Aerosmith lead singer Steven Tyler has finally admitted he has a drug problem. Given the rock star's legendary excesses of the past, such a move might not seem surprising. But there was more to Tyler's decision last week to check himself into rehab than first meets the eye.
The 61-year-old singer had long ago cleaned up his act and put his years of heavy drink and drug abuse behind him. His current problem is very different. He is addicted to painkillers, he announced in a statement – a dependence that began after taking medication to cope with 10 years of injuries from his performances.
Tyler's stage antics have left him with severe chronic pain and damage to his knees and feet. During a show this year he fell off a stage and broke a shoulder. Now he is addicted to the medicines he has used to kill the pain.
But the revelation of Tyler's problem is significant not just for its importance for Aerosmith fans. His is merely the most recent example of a growing US showbiz trend that has seen more and more stars admit prescription drug addiction, while cases of dependence leading to fatal overdoses have soared. Among the deaths linked to prescription drugs are those of Heath Ledger, Anna Nicole Smith and Michael Jackson, a toll that was added to last week with the death of Brittany Murphy, star of 8 Mile and Clueless. The 32-year-old Hollywood actress was pronounced dead at Cedars-Sinai Medical Centre after collapsing at her Hollywood Hills home last Sunday.
Murphy's husband, Simon Monjack, has vehemently denied that she was addicted to prescription painkillers. Yet notes obtained from a Los Angeles coroner's office official have indicated that a formidable list of drugs were found in her room. These notes also stressed that "no alcohol containers, paraphernalia or illegal drugs" were discovered there.
Tragedies like these suggest the celebrity habit of pill-popping – sometimes known as pharming – is spreading alarmingly. Early this year Burt Reynolds admitted he was "a prisoner of prescription pain pills" and checked into rehab, following a long list of stars, including Winona Rider, Charlie Sheen, Jamie Lee Curtis and Friends' star Matthew Perry, who have admitted addiction to painkillers and other prescription drugs.
Such cases make headlines because they expose the lives of superstars. But they represent only the tip of an iceberg, doctors warn. In 2005 non-medical use of painkillers contributed to more than 8,500 deaths in the US. Overdose deaths involving prescription pain relievers increased 114% from 2001 to 2005, the most recent year for which nationwide data are available, says the Office of National Drug Control Policy.
Prescription drugs are becoming America's new addiction, studies show. For example, in one survey of teenagers between the ages of 13 and 18 a total of 155 reported abusing prescription drugs obtained through a friend or taken from a medicine cabinet, sometimes by organising "pharming parties" where pills are put in bowls and shared with friends. The practice has become common in rural areas – hence the use of the term "hillbilly heroin" to describe painkillers that are taken recreationally.
But why is this abuse growing? Is it confined mainly to young people, or are older individuals involved as well? And is this wave of addiction likely to spread to Britain? These are key questions that raise controversial issues about attitudes to medicine in the West.
For a start, there is the issue of our faith in the medical profession. Addiction to prescription drugs often arises as an accidental dependence to a drug first taken, and given, in good faith for a real ailment. For example, Michael Jackson is thought to have become addicted to Demerol – or Pethidine, as it is called in Britain – after suffering a serious burn inflicted during the filming of a Pepsi commercial in 1984.
Twenty years later, use had turned to abuse and Jackson was suffering severe dependence, according to subsequent interviews with his staff. They say the singer frequently asked them to get prescription medicines under different names. One said he took Jackson to doctors' offices in other states and the singer appeared to be "out of it and sedated" after each visit. On top of this Jackson's physician, Dr Conrad Murray, a cardiologist, has admitted that he gave Jackson 25 milligrams of propofol on the day he died and has told police Jackson was dependent on the drug to sleep.
"I think people of all ages don't take medication as seriously as street drugs," says Dr Marvin Seppala, the chief medical officer at Hazelden, a drug and alcohol treatment centre in Minnesota. "There's sort of a naive belief they're safer. The truth is pain medications are in the same exact class as heroin, morphine – they're very addictive."
This point is backed by examining the list of drugs found in Murphy's room. These included Topamax, Methylprednisolone, Fluoxetine, Klonopin, Carbamazepine, Ativan, Propranolol, Biaxin, Hydrocodone and miscellaneous vitamins. Many of these are extremely powerful, says Professor Simon Maxwell, chairman of the British Pharmacology Society's prescribing committee. "Methylprednisolone is a very strong anti-inflammatory drug that should only be used for people suffering from severe inflammatory conditions such as rheumatoid arthritis."
Other medicines on the list include treatments for epilepsy, such as Topamax, powerful pain relievers like Hydrocodone and Vicoprofen, and anti-depressants such as Fluoxetine. "I cannot see how the prescribing of these medicines can be justified on medical grounds," added Maxwell, who is based at Edinburgh University.
These points were backed by Munir Pirmohamed, professor of clinical pharmacology at Liverpool University. "This is a horrendous list. Many of these are powerful medicines that are supposed to be prescribed for very specific, serious conditions."
However, as is clear from the example of Michael Jackson, when a star wants access to drugs, they generally get their way. For his part, Heath Ledger was taking a combination of painkillers, sleeping pills, anti-anxiety medication and tranquillisers when he died. In such cases, official reports often record death as being from a heart attack. "To be frank, that is highly unlikely," added Maxwell. "These are young people. Their hearts stopped all right, but not because they had a heart attack. They died because of all the powerful drugs they were taking."
Thus individuals take these drugs – initially – to counter discomfort or to deal with anxiety that is robbing them of sleep or sometimes, using drugs like Adderall, to increase their concentration. They increase their doses as their tolerance rises, but see no worries as the drugs involved were originally prescribed by their physicians. Eventually they end up on regimes of many drugs that lead to breakdown or death.
Another key factor in this accumulation of potent drugs is the internet. Although it is supposed to be rigorously monitored to prevent people buying prescription drugs, reports indicate that these are routinely circumvented. In this way, powerful painkillers and anti-anxiety medication can be purchased in large quantities by significant numbers of people. As to the issue of painkiller addiction spreading to Britain, there is little doubt that this has already happened.
Last year a parliamentary inquiry concluded that British doctors are unwittingly fuelling numbers of people hooked on prescription drugs that include painkillers, sleeping tablets and anti-anxiety pills. For example, the Home Office blames misuse of benzodiazepines for causing 17,000 deaths since their introduction in the 1960s.
MPs said they had been "extremely concerned" to receive many testimonials of people still being negligently prescribed these drugs by their GPs. Dr Brian Iddon, the Labour MP and former chemist, told the Observer: "Some GPs are addicting people by giving them repeat prescriptions without checking to see how long they've been on the drugs in the first place. They are not stopping patients from getting any more of them after the set amount of time."
The MPs' investigation also claimed that family doctors were contributing to growing problems associated with these substances by not taking seriously enough requests for help from addicts, and by mismanaging patients with chronic pain.
Medical experts told the inquiry that an unknown, but growing, number of people had become addicted to painkillers, often after taking them initially for genuine medical complaints such as a sore back, period pains or bad headaches. Some developed a dependence on over-the-counter drugs as a result. Solpadeine and Nurofen Plus are the two such substances most widely misused, the MPs say, with 4,000 subscribers to one specialist advice website alone hooked on Solpadeine.
"Of course, there is always going to be a subset of people who want to experiment with substances," said Pirmohamed. "There are also individuals who want to take risks. This is not the case with many of those addicted to painkillers and other prescription drugs, however. Many of these people simply do not realise that all drugs – no matter how beneficial – are poisonous at some level.
"That is the real key for dealing with this issue. We need to educate people to the dangers of all the medicines we consume."
