Conrad Murray trial -Day nineteen.

witness believes MJ was dependent on demerol, addicted to opiods

Still doesn't get Murray off for what he did and didn't do while treating MJ and while trying to save his life.


ETA: I have faith in Walgren! He'll clear up any doubts in the jurors' minds! :)
 
Now trying to say these are not the doctors notes or records because of the lack of siggys and or intials.
 
I've missed quite a bit of this part, re MJ's visits to Dr Klein.

Has Chernoff said, according to Dr Klein's notes, why MJ was going to
Dr Klein's office & the reason for the demerol, besides for botox?

FYI... I've had botox & dysport between my eyebrows... it does hurt!
I can't imagine in the groin or arm pit. Nor understand the reason for either area!!!

Don't know purpose for botox injections in the groin, but I have heard of botox used for excessive sweating (hyperhidrosis).

http://www.excessive-sweating.net/botox.html
 
Witness is giving an overall talk about drug addictions, prescript meds, etc. Haven't even gotten to how this exonerates CM from his guilt (IMO) in abandoning MJ.

<sarcasm alert>

Now, now, october, we've got all day, at least. Be patient. I'm sure it's coming right up. I mean, how does 80 nights of IV propofol even come close to comparing these large IM doses given to MJ in a doctor's office with several people (and we will have to assume Dr. Klein) in attendance in what is probably a very well-fitted examination/treatment room?? Gee, don't let's get too carried away...
 
Talking about giving "the hair of the dog" to treat withdrawl. Note- that is my term.
 
Yayyyy Walgren for questioning witness about his knowledge of CM having shipments of benzos sent to girlfriend's apartment!


Yayyyy Judge for allowing the question after Chernoff objected!!!
 
Very interesting... Dr. says MJ could have been addicted to opiates, but was not given Murray's non-existent notes about how many opioids and benzos he was administering.
 
Direct by Chernoff / Dr. Waldman - Addiction Specialist

Klein's Records begin Jan. 2009 - June 2009

11:30am 100mg I/M injection of demerol LUQ with 1mg of diazalam

12:00pm 100mg I/M injection of demerol LUQ

50mg is standard for someone who has never had demerol before

200mg is large dose - sleepy, lethargic - no good way to know how someone is going to respond - should start with small dose and work up but 200mg is large

3/17 - Similar treatment but no botox (my note: at top of page it does say restylane treatment)

10:45AM and 11:45AM - total 200mg of demerol

Month of April:

4/6 8PM - 200mg demerol / 1mg midazolam

4/9 - 3:30PM 200mg demerol / 1mg midazolam

4/13 - 11:15AM 200mg demerol/1mg midazolam

4/15 - 200mg demerol / 1mg midazolam

4/17 - 7PM 200mg demerol / 1mg midazolam
7:30PM 100mg demerol / 1mg midazolam

4/21 - 10:30AM 200mg demerol / 1mg midazolam
11:30AM - 100mg demerol

Implies that not getting enough from first shot of therapeutic value and is developing tolerance

4/22 - 11:30AM 200mg demerol/1mg midazolam
12:30PM 100mg demerol
1:30PM 75mg demerol

Waldman has never given such a high dose of demerol
Highest recommended dose is 600mg over 24 hour period

4/23 - 100mg demerol/1mg midazolam

775mg in 3 days (4/21 - 4/23)

4/27 - 11:30AM 200mg demerol/1mg midazolam
12:30pm 100mg demerol/1mg midazolam

(My note: I cannot believe Chernoff did not have an extra copy) So disorganized

4/30 - 12:30pm 200 mg d - 1mg mdz
2:30pm 100d - 1mg mdz

5/4 - 200mg d / 1mg mdz
100mg d / 1mg mdz

Believes he was dependent upon demerol possibly addicted (due to public behavior ???)

6 weeks of frequent high dose would result in opoid dependence and considered very high doses

5/5 - 10:30AM 200mg d / 1mg midz
100mg d/1mg midz

5/6 200mg d/1mg mdz
100mg d/1mg mdz

No notations by doctor - does not see his initials

3 days in May - 900mg demerol total

gap between 5/6 and 5/19

5/19 200mg d/1mg versed (generic for midazolam)

5/20 200mg d/1mg versed

5/21 100mg d/1mg midz

6/1 - 200mg d/1mg mdz

6/3 - 200mg d/2mg mdz

6/9 - 200mg d/2mg mdz

6/16 - 100mg d/1mg mdz

6/22 - 100mg d/1 mg mdz
============================
Withdrawal can cause insomnia in varying degrees

Daily/intermediate - possibly chronic - can last weeks to months

Can get relief from injections of reduction of demerol during withdrawal

If individual physically dependent -- any opoids can relieve symptoms

Symptoms of withdrawal would come back -- varies
 
Walgren on cross of Dr. Waldman

No written report

One can be addicted to benzos such as lorazepam &#8211;

Lorazepam &#8211; is a scheduled controlled substance and regulated by DEA

Highly addictive drug

Reviewed Klein's records, autopsy records, tox reports

No demerol in tox findings

Did not read Murray's interview

Did not ask for it &#8211; did not view it as pertinent to his expertise on addiction and withdrawal

Was he aware that CM made shipments of lorazepam and midazolam shipped to girlfriend's apt and subsequently administering drugs

Was he aware of volume of drugs sent to CM &#8211; No

Did not think it was pertinent

Symptoms of benzo withdrawal &#8211; similar to opiate withdrawal &#8211;

Except sweating, diarrhea, muscle, aches and pains

Tremendous crossover &#8211; varies depends on patient &#8211; will differentiate from interview with patient

Opinion based on demerol addiction &#8211; some evidence for addiction but not a lot. He did not interview or examine MJ

Based upon records and public record

Presumptive opinion &#8211; but would need more evidence to actually claim he was an addict

Would you diagnose MJ as an addict based strictly on medical records - &#8220;Probably not&#8221;

Tricky area of medical care &#8211; need training and experience

Care would begin with interview, physical exam, complete medical history of patient, lab tests, other meds being given used

Comprehensive lab information

Not board certified in addiction

Explains diffusion &#8211; as soludes go from one side to another / from greater to lesser concentration

If Dr is untrained &#8211; what they should do is consult with specialist unless they are competent in that field

Reviewed what was given to him and did not ask for more.

Break &#8211; 15 minutes
 
Urine testing is practically always done.... it's routinely done on admission!

Even though patients come on their own and are very serious about getting detoxed & treatment,
they are usually not truthful about the amount of substance they've been using/abusing.

Patients using alcohol almost always minimize the amount & how often they drank.
This is because they are embarassed that their tolerance allowed them to drink so much.

Drug users usually maximize their usage because they are afraid of the depression and discomfort
they'll have if not given enough detox meds.

Because it's known that alcohol users minimize their use, it is very important that their vital signs be checked frequently.
Alcohol is the most dangerous of detoxes. Patients can have seizures and they may die during detox, if not given the correct
dosages of detox meds or if patient stops drinking "cold turkey".

There are tests given to opioid users to determine their actual usage. A drug will be given to them,
a dosage based on what they've told us. Then staff observes patient to see what their tolerance is...
do they fall right off to sleep, are they unsteady on their feet, or are they functioning as "normal"?

Detox meds are then ordered according to the outcome of the tolerance test.

Opioid detox is not dangerous, but is extremely uncomfortable.
All they want to do is curl up in a ball... flu like symptoms, bone aches, chills, vomiting, shakes, etc.
 
There hasn't been any testimony or evidence presented that MJ was going through a detox program, has there?
If not - Why is this Dr. Waldman testifying for the DT?


They want him to say that MJ was addicted to Demerol. (Notice they didn't have the Dr. look at what CM said in his interview about his administration of lorazepam, midazolam, and propofol -- I guess they would rather kind of soft pedal those, but that's just a wild azz guess on my part...) Maybe they think this Demerol "addiction" might have influenced what happened to MJ on the night he died -- again, the fault of MJ asking for Demerol and Klein enabling it. Regardless of the level of Demerol that was in his body at autopsy. Not. That is, IIRC.

I will give Cherny a point for finally getting to pretty good questions for this witness.
 
Walgren never misses an opportunity to drive home the importance of medical notes, patient history, current list of medications, etc., as he is doing with this witness. :)
 
I don't recall what year it was that MJ was filming the Pepsi commercial and his head caught on fire.
But after that time, MJ has admitted to being addicted to pain meds and that he went for treatment.

Regardless, of how long ago it was (and same goes for alcohol) that a person stopped using his drug of choice...
even 20 yrs plus... and then uses again, his tolerance of the substance will shortly be back to what it was when patient was previously using.

IOW... if MJ was addicted to demerol... in order for it to work therapeutically and under the care of a physian,
he would definitely need more demerol to be effective than the normal use, (that amt being what a non-addict would need).
 
:floorlaugh: Arrogant is a great word for Waldren. Also evasive and snotty to boot!
 

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