Addiction specialist in Day 43 of the AEG trial: Michael Jackson wasn’t addicted to Demerol!

Today’s session heard testimony from Dr. Sidney Skolnick. At the start, Michael Kasakoff, the attorney for the Jacksons, began questioning.

Kasakoff asked Skolnick what the consequences of withdrawing from the painkiller Demerol are.

In Day 33 of the trial, a video deposition of another addiction specialist named Paul Henry Erle—who testified for the company—had been played. He had said that Michael became addicted to painkillers, the main one being Demerol, and that doctors were responsible for his addiction. Today, Dr. Sidney Skolnick pushed back against Dr. Erle’s testimony. In response to Kasakoff, Skolnick said that withdrawal from Demerol is unpleasant for patients, “like falling off the edge of a cliff.” Methadone is a medication used to treat addiction to painkillers. Skolnick said the key point is to determine why the patient should stop taking Demerol.

Kasakoff: “What if someone has arthritis?”Skolnick: “Maybe they need Demerol for their entire life. Maybe they’re in a situation where, with the medication, they function better. Using it therapeutically doesn’t cause harm.”Kasakoff: “Do you know a famous person who was dependent on Demerol?”Skolnick: “President John F. Kennedy.”Judge: “Why?”Skolnick: “Back pain.”

Skolnick said that prescribing painkillers in America is very common, but 10 to 12% of people become dependent on these drugs—an equivalent percentage to alcohol addiction. Skolnick explained that pain thresholds differ among individuals, but the feeling of pain is the main reason people seek medical care.

Kasakoff: “Is there any evidence showing that Michael Jackson used Demerol outside of a treatment process?”Skolnick: “No.”Kasakoff: “Did MJ use this medication at some point to treat the pain from a scalp burn?”Skolnick: “Yes.”

Dr. Skolnick then testified about a surgical procedure performed in 1993, before the start of the third leg of the Dangerous tour, to repair a severe injury caused by a fire incident that had happened to Michael ten years earlier. In 1983, while filming a Pepsi commercial video, Michael’s head caught fire and he suffered second- and third-degree burns. The wound was on a nerve, was extremely painful, and Michael used a painkiller. Dr. Finkelstein accompanied Michael on tour.

Kasakoff: “According to Dr. Finkelstein, did MJ use pain medication during the Dangerous tour?”Skolnick: “Yes. I don’t know whether he had become addicted to the drug or not. I didn’t have information that would allow me to make a decision about that.”

However, Skolnick said that records show Michael developed dependence on Demerol in 1993.

Skolnick said Michael went to the Santa Ynez Cottage Hospital due to an overdose of Demerol.

Kasakoff said that, based on the medical documents from the last sixteen years of Michael Jackson’s life, he was away from Demerol for thirteen and a half years. The attorney then asked the doctor: if someone has been away from the drug for so many years, are they an addict? The answer was no.

Skolnick said he reviewed the medical records of Dr. Farshchian. In the early 2000s, Dr. Farshchian performed a surgical procedure on Michael Jackson to treat dependence on Demerol. The procedure involved implanting a piece of the drug naloxone into Michael’s abdomen, which prevented Demerol from taking effect.

Skolnick, who had said yesterday that addicts use drugs to create a euphoric high, testified today that there is no evidence showing that Michael personally injected the drug for fun without a doctor present. This doctor said there is evidence that Michael was afraid of injection needles and did not take more medication than the doctor prescribed.

Kasakoff: “Did MJ use benzodiazepines (a group of sedatives, anti-anxiety, and tranquilizers) at any time?”Skolnick: “Yes.”He said doctors prescribed midazolam and Versed (from the benzodiazepine group) for Michael—medications commonly used for minor surgeries such as dental procedures.

Kasakoff: “Did he use these drugs to sleep?”Skolnick: “Yes.”Kasakoff: “Was that proper treatment?”Skolnick: “Yes.”Kasakoff: “Did MJ have a sleep problem?”Skolnick: “Yes.”

Kahan asked whether it was typical to use Demerol when injecting Botox into the skin. Skolnick said he didn’t know because he doesn’t perform cosmetic skin services. Skolnick said Demerol is no longer used heavily because it has side effects. Skolnick said Demerol is considered a “dirty” drug. Doubts about using Demerol as a painkiller had been raised since the 1990s. Skolnick said the last time he prescribed Demerol was in the 1970s, and today doctors do not keep this medication available.

Dr. Skolnick has treated tens of thousands of patients, and only five or six of them were addicted to propofol. They were medical technicians, and none of them received injections from someone else.

“Usually they steal this drug from the operating room or the intensive care unit and inject it themselves at home or in the bathroom.”

He said that when propofol injections are stopped, its effects fade quickly and the patient regains consciousness. Propofol is the most popular anesthetic drug in the world.

Kasakoff asked Skolnick whether Michael received propofol during the Dangerous tour. Skolnick said Debbie Rowe, who married Michael in 1996, confirmed this question—though he wasn’t sure whether the drug was propofol or fentanyl.

(Fentanyl is a very powerful painkiller with a potency eighty times that of morphine, and it is injected into the patient before anesthesia in the operating room.)

Dr. Skolnick said he doesn’t think Debbie Rowe has a nursing license. Debbie Rowe served as a nurse during the Dangerous tour.

Kasakoff: “Which specialist accompanied Michael during the Dangerous tour?”Skolnick: “An anesthesiologist.”

Dr. Skolnick said that between 1994 and 1996 there was no sign that Michael used propofol.

Skolnick said that after reviewing records up to 1997—including dental records and the records of Dr. Arnold Klein, a dermatologist—he concluded that Michael Jackson was not addicted to medications prescribed by doctors. According to records up to 1997, Michael sometimes used propofol for dentistry or for skin and beauty treatments, which was not without issues, but in 2009 Dr. Murray used this drug to put Michael to sleep, which was wrong.

Skolnick: “Besides that, he (Murray) wasn’t an anesthesiologist.”Kasakoff: “Is there evidence of MJ being addicted to propofol before Dr. Murray started working?”Skolnick: “No.”

Skolnick said the records do not confirm Michael’s use of Demerol between 2003 and 2008.

Skolnick said that from mid-2008 until December of that year, Dr. Arnold Klein injected Michael with 100 milligrams of Demerol. But the dosage increased in January 2009. Skolnick said that if someone has a history of dependence on Demerol and then stops it for a while and later returns to it, their tolerance to the drug increases, and a higher dose would be needed for it to work.

Kasakoff: “Is there evidence showing that MJ received Demerol from another doctor?”Skolnick: “No.”

In April 2009, Michael received the maximum amount—375 milligrams of propofol—from Klein. Kahan, the company’s attorney, asked what would happen to him if he received that amount of medication. Skolnick: “You? You would probably fall asleep for a while—just a few hours.”

Skolnick, however, said he prescribed 50 milligrams of this drug for Kahan. He said drowsiness is a side effect of Demerol injections. If someone becomes dependent on Demerol, when they stop it they may develop insomnia.

People testified that on June 19, 2009, Michael was unwell and was trembling. Skolnick said withdrawal from some pain medications can cause side effects such as feeling cold, a runny nose, watery eyes, pupil dilation, and goosebumps. Specialists can reach conclusions by summarizing these symptoms—whether the person is “hungover” from drugs or has the flu—but non-specialists generally interpret these signs as the flu. Dr. Murray had attributed Michael’s illness on June 19 to the flu.

Skolnick, however, said he doesn’t think the symptoms Michael showed on June 19 were related to Demerol because, in his view, Michael wasn’t dependent on Demerol. But Skolnick attributed the illness to propofol. Propofol was used by Murray to put Michael to sleep.

Michael received his last Demerol injection on June 22, 2009—three days before his death—at Dr. Klein’s office, at a dose of 100 milligrams.

Skolnick said that if there were dependence on Demerol, withdrawal side effects would have appeared within 24 to 36 hours after consumption, but he found nothing in the records showing that Michael experienced side effects during that time. He therefore concluded that it is hard to say Michael was dependent on Demerol in 2009. Michael’s relatives said that on June 23 and 24 he performed well on stage at the Staples Center.

Also, at the time of death, no trace of this drug was found in Michael’s body. Skolnick said Demerol had no effect on Michael’s death. He stated there is no evidence proving that Michael was addicted to Demerol in 2009.

Skolnick said that when a patient isn’t treated properly for their pain, they go from this doctor to another doctor to get access to medication. He explained that a professional doctor knows that addiction to drugs is different from searching for drugs. One of the jurors, who is a nurse, nodded her head in approval.

“If a patient has severe pain that can only be relieved by a pain medication that calms them down, it’s appropriate that the medication be given. Just because Dr. Klein injected MJ with Demerol, you can’t say that he became dependent on Demerol.”

Kasakoff: “Assuming that Murray was hired by AEG, did Dr. Murray have the qualifications to treat MJ’s pain, his dependence on medication, and his sleep problem?” Skolnick’s answer to all three was no. He said Conrad Murray is a cardiology specialist, and his field has nothing to do with pain issues or insomnia.

Kasakoff said: if we assume MJ was addicted to Demerol and benzodiazepines in 2009, would there have been any chance of successfully treating him under the care of a qualified specialist doctor? Skolnick said that if his pain and insomnia were treated correctly, he could have stopped using these drugs and could even have continued performing on stage. Skolnick said that if the two main problems—MJ’s pain and insomnia—were treated, he would have returned to normal life, and these drugs would not have had any effect in shortening his lifespan. In Day 33, Dr. Erle had said these drugs shortened Michael’s life. He also called Michael an addict.

Kasakoff asked Skolnick whether he agreed with the testimony of Dr. Paul Henry Erle, who said Michael was addicted to Demerol and wouldn’t live long.

Kasakoff: “Assuming Michael wasn’t addicted, but had become dependent on the medication during certain periods, would that have affected his lifespan?” Skolnick answered that no, not if he was treated properly.

Skolnick: “He could have been treated if he had the right people around him. Having supportive people and a supportive family is essential.”

Skolnick explained that the lifespan of addicts may be shortened due to overdoses or infections such as HIV. If Michael received proper treatment, he could have had a normal life. He added that Keith Richards and the Rolling Stones have been performing for fifty years. Richards wrote in his autobiography that he had been addicted during certain periods. Skolnick said he is reading the book but hasn’t finished it yet. The company’s attorney objected to the witness speaking about the book.

Skolnick told the jury about Michael’s physical condition at the time of death: “The forensic medical report made it clear that Michael Jackson was in a very, very good physical condition, and these people get the best results from addiction withdrawal treatment.”

Dr. Skolnick also told the attorney that there was no sign of addiction in other members of Michael’s family.

Dr. Skolnick is the creator of the term “Rock Doc” to refer to doctors who work at rock-and-roll concerts.

Kahan asked whether it is ethical for doctors to participate in a tour. Skolnick said it depends on the service they provide. Skolnick himself, in the 1970s, treated artists and their fans during tours—though his main job was to treat the audience. His salary was paid by the concert company. In this regard, Kahan asked:

Kahan: “Do you think there was a conflict of interest?”Skolnick: “Since I behaved ethically, no.”

Skolnick accepted young medical students as assistants on tours.Kahan: “Did you check their background beforehand?”Skolnick: “I knew them well.”

Kahan: “When you assess your patient’s condition, do you assume they are honest with you?”Skolnick: “Yes.”Kahan: “There should be mutual trust between doctor and patient?”Skolnick: “Yes.”

Kahan asked whether Dr. Klein prescribed medication to Michael using aliases. Skolnick said yes. Kahan: “Could MJ get pain pills from other doctors and also receive Demerol from Dr. Klein?” Skolnick: “I don’t want to say anything about what might or might not be possible, because anything can happen in this world. I want to deal with probabilities.”Kahan: “Is writing prescriptions under someone else’s name illegal?”Skolnick: “Yes.”

Dr. Skolnick said that sometimes famous people obtain medication using other people’s names because they don’t want their medical history to be checked by others. Skolnick explained that once Frank Sinatra was taken to the hospital after he fainted on stage. A huge number of people tried to extract from the hospital computer the information about what happened to Sinatra.

Kahan asked about patients who don’t admit their addiction and feel that their use is under control. Skolnick said that it is the job of doctors to make patients realize their problem. He added that no doctor succeeds in 100% of cases, and he himself is not an exception.

Kahan asked about the failure of the Jackson family’s interventions to stop Michael from taking medication. Skolnick said he didn’t know whether those interventions were proper.

Kahan asked whether he had read the testimony claiming that Michael kept boxes of propofol at Neverland and asked a doctor to inject it into him. The answer was yes.

Nurse Sherylin Lee testified that in 2009 Michael told her he was looking for a doctor who would inject him with propofol. Kahan asked Skolnick whether he knew Lee’s answer. Skolnick said Lee had said Michael was going to “try his luck.”

Kasakoff pointed out that Michael had told Lee that as long as he was under a doctor’s supervision, he wouldn’t be in danger.

Kasakoff: “Did Dr. Murray give it to her?”Skolnick: “Yes.”

In the middle of the trial, after a break and in the absence of the jury, Judge Brian Panish, the Jacksons’ attorney, was reprimanded for what happened in court the previous day. The witness from the previous day, Jane Searight, an expert in human resources, had said from the stand that she believes AEG hired Dr. Murray. The judge told Panish that it is the attorney’s duty to instruct the witness so that their own opinions are not planted in the jury, because the jury is responsible for deciding the case. The judge warned Panish that this would lead the court off track, and Panish told the judge that he had already warned the witness about it. Putnam, the company’s attorney, said he agreed with the judge.

In explaining, Panish said that before this, the company’s attorney had pointed out that Searight was not an expert, and that Panish had tried yesterday to prove the opposite. The judge then told Panish: “Mr. Panish, I don’t know why your finger is pointing at the AEG attorneys like that—honestly, I don’t know.” He instructed Panish to remind all of his witnesses that they should not express their personal opinions about hiring Dr. Murray while on the stand.

After the jury entered the courtroom, the judge told them to ignore Searight’s opinion about AEG hiring Murray.

Source: eMJey.com / ABC7 & AP & LA Times