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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.^{[citation needed]}

CDI can occur with numerous drug combinations, including mixtures of over-the-counter (OTC) drugs, legally or illegally obtained prescription drugs, herbal mixtures, and home remedies. Ingestion of alcoholic beverages, in combination with other drugs, increases the risk of CDI.^{[citation needed]}

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] It has also become a prevalent risk for older patients.^[3]

Contents 1 Risk factors 2 Prevention 3 Direct causes of death 4 Paracetamol / Acetaminophen Deaths 5 Celebrity deaths due to CDI (or MDI) 5.1 Anna Nicole Smith and Daniel Wayne Smith 5.2 Heath Ledger 6 CDI-related legal cases 6.1 Karen Ann Quinlan 7 See also 8 Notes 9 External links

[edit] Risk factors

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 combined with age-impaired judgment, leading to confusion in taking medications.^[2][3]

Recent veterans back from war and suffering from Post Traumatic Stress Disorder (PTSD) in combat are at risk of dying from CDI/MDI.^{[citation needed]} Nine Veteran PTSD patients died from CDI/MDI in America in 2007.^{[citation needed]} There are anecdotal reports of veterans dying from combinations of antidepressants, antipsychotics and tranquilizers used in combination with OTC medicines like Diphenhydramine.^{[citation needed]} While still a U.S. senator from Illinois, United States President Barack Obama asked the U.S. Congress to inquire about the safety of these drugs.^{[citation needed]} There is an ongoing investigation of the matter.^[4]

[edit] Prevention

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.

[edit] Direct causes of death

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

CDI/MDI deaths often involve multiple CNS depressants, such as benzodiazepines (particularly strong hypnotics like temazepam, nitrazepam, or triazolam) 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.

Certain drugs potentiate or amplify the effects of another drug and can lead to much stronger effects than either drug taken alone would produce; for example, Alcohol, a depressant, will potentiate the effects of other depressants and can cause respiratory depression and bradycardia; yet, because it 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, and cause constipation or lower intestinal blockage, which may fail during constipated bowel movements. Many victims are found dead on 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 paracetamol(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]}

[edit] Paracetamol / Acetaminophen Deaths

On June 30, 2009 an FDA advisory panel recommended that Vicodin and another painkiller, Percocet be removed from the market because they have allegedly caused over 400 deaths a year. The problem is with Paracetamol overdose and liver damage. These two drugs in combination with other drugs like Nyquil and Theraflu can cause death by Multiple Drug Intake and or Drug overdose or both.

[edit] Celebrity deaths due to CDI (or MDI)

Over 29 Celebrities have died from CDI/MDI. Celebrities who died from CDI include:

• Writer/Actor /Comedian Freddy Soto from Fentanyl, Alprazolam and Alcohol;
• Baseball athlete Ken Caminiti from Cocaine and Opioid painkillers ;
• Actor Trevor Goddard from cocaine, heroin, hydrocodone, and diazepam.
• Stand up comedian Mitch Hedberg from Cocaine and Heroin speedball.
• Pro westling manager Elizabeth Ann Hulette aka Miss Elizabeth from alcohol, alprazolam, temazepam, oxycodone, hydrocodone, and anabolic steroids.
• Child actress Anissa Jones from Cocaine, PCP, Methaqualone and Secobarbital
• Pro Wrestler Louie Spicolli from Carisoprodol, Alcohol, painkillers and Benzodiazepines.
• Actor River Phoenix, who died from acute multiple drug intoxication caused by combining Heroin with Cocaine and Methamphetamine and Diazepam;
• Hawthorne Heights guitarist Casey Calvert, who died from a combination of the antidepressant Citalopram, the Benzodiazepine Clonazepam, and the Narcotic painkiller Hydrocodone^[1][5];
• 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 on his toilet. (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, Pethidine(Meperidine), and Thioridazine;
• 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 on his toilet from combining over 10 drugs^[6];
• Actor Lani O'Grady, of Eight is Enough, who died from combining Hydrocodone and Fluoxetine;
• Elisa Bridges, who died in 2002 from the combined effects of Heroin, Methamphetamine, Pethidine(Meperidine) and Alprazolam". ;
• Bridgette Andersen, who died from combining alcohol and multiple drugs;
• Zac Foley, of EMF, who died from combining multiple illegal drugs;
• John Kahn, a Jerry Garcia collaborator and member of the Jerry Garcia Band, who died from combining Heroin, Cocaine, and Fluoxetine;
• Edie Sedgwick, who died from combining Barbiturates with Alcoholic drinks.
• Dana Plato who died from combining Carisoprodol with Hydrocodone;
• Rory Gallagher, died from alcohol and Polydrug Abuse;
• Actor/comedian Eric Douglas the youngest son of actor Kirk Douglas, who died from alcohol, painkillers and tranquilizers.^{[citation needed]}
• Michael Jackson, who died on June 25, 2009 after a lethal overdose of the anesthetic propofol, and two other sedatives.

[edit] Anna Nicole Smith and Daniel Wayne Smith

In February 2007, just five months after her son Daniel Wayne Smith was found dead from CDI earlier in September 2006, with Methadone, Sertraline and Escitalopram in his system,^[7] Anna Nicole Smith died from CDI/MDI also, an autopsy detecting 11 drugs in her bloodstream. On March 12 2009 California State authorities under State Attorney General Jerry Brown indicted Smith's live in legal Companion Howard K. Stern and two physicians, Sandeep Kapoor, and Khristine Eroshevich for conspiracy to provide the drugs that led to Smith's death. All were released on bond. Stern was charged with conspiring to get mind altering drugs to a known drug addict {Smith}. Methadone is commonly given to known drug addicts by physicians to both kill chronic pain and help them withdraw from other more addictive drugs or both. Methadone can cause severe memory impairment problems and cause the patient to forget that they took their pills and take too many pills and die from MDI/CDI or drug overdose. Both Physicians face loss of their license to practice medicine and may get fined or prison time. ^[8][9]

[edit] Heath Ledger

Australian actor Heath Ledger was found unconscious and later died 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 or combine drug intoxication(CDI)."^[2][10][11]

[edit] CDI-related legal cases

[edit] 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 more years comatose in the hospital, before dying from pneumonia in 1985.^[12]

[edit] See also

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

[edit] Notes

13.Bannoura

[edit] External links

• Drug Interactions Checker at Drugs.com: Drug Information Online.
• Drug Interaction Checker at Medscape (registration required).