When Carrie Fisher went into cardiac arrest and died in December 2016, everyone familiar with her struggles with alcoholism and drug abuse wondered if this was yet another tragic story about a Hollywood celebrity succumbing to personal demons.
“My mom battled drug addiction and mental illness her entire live. She ultimately died of it. She was purposefully open in all of her work about the social stigmas surrounding these diseases.”
~ actress Billie Lourd, Carrie Fisher’s daughter
This week, the Los Angeles County Medical Examiner released its official autopsy report. Among the findings:
- The official Cause of Death was due to “sleep apnea and other undetermined factors”
- Other conditions: “atherosclerotic heart disease, drug use”
- Significantly, the report pointed out the “multiple substances that were detected in Fisher’s blood and tissue.”
- The “multiple substances” included alcohol, heroin, methadone, Ecstasy, and cocaine.
- Of special relevance, the tests revealed that the cocaine had been consumed within the 72 hours immediately preceding her death.
- The dose and time of the heroin consumption could not be determined.
- How Injury Occurred: “Multiple drug intake, significance not ascertained”
While “significance not ascertained” may be the official ruling, what is known about the substances that Fisher evidently consumed tells much of the tale. They ALL played a role in her hastened demise.
Alcohol: A Ticking Time Bomb for the Heart
“In an elderly population, increasing alcohol intake is associated with subtle alterations in heart structure and function, with women appear more susceptible than men to the toxic effects of alcohol.”
~ Dr. Alexandra Goncalves, Brigham and Women’s Hospital and Harvard Medical School
Carrie Fisher was a 60-year-old woman with a history of alcoholism. Why does that matter? Contrary to previous reports that drinking in moderation might provide health benefits, a recent study suggests that it might instead harm the heart. These findings are especially true for women or seniors. In a study involving 4446 senior citizens – average age 76 years – researchers discovered that even moderate drinking could result in negative consequences for their cardiac health. Over half of the participants self-reported that they “never drink”. The researchers used an electrocardiograph machine to measure different parts of the heart for size, structure, and motion. Women who drank in moderation – taking just one daily drink – suffered reduced heart function. Likewise, men had more than an average of 2 drinks per day experienced an enlargement of the left ventricle wall – the heart’s pumping chamber. For men, this qualifies as “heavy drinking”. A “standard drink” is defined as –
- 4 ounces of wine
- one 12-ounce beer
- 1-1.5 ounces of hard liquor, depending upon its proof
This contradicts the American Heart Association’s long-standing recommendation that alcohol should only be consumed in moderation – no more than 1-2 daily drinks for men, and 1 daily drink for women. Earlier research had suggested that light-to-moderate daily drinking reduced the risk of heart failure. However, the AHA has steadfastly cautioned against starting to drink as a means of improving health. Earlier, a study conducted in Sweden discovered that adults in their 50s and 60s who drink heavily have an elevated risk of stroke that is 34% higher than those who drink less. This means they are more likely to suffer a stroke up to five years earlier, regardless of their genetic history, their overall health, or lifestyle. These findings demonstrate that binge drinking is even more deleterious to health than accepted hazards like diabetes or hypertension. “Our findings highlight the possible hazards to cardiac structure and function by increased amounts of alcohol consumption in the elderly, particularly among women…women may be more sensitive than men to the toxic effects of alcohol on heart function. Compared with men, women may develop alcoholic-related heart disease by drinking a lot less alcohol over their lives,” Dr. Goncalves concluded. Cocaine: The Perfect Heart Attack Drug
“This preliminary study demonstrates potentially beneficial effects of cocaine abstinence/reduction on inflammation and coronary plaque phenotype… The findings… may have important implications for the prevention of cocaine-induced coronary artery disease.”
~ Dr. Shenghan Lai, Johns Hopkins School of Medicine
Carrie Fisher evidently used cocaine between one and three days before she went into cardiac arrest. Why does that matter? Cocaine use – habitual or casual – results in serious coronary problems, including:
- 35% greater aortic stiffness
- 8 mm Hg higher systolic blood pressure
- Accelerated heart rate
- 18% increased left ventricular mass
- Decreased coronary blood flow
Combined, these factors can trigger a “cardiac event”, such as:
- Angina
- Arrhythmia
- Acute Coronary Syndrome (ACS)
- Myocardial Infarction – i.e., a heart attack
However, a recent study published in the Journal of Addiction Medicine, coronary atherosclerosis can be reversed if the use of cocaine is cut back or stopped altogether. In other words, the type of coronary plaques that causes heart attacks and strokes may be reduced. In this study, longtime cocaine abusers who also had atherosclerosis with a greater than 50% blockage of their coronary arteries took part in a program assisting them with reducing their use of cocaine. After a year of follow-up, it was discovered that a number of markers for coronary disease had decreased. Not only were the plaque reductions significant, they were also found even when the participant was not taking a cholesterol-lowering statin medication. “In the past, there has been excellent work to uncover the consequences of drug use. However, few studies have revealed what happens after drug use stops. Studies of this kind give people hope for a healthier life after stopping drug use,” Dr. Lai explained. To say it plainly—cocaine causes use coronary artery disease, but abstinence allows the body to reverse the damage the drug.
Opioids: A Road to an Early Grave
“…the large increase in cardiovascular death risk is a novel finding… it suggests being even more cautious with opioids for patients who are at high cardiovascular risk…”
~ Dr. Wayne Ray, Ph.D., Department of Health Policy at Vanderbilt University School of Medicine
Before she died, Carrie Fisher had recently used heroin and methadone, both opioids. Why does that matter? According to a study published in the June 2016 edition of the Journal of the American Medical Association, patients given opioids have a 64% higher risk of early death, compared to those given other types of pain medication. Even more relevant, opioid-receiving patients ALSO face a 65% greater likelihood of dying specifically because of a NEW heart problem. These findings dovetail with two 2015 studies reporting that using opioids increases the chances of developing arterial fibrillation, or irregular heartbeat. And that condition increases the risk of heart attack by 63%, with an even higher risk for women.
Ecstasy: The “Feel-Good Drug” That’s Bad for the Heart
“…MDMA requires the heart to use more oxygen.. This puts (users) at short-term risk for a heart event like a heart attack.”
~Dr. Steven Lester, MD, a cardiologist at Mayo Clinic Scottsdale
The potential heart harm from the use of MDMA/Ecstasy has been known for almost 20 years. In 2000, a study was published in Annals of Internal Medicine reporting that use of the drug increases blood pressure, oxygen consumption by the heart, and heart rate, but without an increase in efficiency. Even more worrisome was a 2004 study conducted by the National Institute of Mental Health’s Psychoactive Drug Screening Program that determined that Ecstasy use can increase the risk of coronary valve disease. When the drug is used regularly, it stimulates overgrowth of heart valve cells, which in turn leads to valvulopathy. With this condition, valves become inefficient and leak blood back into the heart. This overloading of blood enlarges the heart and compromises its ability to pump blood throughout the body. Up to 15% of longtime Ecstasy users will develop valvular heart disease (VHD).
What You Need to Know about Alcohol, Opioids, and Sleep Apnea
“We found that sleep-disordered breathing was common when chronic pain patients took prescribed opioids.”
~Dr. Lynn R. Webster, MD, Lifetree Clinical Research and Pain Clinic
The connection seems obvious: sleep apnea is a disorder characterized by the inability to breathe normally during sleep, and both alcohol and opioids such as methadone and heroin are central nervous system depressants that also suppress breathing, especially when used together. In fact, chronic use of an opioid seems to be one of the factors that can cause sleep apnea. According to an article in the September 2007 edition of Pain Medicine, the journal of the American Academy of Pain Medicine, made the following observations:
- Central sleep apnea is when a person’s brain “malfunctions”, causing them to stop breathing during sleep.
- In the general population, the prevalence of central sleep apnea is 5% or less. Importantly, the highest rates are among people in their 60s and older.
- Obstructive sleep apnea is breathing is interrupted or blocked by other health conditions. It is characterized by loud snoring.
- In the general population, the prevalence of obstructive sleep apnea is 4% or less.
- However, among study participants who took opioids, central and obstructive sleep apnea occurred at a 75% rate.
- This is over 15 times the rate of the general population.
But Carrie Fisher did more than take opioids. She also drank alcohol. A 2017 study by the Anesthesia and Pain Research Unit at Leiden University Medical Center suggests that even drinking a “modest” amount of alcohol, in combination with just one dose of an opioid drug raises the risk of potentially-deadly respiratory depression. Two test groups, one between the ages of 21-28, and the other between the ages of 66-77, were given the equivalent of one 20 mg OxyContin tablet and 5 drinks. The results were startling:
- The OxyContin depressed normal respiration by 28%.
- The alcohol depressed normal respiration by another 19%.
- The opioid/alcohol combination depressed respiration by an alarming 47%.
- Pointedly, mixture increased the incidence of breathing stoppages.
- These results were most common among participants in the older group.
Carrie Fisher’s Death – the Perfect Storm?
To summarize, Fisher had five substances in her system, each of which individually damages the heart and makes an adverse cardiac event that much more likely. And three of those substances, when used together, drastically reduce the ability to breathe normally. Additionally, two of those substances are associated with causing sleep apnea, her primary cause of death. Finally, the studies show that because she was a woman in her 60s, the damage from these substances was greatly magnified.
What Can We Learn from All of This?
From the outside, Carrie Fisher had it all – a privileged upbringing, fame and fortune in her own right as an adult, and the respect of her peers. She was multitalented as an actress and author. Fisher was even experiencing a career resurgence with the release of the newest Star Wars films But underneath all that, Carrie Fisher had the same struggles as millions of other Americans. For most of her life, Fisher battled bipolar disorder. She even referred to her drug use as a form of “self-medication”. But eventually, her drug use escalated. As Fisher herself said, she was “losing my choice in the matter.” The roller coaster of mental illness, drug use, therapy, sobriety, and relapse remained a cyclic constant. So, what can we take away from all of this? Mental illness and drug addiction can happen to ANYONE – the rich, the famous, the talented, and the rest of us. Recovery from either disorder requires a lifetime commitment, expressed one day at a time.
Sources:
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