[Noozhawk’s note: This article is part of Noozhawk’s special investigative series, Prescription for Abuse. Related links are below.]
Santa Barbara psychiatrist Sherif El-Asyouty served as a medical expert witness in the trial of Dr. Conrad Murray, the physician charged and convicted in the 2009 death of King of Pop Michael Jackson.
El-Asyouty never testified, but his work in addiction medicine and involvement as a reviewer for the Medical Board of California got the attention of Los Angeles County Deputy District Attorney David Walgren.
“It was really an honor to work with Mr. Walgren,” El-Asyouty said.
El-Asyouty couldn’t talk about details of the case. Murray is expected to be sentenced at the end of the month after he was found guilty this week of involuntary manslaughter.
The high-profile case focused on Murray regularly providing Jackson with Propofol — a surgical anesthetic on which Jackson fatally overdosed — as a sleep aid.
El-Asyouty and Dr. Joe Frawley founded Recovery Road Medical Center, which specializes in helping patients overcome addictions. The two work closely together, and Frawley has been a mentor, encouraging El-Asyouty to get involved with the Medical Board. He has experience reviewing cases like this one, although not nearly as high-profile.
In trials such as Murray’s, medical expert witnesses like El-Asyouty comment on how it compares with the standard of care, and what an average physician would do in the situation. In Murray’s trial, El-Asyouty said prosecutors referred to several practices as being extreme deviations from the standard of care.
Murray was accused of delivering the fatal dose of Propofol, which was being given to Jackson intravenously as a sleep aid, and he could be sentenced to four years in prison, according to the Los Angeles Times.
Jackson, 50, was found, not breathing, in a rented Los Angeles mansion on June 25, 2009. Investigators determined the death was a homicide, however, and not an accidental overdose. Murray’s defense attorneys argued that Jackson was addicted to sedatives and painkillers and gave himself the fatal dose of Propofol after Murray left the room, according to news reports.
Propofol is not a controlled substance but is used by medical professionals for “short diagnostic tests and surgical procedures,” according to Drugs.com. It is delivered by a professional and can interact with prescription drugs, including sleep aids, anti-anxiety drugs, cold or weight loss drugs, painkillers or mental health medications.
The Murray case revived many of the same issues brought up after the death of model and actress Anna Nicole Smith.
Smith’s lawyer and boyfriend, Howard K. Stern, and two doctors were all accused of conspiring to illegally supply controlled substances to an addict and obtaining the medication through fraud, but not of causing Smith’s 2007 overdose death.
The prosecution argued that the three gave Smith medications she wanted — not medically needed — because of her fame, sometimes through prescriptions written with false names.
Smith’s psychiatrist was convicted of four counts of obtaining medication through fraud, the Los Angeles Times reported, “for cases in which Smith was prescribed medication under false names.” Stern was convicted of conspiring to aid and abet doctors, and her physician was acquitted of all charges.
The judge in the case later overturned the drug conspiracy convictions of Stern and Smith’s psychiatrist, finding that Stern didn’t have the intent to defraud when he used his name and other names to obtain prescriptions for Smith.
The deaths of Jackson and Smith put the spotlight on the larger issues of overprescribing and prescription drug abuse. While there are many reasons a health professional may overprescribe, including for financial gain, El-Asyouty said many people think they’re helping when they’re really hurting their patients.
“A lot of doctors, unfortunately, overprescribe — and you don’t have to be a celebrity to be overprescribed to,” he said.
When interviewed for Noozhawk’s Prescription for Abuse series, Frawley and El-Asyouty said there’s a strong connection between substance dependence and untreated mood and anxiety disorders, and that people will self-medicate with prescription drugs to feel “normal.”
Compounding the issue is that people perceive prescription medications to be safe and will take them — and share them — readily, even for nonmedical use.
El-Asyouty said the important thing is to view addiction as a disease, not a personal choice or bad habit. He added that during Murray’s trial, defense attorneys often referred to Jackson as an addict who brought his problems on himself.
In Jackson’s case, El-Asyouty had to wonder why he was never treated for addiction if he had a problem.
He said the medical community needs to be cognizant of potential abuse when prescribing drugs. Physicians get sued or reprimanded if they fail to diagnose or treat a patient, but addiction doesn’t always garner the same scrutiny. Many overdose deaths do result from legitimate prescriptions. Drug overdoses are preventable, which makes news of local deaths hard for El-Asyouty to hear, as a professional working with addiction.
Addiction medicine is still a new specialty. Board certification for addiction psychiatry didn’t exist until 2000, and addiction medicine until 2008, El-Asyouty said. He said he was in a respected psychiatry residency program for four years and only two weeks were dedicated to talking about addiction, and psychiatry was the only discipline that even addressed the subject.
“It’s important to realize addiction is a disease like any other disease,” he said, and education can go a long way to preventing it.
Being aware of the problem, talking about it openly with family and friends, and controlling access to commonly abused drugs can save lives.
As Santa Barbara County sheriff’s Sgt. Sandra Brown, supervisor of the Coroner’s Office, said at a Carpinteria forum: “Listen to your Spidey sense. I know it sounds goofy, but we all have it. When something doesn’t feel right, it’s not right.”
Polydrug use — mixing multiple medications — and mixing drugs with alcohol is the biggest concern with overdoses, and reducing access is a key to preventing misuse, abuse or addiction. In Santa Barbara County, any type of medications, even controlled substances, can be safely disposed of at any Sheriff’s Department substation.