UPDATE: 2 Autopsies and 1 Slow Recovery

PART 1 AUTOPSY RESULTS ANDREW KOPPEL:

Andrew Koppel, son of ABC News Commentator Ted Koppel who died May 31, had his death ruled an accident. According to Ellen Borakove, spokesperson from the NYC medical examiner’s office, Koppel died from acute intoxication due to the combined effects of alcohol; heroin; cocaine; diazepam (the generic form of Valium) and Levamisole, a drug used to cut other drugs.

Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.”

What are Opioids?
Opioids are commonly prescribed because of their effective pain-relieving properties. Studies have shown that properly managed medical use of opioid analgesic compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction.

Among the compounds that fall within this class are hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin—an oral, controlled-release form of the drug), morphine, fentanyl, codeine, and related medications. Morphine and fentanyl are often used to alleviate severe pain, while codeine is used for milder pain.

How are Opioids Abused?
Opioids can be taken orally, or the pills may be crushed and the powder snorted or injected. A number of overdose deaths have resulted from the latter routes of administration, particularly with the drug OxyContin (which was designed to be a slow-release formulation), and heroin. Snorting or injecting opioids results in a rapid release of the drug into the bloodstream, exposing the person to high doses and causing many of the reported overdose reactions.

How do Opioids Affect the Brain?
Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these compounds attach to certain opioid receptors in the brain and spinal cord, they can effectively change the way a person experiences pain.

In addition, opioid medications can affect regions of the brain that mediate what one perceives as pleasure, resulting in the initial euphoria or sense of well-being that many opioids produce. Repeated abuse of opioids can lead to addiction—a chronic, relapsing disease, characterized by compulsive drug seeking and abuse despite its known harmful consequences.

What Adverse Effects Can be Associated with Opioids?
Opioids can produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death.

These medications are only safe to use with other substances under a physician’s supervision. Typically, they should not be used with alcohol, antihistamines, barbiturates, or benzodiazepines. Because these substances slow breathing, their combined effects could lead to life-threatening respiratory depression.

PART 2 AUTOPSY REPORT ON SLIPKNOT’S PAUL GRAY

Polk County Medical Examiner, Dr. Gregory Schmunk, announced that Slipknot bass player Paul Gray died of an accidental overdose of morphine and fentanyl, authorities said Monday. Although pills were also found at the scene, Dr. Schmunk said that only the injected drugs (morphine, fentanyl) caused Gray’s death.

Fentanyl is a potent narcotic analgesic, abuse of which leads to habituation or addiction. It is primarily a mu-opioid agonist. Fentanyl is also used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance. Fentanyl is approximately 100 times more potent than morphine.

Intravenous fentanyl is extensively used for anesthesia and analgesia, most often in operating rooms and intensive care units. It is often administered in combination with a benzodiazepine, such as midazolam, to produce procedural sedation for endoscopy, cardiac catheterization, oral surgery, etc. Additionally, fentanyl is often used in cancer therapy and other chronic pain management due to its effectiveness in relieving pain. There is no known opioid better than fentanyl in reducing cancer pain, which makes it the first choice for use in cancer patients.

Illegal use of fentanyl first appeared in the mid-1970s in the medical community and continues today.  There are over 12 different analogues of fentanyl which have been produced and distributed illegally. The biological effects of the fentanyls are similar to those of heroin, except many users report a noticeably less euphoric ‘high’ associated with the drug and stronger sedative and analgesic effects.

See the information about fentanyl above to learn more about this opioid works.

PART 3  WILLIAM “THE REFRIGERATOR” PERRY

In April 2009, we reported that NFL star William “the Refrigerator” Perry had been admitted to a South Carolina hospital in serious condition with Guillain-Barre Syndrome. Now, over a year later, his brother Michael Dean Perry told The Republic that his 47-year-old brother has regained most of his strength but still has some hearing loss. Perry lost nearly 100 lbs during his illness, but is now back to about 330 pounds.  After his hospitalization he spent several months in a North Carolina rehabilitation hospital before being sent home to complete his rehabilitation.

Guillian-Barre Syndrome (GBS) is a disease where the body’s immune system turns against the nervous system. Specifically, the immune system attacks the coating around nerve cells (myelin) that allows them to transmit messages from the brain to the rest of the body.

It is unknown what causes GBS, but it is frequently preceded by a relatively mild viral illness, which in some way, may trigger the immune system to react in an abnormal way. Initial symptoms include muscle weakness and tingling in the legs. Weakness can progress up the body, and in severe cases, can cause complete paralysis. If the paralysis includes the breathing muscles, this is a medical emergency, and a patient must be put on a respirator.  Fortunately, the process is usually self-limited, and with support, the symptoms gradually resolve, although some mild weakness may remain.

Although there is no known cure for GBS, there are a couple of treatments that may lessen the symptoms or clear them up more quickly. One of these is called  plasmapheresis. The blood is removed from the body, filtered to remove harmful autoantibodies, and returned to the body).  The other is called high dose immunoglobulin therapy, where a patient receives an injection of  healthy antibodies pooled from a large number of donors. These antibodies block the harmful antibodies of GBS. However, the most critical part of treatment in all GBS patients is providing supportive care  to keep the body functioning during the illness.

For more information:

Resounding
Health(tm)
Guillian-Barre Syndrome
Resounding
Health(tm)
Opioid analgesics (painkillers)
Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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