Whitney's Death: A Probable Cause?

While the exact cause of Whitney Houston’s death is still only speculative, there is good reason to talk about how drugs, particularly the combination of prescription drugs and alcohol, might lead to serious harm and, in the case of too many of our stars, death.

Drugs that affect the central nervous system are particularly dangerous.  Many of the drugs that are used for anxiety or sleep belong to a class of drugs that we call benzodiazepines (or benzos, for short).  The most recognized drugs in this class are ones like, Xanax, Ativan and Valium. These sedative drugs when used properly bring relief to many suffering from conditions that range from seizures and insomnia to generalized anxiety and panic attacks.  We routinely use benzos in procedures, like angiograms and colonoscopies, to induce a controlled sedation in the hospital setting.  But when misused or abused can lead to serious consequences in the central nervous system, causing a range of abnormalities from a stuporous or obtunded state to coma and death. 

How Benzos work: 

Benzodiazepines mimic a naturally occurring substance called GABA, the major inhibitor—or “breaks”—of the central nervous system (CNS).   Therefore, benzos are capable of slowing down many brain functions, including the drive to breathe and the heartbeat.  Both of these functions are controlled by a part of the CNS that works automatically, meaning that you don’t have to remember to breathe or to make your heart beat.  Benzos in excess can slow down the autonomic nervous system to the point of significantly reducing the drive to breathe or causing complete respiratory arrest.

However, in typical benzo overdose, where no other substance is involved, we don’t usually observe respiratory arrest.  The most common signs of overdose from benzos are slurred speech, balance or gait instability and altered mental status.  But the person is often still arousable.  When respiratory arrest occurs, physicians should be suspecting ingestion of another substance, usually alcohol, that leads to an accelerated slowing of the CNS, coma or death.

Speculation:

Many are speculating about the cause of Whitney Houston’s death, but from a medical standpoint, drowning, as the immediate cause, seems unlikely to have occurred.  Based on the coroner’s finding that only small amounts of water were found in the singer’s lungs, drowning was likely not the cause.  Moreover, even if someone loses consciousness—that is, a temporary loss of higher brain function and awareness, but lower brain function (breathing, heartbeat) remains intact—a sudden submergence under water would be expected to interrupt breathing, causing her to jolt and struggle for breath.  In other words, a simple loss of consciousness, with no other loss of vital function, does not take away the body’s basic drive to breathe—to survive.

In the intensive care unit, we give a medication called, flumazenil, to reverse the effects of benzo overdose.  One can only wonder if the lives of some of our stars that have recently succumb to these drugs might have been saved if they were brought to medical attention sooner. 

Dave Montgomery, M.D., Ph.D., is a board-certified physician and EBONY's Special Contributing Health Editor. You can find him on Facebook or follow him on Twitter: @DMontgomeryMD. Send your health questions to drdave@ebony.com