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S. Robert Lathan, MD
Corresponding author.

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Numerous celebrities the the past fifty percent century have been plagued through substance abuse problems, with destructive results. This post highlights some of the most well known cases and also briefly discusses clinical views of problem abuse from Osler"s time to the present.


ELVIS PRESLEY

Elvis Presley, the undisputed king that rock and roll, had actually it all: a great voice, talent, and especially charisma. His performances were electrifying and his recordings collection sales records. Being very generous, his action of charity were legendary. His an initial album in April 1956 featured “Heart break Hotel” and catapulted his fame. In 1957, Elvis to be on peak of the world. The proudly served his country in the US army from 1958 come 1960. Picture portraying the “young Elvis” was provided by the united state Postal service as a rubber stamp in 1993 and also became the most popular US rubber stamp of every time (Figure).


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Figure

Watercolor the Elvis by mark Stutzmamn, indigenous the collection of the United claims Postal Service.


Elvis started declining in his last 3 come 4 years. That had challenge performing; received unfavorable reviews; and also experienced anger and depression, colon problems, load gain and also bloating, and bizarre behavior. He had “passed” a physics examination but died suddenly on respectable 16, 1977, in the toilet of his Graceland mansion in Memphis, Tennessee. That was discovered on the floor by his girlfriend/fiancee, Ginger Alden, roughly 2:00 pm.

Elvis had actually visited the dentist the day before for a short-lived crown and also was provided codeine. Later he dubbed his physician, Dr. George Nichopoulas (“Dr. Nick”), for enhanced pain and also was prescribed 6 hydromorphone tablets. Also, 3 packets that prescription drugs because that an upcoming tour arrived, and each packet consisted of secobarbital, ethchlorvynol, diazepam, secobarbital/amobarbital, meperidine, and also antidepressants, typical of what he took on tour.

Elvis play racquetball at 3:00 am on the morning that his death and was detailed to tire easily. Still, he seemed in a an excellent mood and stayed up the rest of the night together usual, to chat his friends and playing the piano and singing before he retired in ~ 8:00 am. (He normally went to bed between 6:00 and also 7:00 am.)

After being found at 2:00 pm, he to be probably already dead. The was required to the emergency room in ~ Baptist Memorial Hospital and pronounced dead in ~ 3:30 pm. Elvis was only 42 year old. One autopsy fail to display an obvious cause the death, but 2 months later a toxicology report shown polypharmacy: 14 medicine were discovered in his system, consisting of codeine (at 10 times the therapeutic level), methaqualone (in a toxic amount), morphine, meperidine, ethchlorvynol, diazepam, and also several barbiturates. The mix of central nervous device depressants and codeine was thought to it is in lethal. However, the clinical examiner"s office grounding to its original diagnosis the “cardiac arrhythmia.”

In stimulate to preserve the Elvis image and legacy, a “cover up” was initiated by the family and also the pathologists. The stomach materials at autopsy to be destroyed prior to analysis, no genuine police investigation was conducted, and also no drugs were uncovered at Graceland. Elvis" sudden death left countless unanswered questions. Many, including F. Lee Bailey, have felt that Elvis could still it is in alive.


MARILYN MONROE

On respectable 4, 1962, at age 36, Marilyn Monroe was uncovered dead in she bedroom in the Brentwood ar of Los Angeles. Her fatality was ruled a self-destruction from an overdose that barbiturates and also chloral hydrate. However, her fatality is still a mystery, and also many are convinced that she to be murdered by organized crime, the FBI, or the CIA. Over there are plenty of conspiracy theories.

An autopsy showed no map of any kind of drugs in she stomach however did present a purplish discoloration that the colon. Toxicology studies found a huge amount that pentobarbital and chloral hydrate in she body. The was argued that the violet colon to be a manifestation of an inflammatory solution to barbiturates, probably administered by enema. (She had enemas frequently, as did other Hollywood stars.) Again, following her death, there was a cover-up through the Los Angeles Police Department and also the government.


JACKIE WILSON

Jackie Wilson, among the first great rhythm and blues vocalists, was born in 1934. His father to be an alcoholic, and also Jackie began drinking cheap alcohol at age 9. In 1975, while performing in brand-new Jersey, he had actually a enormous heart strike followed by cardiopulmonary arrest. He was in a coma because that 3 months, sustaining severe mind damage, and also remained hospitalized because that over 7 years till his fatality in 1984 at age 49.


HANK WILLIAMS

Hank Williams, who videotaped 66 songs and also wrote 50 of castle himself, passed away at age 29. The exact cause of fatality is somewhat of a mystery, return Hank was known to it is in a binge alcoholic and abused opioid analgesics because that chronic ago pain. In addition, he take it chloral hydrate frequently.

His last 48 hrs were together follows. ~ above December 30, 1952, Hank invited up his 1952 Cadillac for a tourism that would take the from Montgomery, Alabama, to West Virginia and Ohio. A 19-year-old college student in the first year was his driver. That was really cold, and a snowstorm covered the entire Southeast. En route, Hank drank heavily and also received numerous injections of morphine from assorted doctors. He experienced convulsions and was noted to it is in wheezing. After really slow progress due to the weather, Hank was inserted in the ago seat that his Cadillac and also covered v an overcoat. (In every likelihood, he was dying then.) leaving Knoxville, Tennessee, approximately 10:45 pm, castle drove with the night right into West Virginia. In ~ some allude early top top this new Year"s morning, the driver headed back to traction Hank"s coat over his body and noted that his hands were very cold. In the emergency room, Hank to be pronounced dead in ~ 7:00 to be on January 1, 1953.

An autopsy was performed in a surrounding funeral house by a “Russian intern.” He provided needle point out on Hank"s arms and also multiple bruises. Alcohol was found in his blood however no various other drugs (because castle didn"t look for them). The official reason of fatality was “right ventricular dilatation,” an unusual conclusion.


THE 27 CLUB

Next, we have the “27 club,” celebrity entertainers who passed away at period 27 of substance abuse.

Janice Joplin, rock singer, passed away in 1970 in Hollywood of a heroin overdose. She also drank quite heavily.

Jimi Hendrix, a famous rock guitarist, passed away in 1970 in London the alcohol and barbiturate overdose.

Jim Morrison, psychedelic rocker and lead singer of the Doors, passed away in 1971 at period 27 the a heroin overdose and was buried in Paris.

Kurt Cobain, lead singer of the alternative rock tape Nirvana, died in 1994 in Seattle that a heroin overdose and also a self-inflicted gunshot wound that the head.

More recently, a 28-year-old almost joined the club:

Actor heather Ledger passed away in January 2008 of one overdose of a variety of prescription drugs, including codeine, temazepam, diazepam, and also alprazolam.


DISCUSSION

The common denominator in every these young celebrity deaths is problem abuse, a an illness that can result in depression, insomnia, personality changes, impaired judgment, and poor relationships. In some of these cases, medical treatment was rather questionable and also inadequate, and self-medication to be frequent. The deaths in many cases were shrouded in secret due to cover-up attempts.

Celebrity patients commonly practice polypharmacy using multiple physicians, multiple medicine stores, and also multiple aliases to acquire medications. Denial increases as dependency worsens.

Prescription drugs, particularly the opioid analgesics, now cause more deaths than heroin and cocaine. All of these drugs deserve to cause main nervous system and respiratory depression. They form deadly combinations with barbiturates and also other sedatives and with alcohol.

What would William Osler have actually done or suggested? the is known that Osler and his colleague, william H. Welch, were very supportive that the renowned surgeon wilhelm S. Halsted, who prior to coming come Johns Hopkins had actually been treated because that cocaine seeks by gift switched to morphine. Later, Osler, as Halsted"s physician, had a secret diary that recorded Halsted"s continued addiction come morphine. Osler wrote, “He might do his work on 3 grains/day.” A later entry stated, “He gained the amount down to 1½ grains/day and later possibly acquired on there is no it.” However, in 1934, Welch stated, “Although it has actually been extensively reported that Halsted overcame his addiction, this is not entirely true. As lengthy as that lived, he will occasionally have actually a relapse and go ago on the drug.” Thus, Halsted led a life of controlled addiction. It is conceivable the a supportive, support trusting doctor-patient relationship played a big role in resulting in this favorable outcome, permitting Halsted"s numerous achievements despite his addiction.

Society"s view of medicine addiction has adjusted very little since Osler"s and also Halsted"s time and also is still commonly approached with secrecy and also denial. It should be provided that in the 19th century and also the early on 1900s, morphine consumption was not just legal but an ext socially acceptable 보다 alcohol. Morphine was used during the American Civil battle as a operation anesthetic and was sent home with plenty of wounded soldiers because that pain relief. Numerous hundred thousands soldiers were addicted to morphine in ~ the end of the war.

The commonwealth drug legislations were a response to the rampant opiate addiction trouble in the USA at the finish of the 19th century. Over the years, we have learned the addictive drugs adjust the brain by cross the blood-brain barrier. By mimicking assorted neurotransmitters, they activate the mesolimbic reward device deep within the brain. The brain"s line is altered, desire is created, and also one"s personality is changed.

How can we perform better? Although part advocates think our “war ~ above drugs” is a failure, legalizing medicine is more than likely not the answer. It would spark significant problems. Permissive ideologies in Sweden, the Netherlands, and also the united Kingdom have later backtracked.

Progress is gift made in the therapy of addiction. Residential therapy programs are effective. The rate of drug usage among teenagers has to be cut nearly in half since its peak 30 years ago. Drug courts are now common, and the criminal justice mechanism has come to be the most powerful force in the nation supporting seeks treatment. Education and learning is the key—not only teaching youth around the health dangers of details drugs but likewise teaching around the disease of addiction. Finally, treatment programs should address general wellness and also factors resulting in addiction, consisting of poverty, lack of education, impaired mental health, and also abuse.

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Addendum

At press time, an additional example that celebrity problem abuse has surfaced. The fatality of pop star Michael Jackson on June 25, 2009, is being investigated for this possibility.