heart, brain, or lungs and block blood flow, depriving tissue of oxygen and causing unconsciousness and then death (thrombosis).^{citation needed}

Celebrity deaths due to CDI (or MDI)

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Celebrities who died from CDI include: Hawthorne Heights guitarist Casey Calvert, who died from combining three drugs^[1]; actor Montgomery Clift, who died from alcohol and barbiturates; actor Nick Adams, who died from three or more drugs; Acid Rock guitarist Jimi Hendrix, who died from asphyxia caused by alcohol and barbiturates; singer Elvis Presley, who had over 10 drugs in his system when he died (The license of his physician, Dr. George C. Nichopoulos was later suspended and then revoked after press reports from then-ABC News reporter Geraldo Rivera on 20/20.); Lester Bangs, who died from diazepam and propoxyphene; Deep Purple's Tommy Bolin, who died from alcohol and prescription and illegal drugs in combination; David Anthony Kennedy, son of Senator Robert Francis Kennedy, who died from combining cocaine, demerol, and mellaril; singer Johnny O'Keefe, who died from combining several prescription drugs; Steve Clark of Rock group Def Leppard, who died from combining antidepressants, tranquilizers, and alcohol; executive producer Don Simpson, who died from combining over 9 drugs^[3]; Lani O'Grady of Eight is Enough from combining Vicodin and Prozac; Elisa Bridges, who died in 2002 from combining four drugs; Bridgette Andersen, who died from combining alcohol and multiple drugs; Zac Foley of EMF, who died from combining multiple illegal drugs; and John Kahn of the Grateful Dead, who died from combining heroin, cocaine, and Prozac.

In February 2007, just two months after her son Daniel Wayne Smith was found dead from CDI earlier in December 2006, with over five prescription medicines in his system,^[4] Anna Nicole Smith died from CDI also, an autopsy detecting 11 drugs in her bloodstream.^[5][6]

Australian actor Heath Ledger was found dead on January 22, 2008, in his SoHo, New York City, apartment; the toxicology report concluded that the cause of his death was "acute intoxication" resulting from "the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine" and "that the manner of [his] death" was "accident, resulting from the abuse of prescription medications."^[2][7][8]

Further information: Heath Ledger#Autopsy and toxicological analysis

Karen Ann Quinlan case

See main article: Karen Ann Quinlan

The Right to Die case of then-comatose Karen Ann Quinlan (March 29, 1954 - June 11, 1985) made legal history in 1975 and 1976, stimulating public scrutiny of ethical and moral implications of her case. In 1975, after drinking gin and tonics at a party and then taking diazepam, Quinlan collapsed, suffered respiratory failure and irreversible brain damage, and, after being taken to the hospital, lapsed into a persistent vegetative state. After she had been kept alive on a ventilator for several months without improvement, her parents requested that the hospital discontinue such active care and allow her to die. The hospital refused, and the subsequent legal battles made newspaper headlines and set significant precedents. After the New Jersey Supreme Court ruled in her parents' favor, Quinlan spent nine years more years comatose in the hospital, before dying from pneumonia in 1985.^[9]

See also

• Adverse drug reaction
• Drug
• Drug abuse
• List of drug-related deaths
• Pharmacovigilance

Notes

External links

• Drug Interactions Checker at Drugs.com: Drug Information Online (Micromedex) - "Drugs.com is the most popular, comprehensive and up-to-date source of drug information online. Providing free, accurate and independent advice on more than 24,000 prescription drugs, over-the-counter medicines and natural products." (Home page.)
• Drug Interaction Checker at Medscape (registration required).

Wikipedia content modification information:

• This page was last modified on 10 October 2008, at 04:34.

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