The Enid News and Eagle, Enid, OK

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July 12, 2011

Drugs were controlled substances or prescriptions

By Cindy Allen, Managing Editor Enid News and Eagle

ENID — All the drugs found in Austin Box’s system at the time of his death were controlled substances or prescription drugs.

An informational report released by the Oklahoma State Medical Examiner’s Office to the family of Box on Monday revealed Box, 22, showed a combination of five painkillers and an anti-anxiety drug in his system when he was found unresponsive May 19 in the El Reno home of J.T. Cobble, a friend and son of Box’s former Enid High School football coach, Tom Cobble.

The cause of death, according to the report, was pulmonary edema and aspiration pneumonia due to “probable mixed-drug toxicity.”

The agency said the combination of the drugs likely caused pulmonary edema — or fluid in the lungs — and aspiration pneumonia — inflammation of the lungs caused by inhaling foreign substances. There was no indication on the report alcohol was in use at the time of death, and the report lists the death an “accident.”

The report also noted Box had cardiomegaly, or an enlarged heart, and he had chronic pain history. Cardiomegaly isn’t a disease, but rather a symptom of some other condition, according to the Mayo Clinic website.

The painkillers in Box’s system were oxymorphone, morphine, hydrocodone (Lortab), hydromorphone and oxycodone (Oxycontin).

According to local pharmacist Steve Pryor, of Scheffe’s Pharmacy, these drugs all are used for pain management. Alprazolam (Xanax), which also was found in Box’s system, is prescribed for anxiety.

Pryor said his comments reflect general information on the use of pain medications and not on any particular patient.

There is no indication on the information sheet of the breakdown of the chemicals, and such drugs can break down into additional chemicals, which could account for the number of painkillers found in the athlete’s system, Pryor said. The Oklahoma Medical Examiner’s Office said it could be many more weeks before a complete autopsy report is released.

Pryor said some of the drugs are used together for pain management in patients.

“You’ll see for pain treatment, a drug like Oxycontin in a time-released tablet, usually given twice a day,” he said. “Because it doesn’t last a full 12 hours, you’ll see a drug like Lortab or Percoset given for breakthrough pain.”

Pryor said such treatments usually are provided for a brief period of time.

As for Alprazolam, Pryor noted depression, anxiety and pain often go together in some patients who are in a lot of pain.  He also said all of the drugs are habit forming.

“Pain treatment is difficult,” he said. “People need to follow directions, go to one doctor and one pharmacy and be honest with people who are prescribing (the drugs).”

He also said there are some symptoms of over-use of pain medications, including loss of motor function, decreased ability to concentrate or think and even slurring of speech.

“Some of these are the same symptoms as drinking, but not all,” he said. “There is often a general loss of alertness.”

Pryor said patients can develop a tolerance to the pain-relieving effects of medication, but drug combinations are dangerous because people don’t realize the effects of combining drugs.

Pryor said it is Scheffe’s policy the pharmacy won’t fill medications more than four days early on a 30-day supply. If they suspect a patient is seeing multiple doctors and pharmacies, they also can check online at an Oklahoma Bureau of Narcotics website to see what medications have been prescribed and purchased.

“We try to counsel the patient,” Pryor said. “You can help them by explaining this isn’t a good idea and they need to talk to a doctor.”

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