The actor
Heath Ledger died accidentally “from the abuse of prescription medications” — specifically, six kinds of painkillers, sleeping pills and anti-anxiety drugs — a spokeswoman for the New York City medical examiner said on Wednesday.
Nicholas Roberts/Reuters
A memorial to Heath Ledger created by some of his fans.
Mr. Ledger, who was nominated for an Academy Award for his performance in the 2005 movie “Brokeback Mountain,” died of “acute intoxication” caused by the combined effects of the six drugs, the spokeswoman, Ellen Borakove, said in a statement.
Mr. Ledger was found dead in his rented SoHo apartment on Jan. 22, when a masseuse tried and failed to awaken him for an appointment. Before calling 911, she placed three calls to the actress Mary-Kate Olsen, who she knew was a friend of his. Ms. Olsen sent over private security agents, who arrived at about the same time as emergency medical personnel.
An autopsy was performed the following day. Ms. Borakove said then that the results were inconclusive and that the cause of death would not be determined until toxicology tests had been conducted, which she said would take about 10 days.
Among the drugs found in Mr. Ledger’s system were two widely prescribed narcotics: oxycodone, the main ingredient in the prescription drug OxyContin, and hydrocodone, the principal pain reliever in the prescription drug Vicodin.
Also in Mr. Ledger’s system were three anti-anxiety medications: diazepam, the generic name for Valium; alprazolam, commonly known as Xanax; and temazepam, which is sold under the brand name Restoril and is often prescribed as a sleep medication.
The drug doxylamine was also found in his system. It is an ingredient in some over-the-counter sleeping pills, and is also marketed in some nonprescription cold medicines that contain decongestants.
The medical examiner’s office provided only the generic names of the drugs found in Mr. Ledger’s bloodstream, so it was not known what forms of the drugs he took before he died. In a telephone interview, Ms. Borakove would not say how much of each drug turned up in Mr. Ledger’s bloodstream. She said such concentrations were not normally made public, although the amounts are included in the information given to a person’s family after an autopsy.
She also would not say whether any one drug had contributed more than the others to his death.
“It’s the combination of the drugs that caused the problem, not necessarily too much of any particular drug,” she said in the interview. “All these drugs have a cumulative effect on the body.”
Mr. Ledger’s father, Kim, released a statement through Mr. Ledger’s publicist that said “no medications were taken in excess,” echoing Ms. Borakove’s comments about the medications’ being taken together.
“We learned today the combination of doctor-prescribed drugs proved lethal for our boy,” Mr. Ledger said. “Heath’s accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage.”
There had been rumors about drug use, in part because the police said they had found a rolled-up $20 bill near Mr. Ledger’s body. The police also said they found no evidence of foul play and no suicide note.
In the wake of the medical examiner’s findings, some psychiatrists speculated on Wednesday that Mr. Ledger’s use of the prescription drugs had gone beyond abuse to addiction.
“There’s a possibility that different physicians prescribed these medications, and there’s a possibility that they were not misused,” said Dr. Andrew Kolodny, vice chairman of psychiatry at Maimonides Medical Center in Brooklyn. “Sometimes patients try to take them as prescribed and there’s an accidental overdose — I think that’s unlikely. I think what’s more likely is if someone dies of an overdose like this, that person was suffering from addiction.”
Dr. Kolodny continued, “I can tell you that if I presented a case of an overdose death with a toxicology report that appears like his did, my assumption would be the individual suffered from addiction.”
Dr. Vatsal Thakkar, a psychiatrist at New York University Medical Center and the author of the 2006 book “Addiction,” said another concern was that some of the drugs that Mr. Ledger had taken could build up in the body.
“If someone walked into my office on these six medications and I could verify that these were legitimately given, I’d explain to that person and then try to do the best I could in terms of streamlining or tapering some of these medications,” he said. “There are equally or more powerful alternatives that are often safer.”
Lori Brown, a pharmacist who is the manager of clinical services with Kerr Drug, a regional pharmacy chain in North Carolina and South Carolina, said the list of drugs should have been enough to have raised concerns.
“He was taking what I think any pharmacist would recognize as a potentially lethal, likely harmful combination of agents,” she said. “They all had a risk of sedation, and by combining all these medications, the sedation was substantial enough that it was lethal.”
The federal Drug Enforcement Administration is investigating where the drugs came from and has issued subpoenas to the medical examiner’s office for information about Mr. Ledger’s case, according to a law enforcement official who asked not to be identified because the investigation was continuing.
As it does whenever there is a death by drug overdose, the federal agency is seeking to determine whether the drugs were legally prescribed by a doctor for a medical condition or if any were illegally dispensed. The law enforcement official said the agency was also working with the police to obtain the original police reports about the death.
Mr. Ledger had become a familiar figure in his SoHo neighborhood. He moved there after breaking up with the actress Michelle Williams, who played his wife in “Brokeback Mountain” and with whom he had a daughter, Matilda, 2. Newspapers in Australia reported that Ms. Williams and her daughter arrived in Perth on Tuesday, apparently for Mr. Ledger’s funeral. Ms. Williams was dressed in black, and Matilda was carrying a stuffed rabbit.
Al Baker and Sewell Chan contributed reporting.
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