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          WORLD> America
          Coroner: Jackson death homicide, sleep aids caused
          (Agencies)
          Updated: 2009-08-29 18:06

          Medical experts said the drugs found in Jackson's system magnify each other's effects.

          "Instead of one plus one equals two, one plus one equals three," said Lee Cantrell, a toxicologist and director of the San Francisco division of the California Poison Control System.

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          Coroner: Jackson death homicide, sleep aids caused Coroner says Jackson died from lethal dose of propofol

          A search warrant affidavit unsealed this week in Houston includes a detailed account of what detectives say Murray told them. The doctor said he'd been treating Jackson for insomnia for about six weeks with 50 milligrams of propofol every night via an intravenous drip, the affidavit said. Murray said he feared Jackson was becoming addicted to the anesthetic, which is supposed to be used only in hospitals and other advanced medical settings, so he had lowered the dose to 25 milligrams and added the sedatives lorazepam and midazolam.

          That dosage is very small and by itself it's very unlikely it would have killed him. But with the other drugs there was a "benzodiazepine effect," according to the coroner, and it was deadly.

          Dr. David Zvara, anesthesia chairman at the University of North Carolina at Chapel Hill, said it's difficult to determine what constitutes a fatal dose of propofol in someone receiving other sedatives.

          "It's hard to set any level because of the way those act in synergy," he said. Given after the sedative lorazepam, "Even a small dose of propofol might have a very large effect."

          Jackson had many medical procedures over the year and a long history with various drugs. Following his death, three medical professionals said Jackson asked them for propofol this spring. All refused. One, a registered nurse named Cherilyn Lee, recounted that Jackson told her he liked how the drug knocked him out fast and allowed him to sleep for hours longer than he could naturally.

          Doctors were surprised by the coroner's mention of ephedrine, once sold as the controversial diet drug Ephedra and now banned by the federal Food and Drug Administration, though the drug can be used for resuscitation. Zvara said it's unlikely emergency personnel who responded to Jackson's home would have used that drug since epinephrine, otherwise known as adrenaline, is favored.

          Meanwhile, a lawyer for Dr. David Adams, an anesthesiologist mentioned in a search warrant affidavit, said Murray's account of their meeting with Jackson was inaccurate.

          Documents state Murray told detectives he was present when Adams sedated Jackson with propofol at a cosmetologist's office in March or April.

          Adams' lawyer, Liborius Agwara, said his client spoke to Murray on the phone and met him in person only once, at a meeting with Jackson at Murray's Las Vegas office in March. Adams didn't perform or witness any medical procedures at that meeting, the lawyer said.

          Agwara said Adams administered propofol to Jackson four times in 2008 to assist a dental surgeon.

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