Published on: Tuesday, June 30, 2009 |
Kota Kinabalu: Demerol, the narcotic pain killer supposedly injected into pop star Michael Jackson that caused his death last Thursday, is available in Malaysia but not over the counter and under a different name.
A check by Daily Express revealed many doctors admitting ignorance about the drug or its effects. This is probably due to it being marketed here as Pethidine and as Meperidine in other countries.
Deputy Health Minister Datuk Rosnah Hj Abdul Rashid Shirlin told the Daily Express that the generic name of the product is Pethidine, and that it is available and registered in Malaysia.
"It is a painkiller used in hospitals. Eight Pethidine products are registered with the Ministry of Health (MOH). The name Demerol is not used in Malaysia.
"Pethidine is a prescription drug. It is available mostly as injectables. Oral form is not popular. You cannot simply buy it over the counter. There is strict control over the use of this drug," she said.
In vial form, a usual dose (50mg) costs RM1.10 and a dose of 100mg costs RM1.30.
Jackson was also reported to be "heavily addicted" to the painkiller Oxycontin, and was injected daily along with Demerol.
President of the Malaysian Pharmaceutical Society (MPS), Datuk Nancy Ho described Oxycontin and Demerol as strong narcotic painkillers.
"Demerol is very similar to Pethidine, a derivative of morphine. These powerful analgesics are dangerous drugs. In the event of an overdose, Demerol can cause respiratory depression, and may ultimately lead to cardiac arrest or event heart attack.
"If taken simultaneously (Oxycontin and Demerol), the outcome may be more drastic as both drugs could potentiate each other's effect," she said, adding that both are highly addictive and, thus, subject to abuse.
According to Ho, private pharmacies do not normally stock Pethidine as it would involve a lot of paperwork and reporting to the authorities concerned, who conduct checks on a regular basis.
Consultant Oncologist Dr Jaswant Singh from the private sector said Demerol (Pethidine) is a narcotic analgesic, just like morphine, an opioid analgesic.
"It is used for moderate to severe pain while morphine, which usually lasts for 12 hours, is given for chronic pain. The indications are in cancer patients. It is available in oral or injectable form (intra-muscular or intravenous injection."
He said an overdose of Pathidine can cause respiratory depression (that is, shallow breathing) and circulatory depression which stops heartbeat. This will eventually lead to cardiac arrest. "It is very addictive and users can get hooked to it."
Referring to the World Health Organisation (WHO) guidelines, Dr Singh said the standard practice is that other painkillers are first used to stabilise the patient, and morphine is used as a third step in treating terminally ill patients.
"When we put a patient on morphine, we must ensure that the patient is breathing at least 20 times per minute."
Based on the press reports about Jackson's death, Consultant Physician & Cardiologist Dr Edward Sia said one could only guess what had actually happened.
"We can only suspect there is an overdose, pending additional testing such as toxicology and other studies.
"Demerol is not likely to be used unless one is experiencing a lot of pain.
Like morphine, it is for severe pain. Maybe he (Jackson) had been practising vigorously for his concerts and it was hurting him.
"Doctors worry about the use of this drug because it is habit-forming and thus the possibility of one taking a lot. But personally, one can't buy it (freely)," he said.
On the side effects of taking excessive Demerol, Dr Sia said it may not stop breathing but depresses it, in which case breathing becomes shallow. It could be life-threatening if mixed with alcohol, according to him.
"If there is not enough oxygen in the body, it affects the heart, causing arrhythmia (or irregular heartbeat) and leading to cardiac arrest. The circumstances surrounding Jackson's death, as reported, resemble in the mechanism of action and side effects."
A doctor who cares for cancer patients said Demerol is an opioid painkiller for acute pain rather than chronic pain like cancer pain in which morphine is more commonly used.
Side effects would be similar to those of other opioids, such as drowsiness, nausea, vomiting and constipation.
"An opioid is any synthetic drug that resembles an opiate in its effects (that is, lessens pain)."
According to the doctor, morphine, oxycontin, pethidine and meperidine (or Demerol) are all opioid painkillers.
"In hospitals, they are categorised as dangerous drugs because they are opioids. Morphine and oxycontin are more similar to each other whereas pethidine and meperidine are more similar to each other. We do use oxycontin a lot in cancer treatment."
