Reports that Michael Jackson had become heavily and habitually overmedicated has focused new attention on the widespread abuse of prescription drugs nationwide.
Nowhere, perhaps, is the problem more acute than in the star culture of Hollywood, where there is no shortage of Dr. Feelgoods willing to act as enablers of celebrity dependence on an array of prescription drugs, especially painkillers and anti-depressants.
"When a very nice celebrity comes into your office with a lot of charm and clout and asks for a painkiller, it's very difficult to say no," says Dr. Svetlana Kogan, an internist with practices in Manhattan and Queens, who did not treat Mr. Jackson.
Dr. Kogan said that movie stars and performers turn to the medicine cabinet for varied reasons, including relief from the pain caused by injuries suffered on stage or film sets and for respite from the stress and anxiety associated with life in a fishbowl.
Mr. Jackson himself is reported to have turned to painkillers as long ago as 1984 for relief from painful burns on his scalp incurred when his hair caught fire during the shooting of a Pepsi commercial in Los Angeles.
"I would not be surprised if the toxicology report tells us [Mr. Jackson] was highly medicated," says Dr. Kogan. "He seemed to be a highly stressed individual."
Brian Oxman, a spokesman for the Jackson family, told CNN last week that the Jacksons had been gravely concerned "for months and months" about the music superstar's reliance on drugs and doctors, saying that his death was not "unexpected."
"If you think the case of Anna Nicole Smith was an abuse, this was nothing in comparison," Mr. Oxman, a lawyer, said on CNN on the evening of Mr. Jackson's death.
Dr. Deepak Chopra, the famed medical doctor and spiritualist, was a friend of Mr. Jackson's until, he has said, their relationship became strained in 2005 when he declined to write his friend a prescription for painkillers the star said he needed.
Dr. Chopra, who declined through an assistant to be interviewed for this article, told People.com that Mr. Jackson had at various times in his adult life used OxyContin, Vicodin and Demerol.
Painkillers, such as Vicodin and Percocet, can be effective in alleviating soreness, but "because they are opiates, they have high addiction potential," Dr. Kogan said. "They bind to the receptors of the brain and can cause a circle of addiction in as little as seven days."
On Tuesday, outside advisers to the Food and Drug Administration supported a ban on Percocet and Vicodin, the latter being the most prescribed drug in the U.S.
The high one gets from opioid pain medication is similar to the high one gets from heroin, a substance known for its potency and addictive powers. Another appeal of prescription drugs can be the lack of heavy hangovers the next day, like those that invade the body after the ingestion of large quantities of Scotch or red wine.
Given the strong addictive nature of prescription drugs, experts say that physicians should be wary of patients who have a history of changing doctors or seem to be aggressive or demanding.
Many physicians do not heed these warnings, because "it's all about money and the pharmaceutical companies at the top," Dr. Kogan said. "There is huge pressure from the companies to get doctors to use their drugs."
Painkillers are the most profitable drugs for American pharmacies.
The abuse of prescription medication extends far beyond the privileged precincts of the rich and famous. "It's not just celebrities," she said. "Our entire country has become overmedicated."
More than 7 million Americans use nonmedicinal prescription drugs, including pain relievers, tranquilizers, stimulants and sedatives, according to the National Institute on Drug Abuse, NIDA.
"Prescription-drug abuse comes to the forefront when it's associated with the death of celebrities like Anna Nicole Smith, Michael Jackson and Elvis," said Dr. Erika Schwartz, Cinergy Health Medical Director in New York City. "But every day million of Americans are taking these drugs - and not for aches and pains."
They are particularly popular among adolescents, according to NIDA, which reports that in 2008, among the nation's 12th-graders almost 10 percent reported nonmedicinal use of Vicodin, while close to 5 percent reported use of OxyContin, both powerful opioid painkillers.
Many youngsters report they think these drugs are safe because they're prescribed by a doctor.
"It's a false perception," said Dr. Wilson Compton, director of the division of epidemiology, services and prevention research for NIDA.
Deaths caused by overdosing on prescription drugs have doubled, and now account for more than 20,000 annually since 1999. "It's now the second-leading cause of unintended death after traffic accidents," Dr. Compton said.
Still, in young adults 18 to 25, the nonmedicinal use of prescription pain relievers rose 12 percent between 2002 and 2007, according to the Substance Abuse and Mental Health Services Administration.
Dr. H. Westley Clark, director for Substance Abuse Treatment, a division of SAMHSA, said, "It has to do with accessibility - more than 50 percent of young people are getting them from friends and family for free."
The American Pain Foundation, though, cautioned that there are many legitimate uses for prescription pain medication.
"When prescribed appropriately by knowledgeable health care providers and taken as directed, prescription pain medication can make a tremendous difference for people suffering from pain," said Will Rowe, CEO of the American Pain Foundation in a statement released in response to speculation about the role of pain medication in Mr. Jackson's death.
That raises the question, if prescription pain pills are popped by an increasing number of Americans, are we as a nation in more pain than ever or are we just hunting for another high?
"I don't know. If we're in more pain, then why? If we're all just becoming a nation of drug addicts, then why?" said Dr. Schwartz. "Let's examine it. Let's make this unfortunate death a wake-up call to take responsibility, to create a more positive outcome."