Whitney Houston (NY, 2009)

Whitney Houston (NY, 2009)

by Roseann Vorce, Ph.D., 
Department of Pharmacology and Toxicology
Michigan State University 

The headline was shocking – “Whitney Houston Found Dead”!  At age 48, the iconic singer was gone, found lifeless in a Beverly Hills hotel bathtub in a death scene we have seen too many times for the rich and famous.

Almost immediately, rumors began circulating that Houston’s death involved prescription drugs.  Some claimed that she died from a drug overdose; others claimed that she drowned while in a drug-induced stupor.  Toxicology test results will not be available for several weeks, and we might never know the full story.

Houston had a long history of substance abuse, and she had been in and out of drug rehabilitation programs for years.  With a history of using illegal drugs, many of which can cause death due to overdose, could Whitney Houston really have died due to the use of legally-obtained prescription drugs?

A vial of Xanax (alprazolam) was found in Houston’s hotel room, fueling speculation that prescription drugs caused her death.  Xanax is an anxiolytic drug that is commonly used to relieve stage fright, as well as anxiety caused by many other triggers.  A member of the benzodiazepine family of drugs, Xanax is one of the most frequently prescribed drugs in the United States.  The benzodiazepines work by increasing the effect of the endogenous neurotransmitter GABA (gamma-aminobutyric acid).  GABA is an important neurotransmitter that functions to inhibit activity in the central nervous system (CNS) by acting at the GABAA receptor.  The overall effect of GABA binding to the GABAA receptor is a dampening of activity in the CNS.  Benzodiazepines also bind to the GABAA receptor, where they enhance the effects of GABA on its receptor.  Because the activity of benzodiazepines relies on the presence of endogenous GABA, adverse effects of benzodiazepines are limited to impaired motor function (stumbling, difficulty walking), and drowsiness.  Only at very high doses can benzodiazepines cause death by inhibiting breathing.

Houston was seen drinking alcohol in the days prior to her death, and she reportedly indulged in champagne on the day she died.  Like the benzodiazepines, alcohol (ethanol) depresses the CNS.  Unlike the benzodiazepines, alcohol exerts a profound inhibitory effect on respiration.  The effects of ethanol poisoning include loss of consciousness (“passing out”), coma, and respiratory depression.  Ethanol poisoning is a medical emergency, and mechanical ventilation often is needed to maintain respiration.  Without treatment, a person suffering from ethanol poisoning can die.

Although Houston was reported to be drinking on the day of her death, there is no evidence that she was acutely intoxicated, nor is there evidence that she took an overdose of Xanax.  However, the combination of a benzodiazepine and alcohol can be deadly, even when the individual doses of each are not lethal.  Both alcohol and Xanax are CNS depressants, and their effects are additive.  Simultaneous administration of both can cause respiratory depression severe enough to stop breathing, a situation that ends in death if artificial ventilation is not initiated.  In contrast, some people die due to injuries suffered in accidents occurring secondary to intoxication with benzodiazepines and alcohol.  Automobile accidents, falls, and drowning in the bathtub all have been reported as the cause of death in people who are under the influence of benzodiazepines and alcohol.

We will not know the cause of Whitney Houston’s death until the results of toxicology testing are available. However, this story provides an opportunity to reinforce a warning that mixing prescription drugs with other drugs, including alcohol, can be very dangerous, and even deadly.

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