The actor Heath Ledger died accidentally “from the abuse of prescription medications” ? specifically, six kinds of painkillers, sleeping pills and anti-anxiety drugs ? a spokeswoman for the New York City medical examiner said on Wednesday.
Ledger, who was nominated for an Academy Award for his performance in the 2005 movie “Brokeback Mountain,” died of “acute intoxication” caused by the combined effects of the six drugs, the spokeswoman, Ellen Borakove, said in a statement.
Ledger was found dead in his rented SoHo apartment on Jan. 22, when a masseuse tried and failed to awaken him for an appointment. Before calling 911, she placed three calls to the actress Mary-Kate Olsen, who she knew was a friend of his. Olsen sent over private security agents, who arrived at about the same time as emergency medical personnel.
An autopsy was performed the following day. Borakove said then that the results were inconclusive and that the cause of death would not be determined until toxicology tests had been conducted, which she said would take about 10 days.
Among the drugs found in Ledgers system were two widely prescribed narcotics: oxycodone, the main ingredient in the prescription drug OxyContin, and hydrocodone, the principal pain reliever in the prescription drug Vicodin.
Also in Ledgers system were three anti-anxiety medications: diazepam, the generic name for Valium; alprazolam, commonly known as Xanax; and temazepam, which is sold under the brand name Restoril and is often prescribed as a sleep medication.
The drug doxylamine was also found in his system. It is an ingredient in some over-the-counter sleeping pills, and is also marketed in some nonprescription cold medicines that contain decongestants.
The medical examiners office provided only the generic names of the drugs found in Ledgers bloodstream, so it was not known what forms of the drugs he took before he died. In a telephone interview, Borakove would not say how much of each drug turned up in Ledgers bloodstream. She said such concentrations were not normally made public, although the amounts are included in the information given to a persons family after an autopsy.
She also would not say whether any one drug had contributed more than the others to his death.
“Its the combination of the drugs that caused the problem, not necessarily too much of any particular drug,” she said in the interview. “All these drugs have a cumulative effect on the body.”
Ledgers father, Kim, released a statement through Ledgers publicist that said “no medications were taken in excess,” echoing Borakoves comments about the medications being taken together.
“We learned today the combination of doctor-prescribed drugs proved lethal for our boy,” Ledger said. “Heaths accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage.”
There had been rumors about drug use, in part because the police said they had found a rolled-up $20 bill near Ledgers body. The police also said they found no evidence of foul play and no suicide note.
In the wake of the medical examiners findings, some psychiatrists speculated on Wednesday that Ledgers use of the prescription drugs had gone beyond abuse to addiction.
“Theres a possibility that different physicians prescribed these medications, and theres a possibility that they were not misused,” said Dr. Andrew Kolodny, vice chairman of psychiatry at Maimonides Medical Center in Brooklyn. “Sometimes patients try to take them as prescribed and theres an accidental overdose ? I think thats unlikely. I think whats more likely is if someone dies of an overdose like this, that person was suffering from addiction.”
Kolodny continued, “I can tell you that if I presented a case of an overdose death with a toxicology report that appears like his did, my assumption would be the individual suffered from addiction.”
Vatsal Thakkar, a psychiatrist at New York University Medical Center and the author of the 2006 book “Addiction,” said another concern was that some of the drugs that Ledger had taken could build up in the body.
“If someone walked into my office on these six medications and I could verify that these were legitimately given, Id explain to that person and then try to do the best I could in terms of streamlining or tapering some of these medications,” he said. “There are equally or more powerful alternatives that are often safer.”
Lori Brown, a pharmacist who is the manager of clinical services with Kerr Drug, a regional pharmacy chain in North Carolina and South Carolina, said the list of drugs should have been enough to have raised concerns.