The dope on Jackson's demise.

August 25, 2009 9:10 AM

10 mgs of Valium. 2 mgs of Lorazepam. 2 mgs of Midazolam. Another 2 mgs of Lorazepam. Another 2 mgs of Midazolam. During a futile, nine-hour intravenous marathon, the insomniac Michael Jackson received a near-continuous cocktail of meds, culminating in the Propofol that killed him. The County of Los Angeles releases its Search Warrant and Affidavit.

The coronary report, now made official at The Smoking Gun, reveals that Dr. Murray had attempted to wean Michael Jackson from Propofol--and went to great lengths to do so. Beginning at 1:30 am on June 25, he initiated an IV drip, adding new meds at regular intervals to induce slumber. At 10:40 am, over nine hours into the battle, Michael Jackson remained awake. And Dr. Murray relented, administering the fatal dose of Propofol.

posted by Gordion Knott (107 comments total)

Did no one think of trying warm milk?
posted by stavrogin at 9:23 AM on August 25 [16 favorites]

A fellow writer told me that Richard [Hell] once told her that the best thing about being a rock 'n' roll star would be the option of constructing his environment so that he would never have to be around anyone he didn't want to know from, which not only sounds like building your own concentration camp but is just exactly what most of the declining rockstars of the sixties have done to themselves. - Lester Bangs, "Richard Hell: Death Means Never Having To Say You're Incomplete" (1978)

An unlimited ability to construct one's environment turns out to be a very dangerous thing.
posted by Joe Beese at 9:23 AM on August 25 [7 favorites]

All those benzos and Michael couldn't sleep? A couple of Ambien wouldn't have killed him. Anesthetics are dangerous. That's why anesthesiologists get paid so much.

Uri Geller was on the radio this morning saying Jackson had been strung out for decades.
posted by kozad at 9:24 AM on August 25

I guess I haven't watched enough TV or read enough celebrity magazines. Four different drugs to fight a nine-hour sleep deprivation problem?
posted by DU at 9:24 AM on August 25 [2 favorites]

Jesus. That's a lot of benzos. That would make a rhino stop breathing.
posted by dortmunder at 9:24 AM on August 25

Did no one think of trying warm milk?

I took it you read the affidavit then?
posted by Sova at 9:24 AM on August 25

Don't miss the block party!!
posted by spicynuts at 9:26 AM on August 25

Just reading the FPP made me sleepy.
posted by vibrotronica at 9:27 AM on August 25

That must be a pretty awkward moment though, "oh shit, did I just kill Michael Jackson?"
posted by shownomercy at 9:28 AM on August 25 [33 favorites]

I administer propofol and midazolam to patients almost daily and am amazed at the apparently cavalier attitude Dr. Murray (and perhaps others) took toward the use of propofol. It is an excellent anesthetic, but to be given safely the patient must be fully monitored, as described here. In our hospital there are strict limits on who can give propofol and under what circumstances. I am also curious as to what the actual level of propofol was in his blood; in many cases of death due to inappropriate use of propofol the levels are within the usual clinical range, but the patient loses their airway, basically an extreme form of sleep apnea. This is one reason why you don't leave people who are being sedated alone and if you are sedating someone you need to be prepared to immediately intervene and help them maintain an airway.
posted by TedW at 9:29 AM on August 25 [17 favorites]

I really cannot grok what it means to require such heavy drug intake every night to sleep. I mean, I've done my share of all kinds of chemicals and whatnot, but at some point, sleep always became inevitable. How does the physiology of this work? Couldn't he just have been given no drugs at all for a few days at some point until he just collapsed and finally achieved natural sleep?
posted by hippybear at 9:30 AM on August 25 [2 favorites]

Let's be clear here, "sleep deprivation" is a term everyone is using as if benzodiazepines don't give you any kind of euphoric sensation. Money and access to a personal physician is really what separated Michael Jackson from a junkie buying off the street. No one uses Propofol as a sleep aid and it is unclear as to whether or not you actually get the right kind of sleep from Propofol (anyone whose gotten smashed and passed out knows that's not the same as a good night's rest). Furthermore Propofol has euphoric properties itself.

I don't think it is surprising at all that someone who remains constantly doped up on drugs he's built up a heavy tolerance for has abnormal sleep patterns. Nor do I think Dr. Murray is entirely culpable or even culpable at all. We can probably make a good argument if it wasn't him it would be someone else, but that doesn't make it right -- sort of an ethics debate that is outside this article. It would be wrong to say that Michael Jackson was innocent in all this. He clearly demanded drugs that had clear addictive and euphoric properties. I don't hear any cries for Ambien. He knew what he was doing.
posted by geoff. at 9:31 AM on August 25 [4 favorites]

All those benzos and Michael couldn't sleep? A couple of Ambien wouldn't have killed him.

You develop higher and higher tolerances to all these drugs, including Ambien, so you need bigger and bigger doses to achieve the same effects. This is what nailed Heath Ledger.

Michael rocketed right past the big doses and moved onto the really scary stuff. Anesthesiologists jokingly call Propofol their "Milk of Amnesia."
posted by Cool Papa Bell at 9:36 AM on August 25

I really cannot grok what it means to require such heavy drug intake every night to sleep.

I imagine afternoons filled with amphetamines. Or really, really good coffee.

But probably the speed.
posted by A Terrible Llama at 9:38 AM on August 25

Nor do I think Dr. Murray is entirely culpable or even culpable at all.

He could have refused. And the next doctor Jackson went to could also have refused.
posted by Civil_Disobedient at 9:39 AM on August 25 [5 favorites]

Jackson was obtaining prescription drugs under a zillion different aliases, including family member's names and those in his entourage. I mean, seriously, let's stop with the insomnia bullshit. A dopefiend is a dopefiend. And dude was a serious fucking dopefiend.
posted by The Straightener at 9:40 AM on August 25 [25 favorites]

What I find interesting about this story is that Dr. Conrad Murphy was only MJ's personal physician for a few weeks before his death. Who was his doctor before? What was Dr. Murphy thinking? He's gotten ahead of the story in the investigation, making a big show of cooperating with the police.
posted by Nelson at 9:40 AM on August 25

No one uses Propofol as a sleep aid and it is unclear as to whether or not you actually get the right kind of sleep from Propofol

This is the thing that gets me. Was he essentially asking for knock-out drops? It's hard to believe that would result in a restful period of sleep.
posted by contessa at 9:42 AM on August 25

"Jackson had been strung out for decades"

And it didn't affect his parenting skills at all! No, not at all.
posted by 2sheets at 9:42 AM on August 25

From the WaPo: "Medical records have also been subpoenaed from Jackson's other doctors, including dermatologist Arnold Klein"

Remind me not to go to this guy.
posted by snofoam at 9:49 AM on August 25 [2 favorites]

Uri Geller was on the radio this morning saying Jackson had been strung out for decades.

And he should know as he claims to have been one of Jackson's closest 'friends'.
posted by Elmore at 9:49 AM on August 25

I love the doctor's reasoning. "My patient is addicted to Propofol! I will undo this by continually administering huge doses of ultra short acting benzos!" Jackson would have had to have been in a medically monitored detox for a long time just to unwind all that shit without dying from the withdrawal.
posted by The Straightener at 9:49 AM on August 25

"As someone who initially was trained with thiopental (Pentothal) as the induction agent of choice, propofol represented a significant change in my practice. I even remember my first experience using propofol: a young woman who was emerging from a MAC anesthesia looked at me as though I were a masked Brad Pitt and told me that she felt simply wonderful. This bore no resemblance to my experience with other sedation agents, and I felt then that this might become an issue of concern for propofol. A feeling of euphoria with no residual “hangover” might suggest propofol is a near perfect mood-altering drug, but it is one that possesses a very thin window separating the dreamy state from the nonresponsive."

- http://www.csahq.org/pdf/bulletin/propofol_57_2.pdf
posted by kersplunk at 9:52 AM on August 25 [4 favorites]

I'm in favor of full drug legalization, so to be consistent, I don't really have an issue with prescribing him and selling him all the drugs he wants, as long as he was made aware of how dangerous it was, etc.

But actually administering the fatal iv still seems like it should be worth a manslaughter charge, at least.
posted by empath at 9:54 AM on August 25 [1 favorite]

A boring book? A few episodes of MST3K? Sometimes less is more. At any rate, Jackson essentially begged someone to shoot him in the head so I feel bad for this doctor only in so far as he was too stupid to just walk away.
posted by GuyZero at 9:59 AM on August 25

I'm in favor of full drug legalization, so to be consistent, I don't really have an issue with prescribing him and selling him all the drugs he wants, as long as he was made aware of how dangerous it was, etc.

But actually administering the fatal iv still seems like it should be worth a manslaughter charge, at least.

That seems contradictory to me. If you're in favor of full drug legalization, and don't have a problem with overprescription, then why is administration a special problem? If he asks for the drugs to be administered, why would you hold the physician who acquiesced accountable? Is he any more culpable than a doctor who prescribes drug that someone goes on to overdose on?

Michael Jackson knew full well what he was doing. If he referred to profopol as "milk," then I'm sure he had more than a passing familiarity with it.
posted by solipsophistocracy at 10:01 AM on August 25

god, what an odd choice to make.

"look, I know these pain killers and sleep aids could kill you. I know this one in particular is an especially bad idea, that's why I've been trying to wean you off of it for weeks, now. but on the other hand, you're awake and we can't have that. but I guess it's worth risking death to make sure you sleep tonight."

I mean, I'm not a doctor, and I know that it's not totally clear at what point you cross into fatal dosage territory, but isn't he supposed to play it safe and not even APPROACH that level of medication? what the fuck ever happened to telling him "you know what? play some fucking video games to pass the time. insomnia sucks, but people deal with it every day. and they don't have one of the world's best classic arcade game libraries in their basement. shit, go ride your train or something."

I guess what I'm getting at is that this story about a desperate race to get him to sleep doesn't hold up. it seems kind of obvious that this guy was a glorified pusher, and he knew it. If I were the county coroner, I'd probably have called it homicide, too. At least manslaughter, but maybe even homicide just to make a point that it's not okay to push opiates under the auspices of medicine just because you're doing it for celebrities.
posted by shmegegge at 10:03 AM on August 25 [8 favorites]

If the dosage supplied was clearly far greater than acceptable, is it possible that the doctor's disregard for medical standards and ethics constituted a felony? If so, could this be a second-degree murder charge?

If a dealer provides heroin to someone and they overdose, that's second degree murder, because even though the person didn't have intent to kill, their knowingly dangerous behavior is implied malice aforethought. Could this be the same thing, or is the doctor protected? I am clearly not a lawyer, nor am I a dentist, real-estate agent or tae-kwon-do enthusiast.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 10:03 AM on August 25

solipsophistocracy: "If he asks for the drugs to be administered, why would you hold the physician who acquiesced accountable?"

I can't speak for empath, but to my mind it's one thing to say "okay, here are your meds. now BE CAREFUL with these," and hope he doesn't over medicate. it's entirely another to say "okay now here are your meds, and even though I know this is really dangerous territory you're in, I'm going to actually inject you with this potentially fatal medicine anyway."

in one instance, you're trying to make the user aware of his actions and leaving ultimate responsibility up to him. in the other instance, he has no fucking idea how much is too much because you're doing it for him and you go too far when you know it's a bad idea.
posted by shmegegge at 10:06 AM on August 25

This whole situation makes me so sick inside and sort of sad. On one hand, we have a guy who's incredibly messed up, yet has the money to do pretty much whatever he wants (which was to not exist at all, or to exist in a completely euphoric state).

We have the doctors, friends, and family who won't refuse him anything. (I heard Dr. Murray this morning state that he was absolutely innocent, because Jackson was already hooked on drugs by the time he was hired? WTF sort of excuse is that?)

It's actually an incredibly common story, only made fascinating by the fact that this guy was once the most famous man in the world.
posted by muddgirl at 10:06 AM on August 25

Anesthesiologists jokingly call Propofol their "Milk of Amnesia."

Not so much any more; it is now being called "Michael's milk" or "Jackson juice".
posted by TedW at 10:06 AM on August 25 [10 favorites]

Uri Geller was on the radio this morning saying Jackson had been strung out for decades.
posted by kozad at 9:24 AM on August 25

Uri Geller would stab a puppy for five dollars and fuck the corpse for ten, so I don't really think we should be listening to anything he says, even if it's probably true. Geller also wasn't especially close with Jackson except as yet another hanger-on parasite trying to suck out as much money and fame as he could.
posted by Optimus Chyme at 10:06 AM on August 25 [14 favorites]

I'm looking at the man in the coffin.
posted by Brandon Blatcher at 10:08 AM on August 25 [2 favorites]

I use alcohol as a sleep aid. I mean, I eventually pass out from it. Before that, it's a social lubricant, a muscle relaxant, a digestive aid, a balm to sooth my troubled thoughts, a source of courage to help me deal with the guy across the bar, a sterilizer for wounds, and, if things get really bad, a makeshift explosive device. But, at the end of the day, it's a sleep aid.
posted by Astro Zombie at 10:09 AM on August 25 [34 favorites]

Nor do I think Dr. Murray is entirely culpable or even culpable at all.

He went far outside the boundaries of accepted clinical practice in an unmonitored environment while alone. Despite the fact he was not board certified in anaesthesiology (or, to my knowledge, any clinical practice) he administered a dangerous drug that is typically tightly regulated.

What might culpability look like to you?
posted by docgonzo at 10:09 AM on August 25 [3 favorites]

If I were the county coroner, I'd probably have called it homicide, too. At least manslaughter, but maybe even homicide...

The point was made on NPR this morning that "homicide" simply means death at the hands of another; it could be accidental, self-defense, manslaughter, or murder, all of which have different legal implications.
posted by TedW at 10:10 AM on August 25 [1 favorite]

As someone else said above, I seriously doubt that insomnia was this man's only problem. And his doctor seems to have skipped past this part of the Hippocratic Oath: "I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan."
posted by blucevalo at 10:12 AM on August 25

TedW: "The point was made on NPR this morning that "homicide" simply means death at the hands of another; it could be accidental, self-defense, manslaughter, or murder, all of which have different legal implications."

good point, and thanks for the clarification. I was getting homicide confused with murder, legally.
posted by shmegegge at 10:14 AM on August 25

What might culpability look like to you?

You're right, I change my stance on Murray. Do pharmacies even carry propofol? I was under the impression that certain drugs do not leave hospital settings. Can a doctor write a prescription at a hospital pharmacy and take out whatever he needs?
posted by geoff. at 10:17 AM on August 25

This was not homicide. This was suicide. Michael Jackson wanted to die. Sad but that is it.
posted by bukvich at 10:21 AM on August 25

As someone mentioned above, I don't think that the "sleep" you get when sedated provides the same benefits as normal REM sleep--and REM sleep, it appears, is somewhat vital for health and survival.

You'd think someone would have mentioned this to Mr. Jackson somewhere along the way.
posted by elfgirl at 10:23 AM on August 25 [1 favorite]

This makes me feel like Michael's much-publicized robot/lazer battle with Joe Pesci was all just a big show.
posted by anazgnos at 10:23 AM on August 25

Murray didn't tell paramedics or doctors at the UCLA hospital where Jackson was rushed about any drugs he administered other than lorazepam and flumazenil, a "rescue drug" to counteract problems from too much lorazepam, according to the affidavit.

This seems like an important piece of evidence about the doctor's motivation.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 10:26 AM on August 25 [1 favorite]

Can a doctor write a prescription at a hospital pharmacy and take out whatever he needs?

That's a very good question. I don't know what the regulations are in California but certainly there is an urgent need in all states to identify and block the routes used to divert legal pharmaceuticals into illicit markets.

The CDC, noting that unintentional poisoning (almost all of which comes from illicit drug overdose) is now second only to automobile accidents in causes of accidental death in the US, recently determined:

Unintentional drug poisoning mortality rates increased substantially in the United States during 1999--2004. Previous studies, using multiple cause-of-death data, have indicated that the trend described in this report can be attributed primarily to increasing numbers of deaths associated with prescription opioid analgesics (e.g., oxycodone) and secondarily to increasing numbers of overdoses of cocaine and prescription psychotherapeutic drugs (e.g., sedatives), and cannot be attributed to heroin, methamphetamines, or other illegal drugs (3,5).
posted by docgonzo at 10:27 AM on August 25 [2 favorites]

Um, yeah guys. Having worked in a harm reduction setting in homeless services, while it's not a condition of your client's housing terms that they be clean and sober, as a part of their mental health treatment team you want to at least see them stable, at least involved in some maintenance program if they can't stay clean and sober, and you are constantly encouraging them in that direction because their life-quality will never improve until that happens. Likewise, I would think this doctor's medical obligation would have been to make sure Jackson understands that his dependence on these drugs is the number one health issue negatively impacting his life, and should have been making the necessary referrals to medically appropriate settings where Jackson could have been safely detoxed and then treated for any post-detox persistant insomnia also in an appropriate setting. It was hard enough for the team I worked with to watch certain clients drug themselves to death despite our constant efforts to prevent that outcome. I can't imagine how I would feel if I had been sitting there lighting the crack stem for them. I can't condone a physician drugging his addicted patient to death because that's what the patient wanted, nor do I think that position is part of a progressive stance on drugs in general.
posted by The Straightener at 10:30 AM on August 25 [18 favorites]

hippybear: I really cannot grok what it means to require such heavy drug intake every night to sleep. I mean, I've done my share of all kinds of chemicals and whatnot, but at some point, sleep always became inevitable. How does the physiology of this work? Couldn't he just have been given no drugs at all for a few days at some point until he just collapsed and finally achieved natural sleep?


shmegegge: I mean, I'm not a doctor, and I know that it's not totally clear at what point you cross into fatal dosage territory, but isn't he supposed to play it safe and not even APPROACH that level of medication? what the fuck ever happened to telling him "you know what? play some fucking video games to pass the time. insomnia sucks, but people deal with it every day. and they don't have one of the world's best classic arcade game libraries in their basement. shit, go ride your train or something."

For a small number of people, no. People with true total insomnia have - for a variety of reasons - lost the capacity to do what you're both describing. It can be so far removed from what you and I think of as possible or normal that it's just hard to bend your head around it unless you've seen it up close. FWIW, I have. To really, truly lose the capacity to sleep is terrifying. It's not unlike losing your sanity, and many people who reach this point would rather die than go on. The "sleep will just come naturally" claim is just false for a small number of people with certain severe conditions. Thinking that it will is like thinking that a heart attack patient's heart will calm down in a little while, just like mine does after I exercise, or that someone suffering a stroke will start thinking or moving normally again after they chill out for a while, just like I do. We have to remember that insomnia is a symptom, not a disease, and while that symptom works itself out for most of us in most cases, there are those with conditions that preclude that. I have seen this up close, and it's truly horrifying.

Now, having said that much, I can't say whether this is true of Michael Jackson. I'm not his doctor, and vague reports of "really bad trouble sleeping" in media reports don't tell us squat, frankly. And even if he's a member of the small set of people I'm talking about, dosing him nightly with propofol is still a phenomenally stupid way of handling the problem. That it ended up killing him (if this is so) under the conditions described should come as a surprise to no one, including those closest to the situation. If Murray really was trying to wean him off of it, that is the fentometer-wide sliver of sanity in this whole story.

But sleep is one of the more beguiling phenomena that living organisms undertake, and one we collectively take for granted. Most doctors know stunningly little about it, aside from one or two preferred meds for short-term relief, and most advertised "sleep specialists" offer nothing more than apnea care and boilerplate psychobabble about lowering stress. The number of people who actually have deep knowledge about the neuorchemistry, pharmacology and clinical practice of treating people with total insomnia is remarkably small - you could count the US doctors on your hands. Now, MJ had the money and the access to reach those people if he really had total insomnia, so I don't think there's any denying that there was some drug-seeking and dependence to his behavior. But common sense assumptions about how to handle all this are pretty far from the mark. And while I can't excuse the apparent malpractice carried out here, I can certainly understand the desperation that drove it.
posted by el_lupino at 10:31 AM on August 25 [39 favorites]

What I find interesting about this story is that Dr. Conrad Murphy was only MJ's personal physician for a few weeks before his death. Who was his doctor before? What was Dr. Murphy thinking?
He was thinking that if he turned Jackson down, he'd be taken off of Jackson's payroll. He'd be taken off AEG's payroll and lose all his cushy perks. Probably the same reason Dr. Nick kept prescribing all those pills to Elvis. John Lennon once observed that "the King is always killed by his courtiers. They keep him overfed, over-drugged and over-indulged." If the King ever comes out of his druggy haze long enough to realize how many unnecesarry leeches he has on his payroll, the leeches have a lot to lose.
posted by Oriole Adams at 10:32 AM on August 25 [9 favorites]

To die, to sleep;
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to, 'tis a consummation
Devoutly to be wish'd. To die, to sleep;
To sleep: perchance to dream: ay, there's the rub;
For in that sleep of death what dreams may come
When we have shuffled off this mortal coil?
posted by Pollomacho at 10:34 AM on August 25 [1 favorite]

I think the prescription drug use (apparently dating to the early 80s) explains a lot of things about Michael's tragic decline, his total divorce from reality. I recall an interview with John Landis where he talks about the difference in Michael from the days of Thriller, when he was very professional to work with, and filming Black or White, when he was apparently a demanding, self-involved diva.

I don't think all of that can be explained by the distortions of extreme fame (although certainly some of it); just as I don't think a totally fucked childhood + Jehovah's Witnesses accounts for his peculiarities (though of course that has a lot to do with it); the last twenty years of his life really looks like the slow demise of an isolated drug addict.

I've noticed the tendency of people on these kind of medications to regress into a child like state; I always thought he reminded me of certain women in my family when they arrived doped up at weddings and funerals.
posted by bukharin at 10:49 AM on August 25 [1 favorite]

Umm, "coronary report"? Coroner's report mebbe?
posted by stevil at 10:50 AM on August 25 [1 favorite]

I say this also because apparently Michael was not only very talented but extremely intelligent and a cagey businessman; his biographer says that his speaking voice could actually be much lower in tone and edgy, which you hear in his singing (it never made sense to me that he spoke so high when his singing could be so rough). God knows how anyone separates the 'real' Michael from the public Michael, the true Michael from the drug addict; I suspect at some point he couldn't do it either.
posted by bukharin at 10:52 AM on August 25 [1 favorite]

I'm on the drug
I'm on the drug
I'm on the drug that killed River Phoenix Michael Jackson
posted by acb at 10:52 AM on August 25

el_lupino, I want an FPP about total insomnia, STAT!
posted by rikschell at 10:53 AM on August 25 [10 favorites]

Money and access to a personal physician is really what separated Michael Jackson from a junkie buying off the street.
—.geoff

Very, very true. Exactly.

... It would be wrong to say that Michael Jackson was innocent in all this. He clearly demanded drugs that had clear addictive and euphoric properties. I don't hear any cries for Ambien. He knew what he was doing.
—.geoff

Can't agree here: All Michael Jackson knew was that the drugs made him feel good Then he thought he needed them.

Now for the doctor, on the other hand. This guy knew or should have known the exact workings of the drugs, the full physiological mechanics of risk. This is what a doctor's education and training is! So he is fully culpable.
posted by krilli at 10:54 AM on August 25 [1 favorite]

He wanted to rest?!

Mission accomplished!
posted by markkraft at 11:11 AM on August 25

Propofol has a therapeutic index of 9. That is fairly small and indicates the drug is dangerous. The medical examiner claimed that MJ had lethal doses of propofol - not that he died because of a combination reaction or some unusual susceptibility.
To me that says the doctor administered a too-high dose and killed him. There was no good medical reason for the drug to be administered in the first place. The doctor is a murderer.
posted by dances_with_sneetches at 11:14 AM on August 25

muddgirl: (I heard Dr. Murray this morning state that he was absolutely innocent, because Jackson was already hooked on drugs by the time he was hired? WTF sort of excuse is that?)

It's not that terrible an excuse, really. If he was well and truly dependent on drugs, then not prescribing them to him would send him into withdrawl, and quite possibly kill him. On the other hand, giving him the drugs might send him into an overdose, and quite possibly kill him.

Okay, so the particular details of the night do sound a bit ridiculous in sheer volume and scope, but as has been pointed out, you very quickly develop a tolerance to benzos, so the list might even represent a night of taking it easy by Jacksonian standards. Well, maybe not quite, but it could well be that we're in the same ballpark as his average doses. I imagine we're within what past experience had showed to be 'safe' limits.

I don't really trust this doctor feller, but in my mind, the jury is still out on the extent of his guilt, if any can indeed be ascribed to him.
posted by Brother Dysk at 11:14 AM on August 25 [1 favorite]

He was thinking that if he turned Jackson down, he'd be taken off of Jackson's payroll.

And so, in the midst of a national debate on publicly supporting health care, we have an example which nicely illustrates the risks of the full privatization of health care. For obvious reasons, I'm sure this guy didn't want to kill Jackson, but he weighed the risks and decided he could get away with something he shouldn't have been doing because not to do so would have been financially foolish.
posted by HiddenInput at 11:15 AM on August 25

I met Mojo Nixon & Skid Roper in the 80's and they were adamant that I meet their road manager and admire him as they did. "You can die on the road" was what Mojo said and this was the guy that made sure they got enough sleep, found edible food in the middle of nowhere (before Yelp) and that the electrical outlets were grounded.

I can see how anxiety about an upcoming tour and the heavy practice schedule could make an insomniac dope fiend even worse. The fact that he was a self-indulgent (and sycophant indulged) addict doesn't mean he wasn't anxious.
posted by morganw at 11:22 AM on August 25 [1 favorite]

"And so, in the midst of a national debate on publicly supporting health care, we have an example which nicely illustrates the risks of the full privatization of health care. For obvious reasons, I'm sure this guy didn't want to kill Jackson, but he weighed the risks and decided he could get away with something he shouldn't have been doing because not to do so would have been financially foolish."

I'd say it was a codependent relationship. In exchange for drugs and the illusion of safety, Jackson gave the doctor a boatload of money.
posted by Kevin Street at 11:24 AM on August 25

Pretty cool of the Coroner to let Smoking Gun make it official. Did he get them to sign off on it or what?
posted by Elmore at 11:40 AM on August 25

I know a bunch of other people have already riffed on this, but at the risk of both being repetitive and sounding like a 75-year-old British lady, you know what else generates feelings of euphoria and acts as a sleep aid? That's right, a nice weak cup of tea with milk, honey, and two fingers of Scotch.
posted by infinitywaltz at 11:40 AM on August 25 [1 favorite]

As far as I'm aware, a "homicide" ruling only means that the corner determined that the death was not self-inflicted and probably wrongful. Which certainly seems to be a reasonable conclusion given the off-label use of a dangerous drug administered intravenously.

Whether Dr. Murray is charged with a crime, and if so, which crime, is up to the local DA. On the one hand, a strong case could be made for just negligent homicide or manslaughter. On the other hand, the DA could push for murder on the grounds that the death happened during the commission of another felonious act: illegally providing prescription drugs. If I was a betting man, I'd put my chips on a plea bargain.
posted by KirkJobSluder at 11:41 AM on August 25

I have seen this up close, and it's truly horrifying.

If you wouldn't mind, and if it's not too personal and doesn't violate any confidentiality oaths, could you go into more details? I thought true total insomnia was pretty much just limited to a rare genetic condition detailed in The Family That Couldn't Sleep.
posted by infinitywaltz at 11:45 AM on August 25 [1 favorite]

a nice weak cup of tea

Would cause me to stay wide eyed awake for 12 hrs, whatever time of day it was. Alcohol is also a terrible sleep aid (at least for me) though it can be useful for getting unconscious (not the same thing).
posted by not_that_epiphanius at 11:51 AM on August 25 [1 favorite]

I wanted to say that I think any doctor worth is license who saw the drug regime Jackson was on would recommend immediate detox and rehab. I see The Straightener said it better than I could.

I guess putting Jackson in rehab would have stopped the gravy train the doctor and lot of other people were on.
posted by marxchivist at 11:53 AM on August 25

Uri Geller was on the radio this morning saying Jackson had been strung out for decades.

Bent any spoons lately, Uri? Between him and the former-Oliver! the Musical-child-star who claimed he'd fathered MJs kids, it's like a carnival of celebrity fail.
posted by emjaybee at 11:53 AM on August 25 [3 favorites]

10 mgs of Valium. 2 mgs of Lorazepam. 2 mgs of Midazolam. Another 2 mgs of Lorazepam. Another 2 mgs of Midazolam... one miniature combination Russian phrase book and Bible; one hundred dollars in rubles; one hundred dollars in gold; nine packs of chewing gum; one issue of prophylactics; three lipsticks; three pair of nylon stockings. Shoot, a fella' could have a pretty good weekend in Neverland with all that stuff.
posted by cog_nate at 11:56 AM on August 25 [9 favorites]

How much was Jackson's need for tranquillisers to get to sleep dependent on the fact that he probably needed two fistfuls of methamphetamines to get through the day?
posted by PenDevil at 11:57 AM on August 25

I want a new drug
One that won't go away
One that won't keep me up all night
One that wont will make me sleep all day

-Huey Lewis and the Propofol Lobbyists
posted by ...possums at 12:01 PM on August 25

Jesus. That's a lot of benzos. That would make a rhino stop breathing.

18 mg? No it wouldn't. It wouldn't even make a human stop breathing. The issue was almost certainly the Propofol (although the benzos didn't help!) because benzos are an extraordinarily bad way to kill yourself, even if you're doing it deliberately. That's why benzo overdose is so popular among cry-for-help female pseudo suicide attempts. You can take whole bottles of the stuff and wake up in the hospital not too worse for wear. Xanax is the most dangerous and even with Xanax you need to take a bucketfull and generally in combination with something else. Only something like 1% of deaths involving benzos are from benzos alone.

For Xanax, the most dangerous of the benzos, the LD50 is on the order of a gram per kilgram. So a 120 pound woman would have to take 120grams of Xanax to reach that level. 18mg is less than 0.2% of the LD50.

Benzo overdose = cry for help.
posted by Justinian at 12:33 PM on August 25 [2 favorites]

If the doctor decided he'd had enough of MJ's whining and purposefully dosed him with enough Jackson Juice to kill him, then I'd say we're looking at a murder.

Short of that, it just seems like ordinary malpractice to me.
posted by spilon at 12:39 PM on August 25

I can only hope this will be a wakeup call for the hundreds of patients (and their doctors!) who are abusing painkillers and sedatives. This doesn't just happen to famous people. I have family members who are struggling with this right now, and the Doctors deny they are doing anything wrong - "I'm treating their pain". Let's call it what it really is. You are enabling their self-destructive lifestyle.
posted by Big_B at 12:44 PM on August 25

I could see murder 2 as a possibility.
posted by Astro Zombie at 12:44 PM on August 25

Big_B: *cough* Rush Limbaugh *cough*
posted by KirkJobSluder at 12:47 PM on August 25

I'm in favor of both drug legalization and the right to choose suicide, so I really don't have a legal problem with this. I do think it's very sad, and I would have really liked to know that someone, at some point, had a conversation (or a number of conversations) with MJ discussing whether he truly did desire his own death, and how that could be planned for without this sort of mess. Maybe someone did. I hope so. Dude was clearly hurting badly.
posted by rusty at 12:57 PM on August 25

Justinian: "For Xanax, the most dangerous of the benzos, the LD50 is on the order of a gram per kilgram. So a 120 pound woman would have to take 120grams of Xanax to reach that level. 18mg is less than 0.2% of the LD50."

A minor quibble: A kilogram is not a pound -- 120 pounds is more like 55 kilograms.
posted by A-Train at 12:57 PM on August 25

Ugh, yeah, I obviously know that a kg is not a pound. It's about 2.2 pounds to a kg. I just completely forgot to do the conversion for no apparent reason.

At least I didn't crash the Mars orbiter or whatever. Unlike NASA.
posted by Justinian at 1:03 PM on August 25 [1 favorite]

Were there amphetamines listed in the toxicology report? People keep saying he was taking them, but I don't remember seeing them mentioned anyplace in any reports.
posted by hippybear at 1:03 PM on August 25 [1 favorite]

Justinian: "At least I didn't crash the Mars orbiter or whatever. Unlike NASA."

this is now going to be my justification for everything.

boss: shmegegge, that last video looked like shit and there's a "media missing" slate instead of footage at 1:45:20

shmegegge: At least I didn't crash the Mars orbiter or whatever.

boss: what are-

shmegegge: Unlike NASA.
posted by shmegegge at 1:10 PM on August 25 [18 favorites]

(Just to clarify before someone else "clarifies" me -- under current law it seems like this was some stupendously awful doctoring, and very probably criminal. I was just saying that suicide should be legal and handled nothing at all like this.)
posted by rusty at 1:16 PM on August 25

I say this also because apparently Michael was not only very talented but extremely intelligent and a cagey businessman; his biographer says that his speaking voice could actually be much lower in tone and edgy, which you hear in his singing (it never made sense to me that he spoke so high when his singing could be so rough).

A friend of my husband had a chance to speak with MJ last year while working on a soft drink commercial. He said that he was shocked at how different he sounded from his public persona - not very breathy or childlike but crisp and to the point. He said that he was also surprised at how knowlegeable MJ was about current digital technology.
posted by echolalia67 at 1:18 PM on August 25 [3 favorites]

"My patient is addicted to Propofol! I will undo this by continually administering huge doses of ultra short acting benzos!"

It's a bit like the old lady who swallowed a fly, isn't it? What was his plan to get him off the short acting benzos -- switch him over to valium at some point?

The doctor must have realized that he was providing Jackson with drug-of-choice maintenance on demand.
posted by PeterMcDermott at 1:19 PM on August 25

this is now going to be my justification for everything.

Hah! It wasn't completely out of the blue, though. Mars Climate Orbiter was lost in 1999 because some software used to compute thruster burn used during orbital insertion calculated the burn in pounds-force (Imperial) while the orbiter assumed it was using newtons (metric) so the burn was about four and a half times as powerful as it should have been.

Why in gods name the people who wrote the software used pounds-force I have no idea. Scientists have been using metric forever.

So yeah, at least my failure to convert imperial-metric didn't crash a three hundred million dollar Mars Orbiter. UNLIKE NASA.
posted by Justinian at 1:25 PM on August 25 [3 favorites]

...ay, there's the rub;
For in that sleep of death what dreams may come
When we have shuffled off this mortal coil?


Nice quoting, Pollomacho.

Though Hamlet had it easy compared to the poor Macbeths!
posted by Jody Tresidder at 1:32 PM on August 25

I know a bunch of other people have already riffed on this, but at the risk of both being repetitive and sounding like a 75-year-old British lady, you know what else generates feelings of euphoria and acts as a sleep aid? That's right, a nice weak cup of tea with milk, honey, and two fingers of Scotch.

I'm sorry, this is just naive. To someone who is seriously fucked up on drugs, this is going to have about as much effect as a nice glass of water.
posted by sophist at 1:39 PM on August 25 [2 favorites]

There was an article on Propofol addiction in The Guardian shortly after Michael Jackson's death: there's apparently a growing (albeit currently small in absolute numbers) problem with addiction to it amongst medical staff.

A particularly relevant quote:

As Earley grew more attuned to the problem, he also began to notice a striking factor shared by many Propofol addicts: sexual or physical abuse in their past. "I started seeing a fair number of our patients who are victims of abuse as children," he said. "When I mentioned that to a colleague he said 'Yeah, I've noticed that in my patients too'."

Omar Manejwala, an expert in addiction treatment at the William Farley Center in Virginia, has observed an alarming rate of post-traumatic stress among his patients. PTSD is not uncommon among addicts, presenting in maybe 30% or even 50% of cases; but with Propofol he sees it in 70% or 80%.

The underlying trauma often relates to childhood, from physical abuse to early exposure to sexual experiences or rape. What draws these people to Propofol, he believes, is that the drug has the ability to induce a sense of oblivion.

"What's shocking is that most Propofol patients are not looking for euphoria or for a high, they just want to go into a coma. They are wanting to disappear."

posted by pharm at 1:41 PM on August 25 [2 favorites]

"Couldn't he just have been given no drugs at all for a few days at some point until he just collapsed and finally achieved natural sleep?"

I don't have total insomnia, but I do know what it's like to not be able to sleep.
Pretty good scene in "The Killer Elite" James Caan gets a buddy to cover him with a rifle for this ninja scene. Kinda hokey film, but bits of it are true to life. Anyway, they're up all night, running around, tempers get heated, etc. So late into the next day the sharpshooter pops a pill and Caan says "Upper?" and the guy shakes his head "Downer."
Just resonated with me. Been there. Up for days, physically exhausted and you actually have to work to calm down.
Sometimes you get so hooked into something - and you get used to running that way. Three days without sleep, four, all your attention focused on something. Even in practice.

I can imagine, given the level Jackson was performing at - and I'm not a fan, but yeah, the guy was supremely talented - that he was used to being that sharp.
Doesn't surprise me at all folks talking about how bright he was. You don't blunder into that level of performance by accident or luck. You know exactly what you're doing and you're working very hard, and that's on top of whatever other gifts you're maximizing.

And it's very easy for someone with that kind of focus to completely disregard everything but the object of the focus - even to the exclusion of physical health.
Bruce Lee, same deal (unless you buy into the dim mak and Triad thing). Happens to a lot of athletes too.
You look at Farve being an idiot. Or Jordan coming back over and over. You just can't let it go and you wouldn't be that elite level of performer if you could.
Jackson was probably the same way. Elvis too.

And I think that's one of the differences between him and a junkie and maybe why it screws with doctors who should otherwise recognize addiction. It's not really the drugs they're addicted to. They're not doing it for the high. They're doing it for their performance, to reach that mindset, to achieve something. (Even if they're not really achieving anything)
I don't think Jackson was saying "I need drugs" but rather "I need to sleep because I've got shit to do."
Which, too, doesn't let the doctor off the hook any more than the sports medicine guys giving athletes steroids. I'm just saying it's a different kind of animal.
posted by Smedleyman at 1:49 PM on August 25 [3 favorites]

I'm guessing involuntary manslaughter under CA Penal Code 192.
posted by fairytale of los angeles at 2:02 PM on August 25

People with true total insomnia have ... I can't say whether this is true of Michael Jackson.

Should we add True Total Insomnia to the list of illnesses Michael Jackson had that required extreme medical procedures along with vitiglio, acute hypoxia, and whatever the fuck it was that made his fine broad nose shrink into an empty hole?
posted by Nelson at 2:46 PM on August 25 [2 favorites]

MetaFilter: To someone who is seriously fucked up on drugs, this is going to have about as much effect as a nice glass of water
posted by mazola at 2:47 PM on August 25

I use alcohol as a sleep aid...

you know what else generates feelings of euphoria and acts as a sleep aid? That's right, a nice weak cup of tea with milk, honey, and two fingers of Scotch...

Somebody else already said it, but "[a]lcohol consumption can induce sleep disorders by disrupting the sequence and duration of sleep states and by altering total sleep time as well as the time required to fall asleep (i.e., sleep latency)."
posted by mrgrimm at 2:55 PM on August 25

Though Hamlet had it easy compared to the poor Macbeths!

Well, Macbeth murdered sleep, so he can't really complain.

MetaFilter: a very thin window separating the dreamy state from the nonresponsive.
posted by kirkaracha at 3:35 PM on August 25 [1 favorite]

It's not that terrible an excuse, really. If he was well and truly dependent on drugs, then not prescribing them to him would send him into withdrawl, and quite possibly kill him. On the other hand, giving him the drugs might send him into an overdose, and quite possibly kill him.

Except dude was a cardiologist. As The Straightener said, MJ should have been seen by doctors who specialize in addiction therapy and care. Not whichever doctor would take his money to give him "sleep aids".
posted by muddgirl at 3:52 PM on August 25

Except dude was a cardiologist.

Dude's board certification in Internal Medicine had lapsed; he had not sat nor passed a board examination in cardiology.

Dude.
posted by docgonzo at 4:33 PM on August 25 [2 favorites]

Should we add True Total Insomnia to the list of illnesses Michael Jackson had

Given that it's a symptom and not an illness, I'll say no.
posted by el_lupino at 4:35 PM on August 25

@spicynuts
I just hope there is a bouncy castle in the shape of a phallus to keep all of MJ's activities present on that glorious day when unicorns shit rainbows a few blocks from my apt.
posted by hooptycritter at 4:35 PM on August 25

I took 3mg of lorazepam just to get me through a dentist appointment yesterday. 18mg of benzos would have made him off the wall (ha) but wouldn't have killed him.

He needed some Horlicks.
posted by elsietheeel at 4:41 PM on August 25

Dude's board certification in Internal Medicine had lapsed; he had not sat nor passed a board examination in cardiology.

Even worse. I will be very surprised if the Jackson family doesn't file a lawsuit...
posted by muddgirl at 4:52 PM on August 25

By the way, I got the idea that Murray was a cardiologist from the bottom of this page of affidavit. *Shrug* the cops might have it wrong of course.
posted by muddgirl at 4:55 PM on August 25 [1 favorite]

I'm sorry, this is just naive. To someone who is seriously fucked up on drugs, this is going to have about as much effect as a nice glass of water.

Right, because my suggestion was actual medical advice! Please don't tell the AMA or I'll lose my license!
posted by infinitywaltz at 6:14 PM on August 25

I got the idea that Murray was a cardiologist from the bottom of this page of affidavit. *Shrug* the cops might have it wrong of course.

Something a lot of people don't understand about medicine is that once you are licensed in a particular state (in the US), you can in theory call yourself whatever you want. I am board certified in anesthesiology but I could call myself a neurosurgeon without breaking any laws. On the other hand, getting malpractice insurance and hospital privileges would be difficult, if not impossible without evidence ofproper training such as board certification. In other words, the regulation of medicine is done in large part by non-government entities. So even if Dr. Murray had no training in cardiology beyond what he got in an internal medicine residency he broke no laws by presenting himself as a cardiologist.
posted by TedW at 6:46 PM on August 25

I tell ya, I'm on day 4 or 5 (I've lost track) of pretty serious insomnia jag, and I'm a freaking wreck. I don't know why I can't sleep, but I can't. I wake up about every 30 minutes, I'm pretty sure I haven't had a REM cycle in days...and I've hit the weeping, shaky hands, nervous wreck stage. I know...KNOW if I can't get some sleep soon, I will go bugfuck insane.

Seriously, if I could get someone to drug me into an REM state at this point, I would be grateful. It's so frustrating to lay down, and not be able to sleep. To doze off, and then have that "falling off the curb" jerk that wakes you back up again. Watching the clock get closer and closer to the beeping alarm hour. Crying while you make coffee after the alarm goes off because you *have* to be functional. At this point, I probably shouldn't be allowed to drive, or sign contracts, or do anything else that requires me to be mentally competent.

So...I'm sympathetic to anyone who suffers this sort of thing for any length of time. I can't even imagine how horrible life would be. I absolutely understand how people would/do turn to medical intervention. (I, on the other hand, do not have insurance, and randomly showing up at doctor's office asking for sleep aids is a good way to waste the $200 office visit fee and leave without a prescription. Also, I've been a sleepwalker most of my life, which I'm led to believe makes things like Ambien a very bad idea.)

My (probably rambling) point is this: if MJ had true insomnia, I really do understand how badly the desire for sleep could get. I imagine that dying is a risk that might be worth it at some point.
posted by dejah420 at 7:58 PM on August 25 [1 favorite]

10 mgs of Valium. 2 mgs of Lorazepam. 2 mgs of Midazolam. Another 2 mgs of Lorazepam. Another 2 mgs of Midazolam... one miniature combination Russian phrase book and Bible; one hundred dollars in rubles; one hundred dollars in gold; nine packs of chewing gum; one issue of prophylactics; three lipsticks; three pair of nylon stockings. Shoot, a fella' could have a pretty good weekend in Neverland with all that stuff.

10 mgs of Valium. 2 mgs of Lorazepam. 2 mgs of Midazolam. Another 2 mgs of Lorazepam. Another 2 mgs of Midazolam, two bags of grass, seventy-five pellets of mescaline, five sheets of high-powered blotter acid, a salt shaker half full of cocaine, and a whole galaxy of multi-colored uppers, downers, screamers, laughers . . . and also a quart of tequila, a quart of rum, a case of Budweiser, a pint of raw ether and two dozen amyls . . . Not that we needed all that for the trip, but once you get locked into a serious drug collection, the tendency is to push it as far as you can.
posted by Afroblanco at 8:36 PM on August 25 [2 favorites]

and also a quart of tequila, a quart of rum, a case of Budweiser, a pint of raw ether and two dozen amyls . . . Not that we needed all that for the trip, but once you get locked into a serious drug collection, the tendency is to push it as far as you can.

Michael Jackson clearly had better connections in Las Vegas than Hunter S Thompson.
posted by Lolie at 9:48 PM on August 25

Something a lot of people don't understand about medicine is that once you are licensed in a particular state (in the US), you can in theory call yourself whatever you want. I am board certified in anesthesiology but I could call myself a neurosurgeon without breaking any laws.

The invisible hand works!
posted by kersplunk at 11:44 PM on August 25 [2 favorites]

When his local office was searched they showed pictures of it on the news and it is pretty creepy looking.
posted by dog food sugar at 7:41 AM on August 26