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Whitney Houston doctors in crosshairs, top addiction expert talks culpability

By April MacIntyre Feb 15, 2012, 19:23 GMT

02/12/2011 - Whitney Houston - Authorities confiscated prescribed drugs from Houston\'s suite at the Beverly Hilton Hotel. Officials are awaiting results of toxicology tests on Houston\'s body still. Houston was publicly intoxicated the night before her death, according to reports. © Andrew Evans / PR Photos

The investigation into the death of Whitney Houston has turned inward, as authorities are reverse engineering the trail back to doctors who wrote the script for all of her prescribed medications and whether she was properly diagnosed and monitored for the reported large amounts of drugs found in her possession.

Authorities confiscated prescribed drugs from Houston's suite at the Beverly Hilton Hotel. Officials are awaiting results of toxicology tests on Houston's body still. Houston was publicly intoxicated the night before her death, according to reports.

Whitney Houston was a superstar in the pop music world, and she suffered publicly in a troubled marriage to singer Bobby Brown, having a daughter with the singer. Houston died Saturday in Beverly Hills at the Beverly Hilton Hotel. She was just 48 years-old.

The Los Angeles County coroner's office has issued subpoenas for medical and pharmacy records as Assistant Chief Coroner Ed Winter told the Los Angeles Times that the request is made in virtually all death investigations because it can shed additional light on how people died and if there were serious medical conditions.

According to reports, Houston's initial autopsy found no indications of foul play or obvious signs of trauma.  She was underwater and apparently unconscious when she was pulled from a bathtub.  It could be weeks before the coroner's office completes toxicology tests to establish the cause of her death.

Medical records have come under intense scrutiny in the wake of widely known addicted celebrity death investigations, including inquiries for Anna Nicole Smith, Janie Lane, Corey Haim, Brittany Murphy and Michael Jackson.

Haim's death initially was thought to be a drug overdose. California law enforcement 
officials said he bought more than 550 doses of prescription painkillers and anti-anxiety drugs in the weeks before his death in what they linked to a big, illegal prescription drug ring. However, the coroner's office ruled Haim died of natural causes from a combination of pneumonia, respiratory and heart problems, at age 38. 

Brittany Murphy died from a combination of pneumonia, an iron deficiency 
and multiple drug intoxication, according to the coroner.  The drugs involved were legal and are used to treat respiratory infections, according to her autopsy.

The investigation on Jackson's death had federal investigators looking into the pop icon's medical history and doctors who had prescribed him medication. They decided not to file charges against seven doctors except one unnamed physician to the state's medical board for prescribing medications to Jackson under an alias.  It was Jackson's personal physician, Conrad Murray, who fell hard on the sword, as he was convicted of involuntary manslaughter for the singer's death. He had been giving the  entertainer nightly doses of the operating room anesthetic propofol in Jackson's bedroom as a sleep aid.

In California, law enforcement can access CURES, California's prescription drug monitoring database which collects data culled from pharmacies that can reveal doctors prescribing serious painkillers and other highly addictive medicines outside the course of normal medical practice and cross-reference a patient's information to see if they are getting multiple prescriptions from various physicians.

Houston publicly struggled with illegal drugs and alcohol over the years before her death, and what will come of the investigation remains to be seen. Last May her publicist released a statement saying Houston was going back into rehab.

The singer was in staying in the hotel for the awards and to attend her mentor Clive Davis’ annual pre-Grammys party Saturday night. It was reported Houston was seen acting strangely, skipping and doing handstands near the hotel pool. Her appearance allegedly seemed erratic to observers.

Monsters and Critics asked noted addiction psychiatrist and CEO of top-rated Promises Treatment Centers, Dr. David Sack, how doctors can protect their reputations and keep a code of ethical medical practices. Dr. Sack has been a frequent expert contributor to Monsters and Critics on issues of addiction and recovery. 

Dr. David Sack says, "Take a thorough history of drug and alcohol abuse.   People with a past history of alcohol or drug dependency are at the highest risk to abuse or become addicted to prescription narcotics and sedatives."

"Prescribe limited quantities for specific acute problems.  If someone has a chronic pain problem refer them to a specialist for recommendations and follow them.  Ensure the patient signs an agreement that they will not obtain pain medications, sleeping pills or muscle relaxants from any other physician.  Re-evaluate your patients after a short interval to determine whether pain medications are still required."

We asked Dr. Sack how can a doctor protect himself, and more importantly, how does a doctor suss out who is an addict and who really needs pain relief?

"Never prescribe for a patient you have not evaluated or re-evaluated," says Dr. Sack.  "Scrupulously document your findings and plan. Obtain additional history from reliable collateral resources – family, friends.  Drug test clients when you suspect substance abuse.  Urine tests are helpful in telling whether the person is using now, but hair analysis can give you a picture of what has been going on over the 
last several months.  If history and/or testing confirm your worst fears, and you are not experienced in treating addiction, refer the patient to someone who is.  Never underestimate the difficulty in treating an addict."