Heath Ledger died from accidental drug overdose, medical examiner says

NEW YORK — Actor Heath Ledger died from an accidental overdose of six drugs — painkillers and sedatives — the New York City Medical Examiner's Office said Wednesday, leading doctors to warn of the dangers of mixing prescription drugs.

"Mr. Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine," said the medical examiner's spokeswoman, Ellen Borakove.

"We have concluded that the manner of death is accident, resulting from the abuse of prescription medications."

In addition to the painkiller oxycodone, the list of generic names refer to drugs more commonly known as the painkiller Vicodin, anti-anxiety medications Valium and Xanax, and the sleeping pill Restoril, while Unisom is an antihistamine commonly used as a sleeping aid.

There was no mention of alcohol or illegal drugs.

The medical examiner and police wouldn't discuss who had prescribed the medications Ledger, 28, had in his apartment when his body was discovered Jan. 22. The medical examiner also wouldn't say what concentrations of each drug were found in Ledger's blood.

The Drug Enforcement Administration is investigating how Ledger obtained the medications and whether they were prescribed illegally.

The lesson to be learned from Ledger's death is the danger of mixing prescription drug, experts said.

Taken appropriately, experts said, the six drugs found in Ledger's blood were medically safe.

Taken together, the mix killed him.

What stands out in the list are the two pain-relief narcotics: oxycodone and hydrocodone, said B. Joseph Guglielmo, chairman of the Department of Clinical Pharmacy at the University of California, San Francisco.

"People who are chronically on narcotics become tolerant of the benefit of taking pain away," he said. "But they don't become tolerant to the depression in respiratory drive."

That leads to central-nervous-system depression, said Sid Nelson, dean of the School of Pharmacy at the University of Washington. "You become unconscious and stop breathing."

Doctors not connected with the case said it's not unusual for people to be prescribed painkillers and sedatives, and overdoses are not uncommon.

"This is not rock-star wretched excess," said Cindy Kuhn, a pharmacology professor at Duke University. "This is a situation that could happen to plenty of people with prescriptions for these kind of drugs."

Three of the six prescription drugs found in Ledger's apartment had been filled in Europe, where the actor was recently filming, police said.

Material from The Associated Press, USA Today and the Los Angeles Times is included in this report.