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Ledger lessons are lost

I saw the new Batman movie, The Dark Knight, on Monday night. The theater was full on what is typically a slow day for moviegoing. And this after the film took in a record-breaking $158-million over the weekend.

A major force driving the movie's appeal is Heath Ledger, the talented Australian actor who plays the Joker. Ledger's performance is as advertised: twisted, manic, brilliant.

Ledger died of an overdose of a mixture of prescription drugs in January. His death at age 28 was shocking. Many people are seeing this movie to pay homage to the actor, whose daring career and budding stardom were setting him up to be the next Brando or Nicholson.

But marvel as we might at Ledger's life and performance, something else is getting lost in a shuffle of the Joker's deck of cards: the lessons we must learn from Ledger's untimely death.

Perhaps we could ignore those sad facts if his death were an anomaly. But the fact is, Ledger died from a phenomenon that is killing thousands of Americans a year.

You may recall a series the St. Petersburg Times published in February that chronicled the swelling number of overdose deaths from prescription drugs.

In Tampa Bay in 2007, more than 500 people fatally overdosed on prescriptions — mostly opioid painkillers like OxyContin and antianxiety drugs like Xanax. That's double the number of deaths from five years ago and three times as many who fatally overdosed on illicit drugs like cocaine and heroin.

Statewide, about 2,000 people fatally overdosed on prescriptions in 2007. Most states don't track prescription deaths like Florida does, but if other states are having the same problem we are here, that would put the national death toll at more than 30,000 people a year.

Only auto crashes cause more accidental deaths.

With that many people dying, it's not surprising that the occasional celebrity would get swept up in the surge. Model Anna Nicole Smith and her son also were casualties.

The New York medical examiner determined that Ledger died of an accidental combination of six drugs: two prescription painkillers, three antianxiety drugs and sleeping pills.

There also were reports that Ledger had at one time used illicit drugs like cocaine and marijuana, though no illegal substances were found in his system after his death. Reports also surfaced that Ledger had insomnia and anxiety problems, though it's not clear why he was taking prescription painkillers.

Ledger's autopsy, toxicology and history are similar in many ways to the majority of the prescription overdose deaths in Tampa Bay.

For the Times series, my colleague Abbie VanSickle and I analyzed the prescription overdose deaths in Tampa Bay and found that about 80 percent were ruled accidents and only about 20 percent were suicides. Nearly 70 percent of the deaths were caused by a combination of drugs.

Yes, a lot of the dead were chronic drug abusers who would snort, shoot or swallow just about anything to get high. About 80 percent of the dead had an addiction history.

But many were steered toward prescription drugs by medical conditions, including pain, anxiety or insomnia. Nearly 70 percent of the dead had a previous medical condition like these.

A majority had both medical conditions and addiction histories, which may have been the case with Ledger, too.

A good number of the dead were impressive professionals like Ledger: doctors, lawyers, artists, business owners, teachers, clergy, police officers, soldiers.

Like Ledger, many were complex. They may have had sore backs and a drinking problem. Or depression coupled with anxiety. Or insomnia and sleeping pill abuse exacerbated by a lingering work injury.

Ledger can serve as a tragic spokesman for this legion of the dead. The ultimate lessons to be learned, I believe, are that people need to realize the potential dangers of using, abusing and mixing prescription drugs; and that society must have more dialogue about how we use dangerous prescription narcotics to treat our ills.

But as much as Ledger has been in the spotlight the last few weeks leading up to The Dark Knight's release, I haven't heard nearly as much public discussion about prescription drug use and abuse as I think the topic deserves. And now, while Ledger is at the pinnacle of his posthumous stardom, is the ideal time to get it revved up.

I remember when basketball player Len Bias died from using cocaine in 1986. Afterward, it seemed that cocaine became enemy No. 1. And we've seen heroin use take a beating in the public eye after it wrecked the lives of treasured musicians like Kurt Cobain and Sid Vicious.

But other than some early coverage of the subject after Ledger's autopsy results were released, prescription drug use has gotten a virtual free pass.

Granted, it's a tougher, thicker topic. Not many will argue that cocaine and heroin are good for much of anything at this point in history, but many people believe prescription painkillers and antianxiety drugs should play a substantial role in making people feel better. But at what cost?

Many of us may associate a false sense of safety with prescription drugs because they come from a doctor. But this is one of the contributing factors to the skyrocketing deaths. People feel secure, so they don't fret about taking an extra pill or having an occasional drink or two while taking medications.

But those behaviors put you at risk. Certainly Heath Ledger didn't understand the deadly gravity of his prescription drug use. If only he had known.

The day Ledger's cause of death was released publicly, his father issued a statement.

"We learned today the combination of doctor-prescribed drugs proved lethal for our boy," the statement read. "Heath's accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage."

The statement is chilling, especially the use of "our boy," which reminds us that Ledger was more than an actor and a celebrity; he was a son, a child.

One can't help but admire that Ledger's family — still in the deep throes of grief — felt it important enough to include a warning to others in a personal statement about their son.

They may never emerge from the privacy of their grief. I've seen this occur many times in 13 years of covering thousands of tragedies — murders, car accidents, plane crashes, overdoses.

If they do, one can only hope they will continue to preach that powerful message. They will speak for their son and they will speak for hundreds of thousands more.

I hope that Ledger wins an Oscar for his Joker role. And I hope whoever delivers the acceptance speech for him thanks a short list of people, then spends a good few minutes talking to the millions watching about the dangers of prescription drug use and abuse.

And if the orchestra conductor cuts that person off, he should be tossed from the building.

In the meantime, if you really want to honor Ledger, pay the $8 to see his movie. Talk to your friends and family about how you couldn't take your eyes off the screen while he was up there.

But in the parking lot, when it sinks in that he's dead, keep talking about that, too.

Chris Tisch co-authored a two-part series on prescription drug deaths that can be seen at http://www. He can be reached at (727) 892-2359 or

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To read previous coverage of prescription drug deaths in Florida, see

Ledger lessons are lost 07/26/08 [Last modified: Wednesday, July 30, 2008 4:24pm]
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