By John Horton

Sunday Houston Chronicle (August 30, 2009)

Anna Nicole Smith. Heath Ledger. Michael Jackson. What common bond do these celebrities share? The answer is found not in how they lived, but how they died — prescription drug overdose.

Unfortunately, these disturbing situations are not isolated incidents. According to government data, fatal overdoses from prescription pain killers have more than doubled from 3,994 in 2000 to 8,541 in 2005 (the last year for which data is available). And this trend is forecast to continue growing. The Centers for Disease Control and Prevention (CDC) has predicted that the frequency of this type of overdose continued to increase for 2006 and beyond.

Even without considering the overdose statistics, prescription drug abuse numbers are alarming.

Let’s put the figures in perspective. Remember the crack cocaine crisis of the 1980s? At its height in 1988, there were just over half a million crack users. What about the methamphetamine “epidemic” of a few years ago? Actually, in 2004, there were just under 600,000 meth users. And prescription drugs? Brace yourself. In 2006 and 2007 (the last years for which complete estimates are available) an estimated 7 million Americans were abusing these regulated pharmaceuticals. That’s nearly double the 3.8 million estimated for 2000.

Today, there are more prescription drug abusers than there are abusers of powder cocaine, crack cocaine, heroin, ecstasy, LSD, PCP and methamphetamine combined.

If this is America’s new drug problem, who are the drug dealers? Certainly, over-prescribing “rogue” Internet pharmacies and doctor-shopping all share some part in the blame. But the celebrity cases highlight a disturbing trend: the “hanger-on” who clamors to fill a need in the star’s life, and in return, gets to bask in the glow of the limelight. In the case of prescription drugs, the hanger-on could be a doctor or an intermediary with access to physicians. Either way, these enablers help facilitate the person’s prescription drug abuse, then addiction, and even overdose, just as surely as a street-corner drug-pusher.

In the case of Michael Jackson, early allegations suggest that Dr. Conrad Murray of Houston was essentially hired to be Jackson’s personal prescription-drug provider. As a licensed physician, Murray has the legal authority to prescribe drugs — but also has the obligation to adhere to the centuries-old Hippocratic oath to “do no harm.” This means that responsible physicians must sometimes refuse requests for painkillers, when the motive isn’t pain or treatment, but recreation or addiction.

With Anna Nicole Smith, a physician may not have been on staff, but an intermediary surely was. Shortly after her death, local authorities charged Howard K. Stern — first her attorney, then her agent, then her lover — with several felonies, including obtaining fraudulent prescriptions and conspiracy to furnish controlled substances. Stern is accused of having recruited two physicians to ensure that Smith had a steady supply of prescription drugs, irrespective of whether she had a genuine medical need. Smith’s autopsy report indicated that in addition to a sedative (Chloral Hydrate), she had at least seven other prescription drugs in her system, including Valium and Klonopin — a potent and fatal combination.

Do no harm, indeed.

Even more disturbing are the financial stakes involved. If the reports are accurate, Murray was heavily in debt, and was paid $150,000 a month to act as Jackson’s personal physician. It is not difficult to understand why Murray might have been reluctant to decline Jackson’s repeated requests for prescription drugs.

As for Stern, California Attorney General Jerry Brown noted that “there (was) a lot of money floating around.” Stern’s alleged facilitation of Smith’s prescription drug abuse may well have ensured her dependence upon him, and thus his continued employment with her. Street-level drug dealers have always aimed to make their customers dependent, solely for financial reasons. The evidence suggests that these celebrity consiglieres are no different.

And what of the rest of us? The allegations against Murray and Stern highlight a dynamic that’s played out on a smaller scale every day across the nation.

Most physicians responsibly distinguish between a legitimate medical need for prescription drugs and requests for prescription drugs designed to feed an addiction. But, there are also those who are little more than drug dealers in white coats, supplying drug seekers regardless of medical need. If unwarranted requests for prescription drugs continue to be met with an easy supply chain — among celebrities and the general public — we should prepare ourselves for a frightening growth in membership to the overdose club.

Horton is the president of LegitScript.com, which conducts market research on the online pharmaceuticals market and verifies the legitimacy of Internet pharmacies. He served as an associate deputy director in the White House Drug Policy Office from 2002 through 2007, and before that, was a prosecuting attorney in Multnomah County, Ore.