So much of the Dr. Conrad Murray trial has revolved around drug use (and possible abuse), addiction and treatment. So we're turning to addiction specialist Dr. Drew Pinsky to help answer some of the burning questions about this case after two weeks of testimony.
Smith: Let's talk about Michal Jackson's death. Because one thing that stunned me once I saw the autopsy report, was not only just the level of propofol in his system, but it’s all the other drugs in his system. I want you to start with propofol. What is propofol typically used for and what was it used for here?
Dr. Drew : Propofol is typically used in a hospital, really with general anesthetic level of monitoring. So we use it in an operating room, we use it in an ICU for somebody on a ventilator, you don't want them to suffer with that. You use it in an emergency room for a procedure and that's it. When I first heard that they were using propofol outside of a hospital, to me that was like saying, "An asteroid landed outside this building." I mean that was like unheard of to me.
I had heard of people abusing propofol. The only circumstance in which I'd ever heard that was anesthesiologists, because they could get it. And they could administer it to themselves and they would abuse it and they'd get severely addicted. But that's the only time I'd ever heard of it outside of a hospital.
Smith: But why would people get addicted to propofol? What's the addictive quality that it gives?
Dr. Drew: It's a sedative. It [acts like] a barbiturate. In and of itself, it's not that addictive in my experience, because its hard to administer and it requires continuous infusion and stuff, but it's similar to say a Xanax addiction.
Now that I've brought up Xanax, he actually was given the night he died, a massive dose of a relative of Xanax called lorezepam which some people know as Ativan which comes in a pill. It's also available by shot and intravenous. He got it intravenously. He got enough Ativan to put you and me to sleep for the next 36 hours.
That in of itself should be a "wow" for everybody. But I'll tell you, the thing that was the most disturbing part of this for me is that propofol is a barbiturate. Ativan is a benzodiazepine. On paper, you are never supposed to use those together. Together they cause respiratory suppression. They cause people to stop breathing.
So in my world once somebody has received an Ativan-like drug, you just don't give a barbiturate for at least 24 to 48 hours. You just don't do it. And here was a guy getting massive doses of both. To me, outrageous.
That, as an addictionologist, you know we take people off the benzodiazepine drugs, the Ativan, the Xanax, and we use the barbiturates to take them off. But we don't even administer the barb until they've had at least 24 hours. They just don't even overlap. You never let those two things occur in the body together.
Smith: So what does it tell you that he had seven different drugs in his system?
Dr. Drew: Well, it tells you he's very tolerant. It tells you that wasn't the first time he's exposed to those drugs.
And as I watched the evening unfold, it's clear to me he was in drug withdrawal. And there is some documentation that Dr. Murray was trying to get him off drugs. That's probably what was going on. That's why he started spinning so, so high. And you know the number one complaint of someone in drug withdrawal is "I can't sleep."
Dr. Drew: That's the number one complaint. And it's even harder to get them to sleep once the withdrawal has escalated. So he was in a situation where I suspect, there was severe drug withdrawal going on and the way he approached it was not sophisticated at all. It wasn't in terms of treating drug withdrawal. And, and on top of that, he seemed to kind of miss the drug withdrawal and just thought he was treating sleeplessness which is just not the case.
Smith: Well I think that one thing we'll probably hear in this trial is that Dr. Murray wasn't aware of everything that Michael Jackson was taking and again I'm not trying to say this will definitely be the defense's strategy.
Dr. Drew: I think that's relevant. I do think it is relevant. It doesn't justify the combination of things he got and the way they were monitored and the fact that it was outside of a hospital. Now they'll also probably say, "Well he's been getting this outside of the hospital for a while." Yeah, I'm telling you though, if, if I'd seen that, it would've been a hands up, "We we can't do this."
Smith: And that's the thing that gets me. The idea that yes, Dr. Murray has said,"Well we were trying to wean him off the propofol."
Dr. Drew: Unacceptable from my standpoint. Again, but remember I'm an addictionologist. Dr. Murray's a cardiologist and who do we blame for that? You know is that AEG? Is that Michael or is that Dr. Murray? The fact that a cardiologist was monitoring a complex drug withdrawal patient with probably some psychiatric problems and some medical problems. Who thought this was the right guy for that? Who do we hold accountable for that?
Smith: You know it's interesting that you bring that up because alright, who do we hold responsible? But at the same time, isn't it the doctor who needs to say, "I need to take myself out of this?" Because I know as a lawyer, if somebody says, "Hey Ryan, can you do this uh, this tax transaction for me.” No I can't. I've never done that work before.
So, let's get some of your impressions of Michael Jackson. What did you see in him?
Dr. Drew: Well, you know I've actually met him a couple of times and he's an... unusual person. People around him loved him. And I think we all know later in his life he got very involved with substances, pharmaceutical substances. And bottom line from my perspective is, my profession ill-served him, didn't do well by him.
Dr. Drew: Well you know, he was getting drugs from multiple sources, the pharmaceutical system had no checks and balances to sort of put up a red flag and apparently people are prescribing it to other names. And ultimately we have a doctor that really relinquishes his practice to dedicate full-time to the care of Michael Jackson and clearly that care didn't go well.
Smith: It seems that people saw Jackson as a caricature instead of a real person. Why do we have the tendency to see him in that other light?
Dr. Drew: Because he became somebody that seemed to be peculiar to us. I mean we certainly weren't making that kind of a figure of him back in the "Thriller" days, were we?
But as he started sort of morphing and changing and having surgeries and withdrawing more, and by the way, as he became more famous, that's part of what he may have been reacting to. That's when we started becoming more critical I think. And I wouldn't even say we. It's when the press specifically became more critical and so the public started perceiving those things as the totality of who he was the sort of caricatures that were being painted of him. Remember all this horrible stuff in the British press and everything?
Dr. Drew: I mean, yeah, there was some truth in it. There were peculiarities and maybe that's a function of how famous he was. But it missed apparently who the person was.
And, and I'll tell you what, that again bore out in his medical care, because he was not being treated as a total person the way we normally would [normally treat someone].
Let me sort of tell you what I mean. You know, somebody that's complicated, that has a substance history that has insomnia, emotional issues and sort of special life circumstances -you would never try to tackle that on your own, as a doctor. But because he was special, he got the special care of one individual. And whenever a celebrity gets special care, they get sub-standard care.
Smith: It's interesting that you say that because every time we hear that word "special", we think well, that's gonna be better. They have all of this money, celebrities do, it's gotta be better, it's gotta be better than what I would normally have.
Dr. Drew: Most of the time it's not. I mean its one thing to say there's a surgeon out there that does a special procedure. That's very different than the totality of my care for my needs.
Smith: So let me ask you this. Is the mere fact that Dr. Murray chose to become his doctor, was that irresponsible just on its face?
Dr. Drew: Yes.
Smith: Because you say he should have had this team around him.
Dr. Drew: Correct. You're using a specific word, "irresponsible." I'm not sure if I'm prepared to use that word yet, but I can tell you it's where he got off the rail. Right there, that's where the thing jumped off the rail and there was no possibility of it going well.