His voice had the unusual ability to convey both aggressive muscularity and profound vulnerability. Scott Weiland and Stone Temple Pilots were icons of my adolescence. Personally, my memory of Mr. Weiland will always be inextricably linked with “Plush,” that initial hit single which, upon first listen, instantly captivated me and thousands of other kids like me.
During my high school days, “Plush” was elevated to the highest sonic status possible, joining Metallica’s “Enter Sandman” and Pearl Jam’s” Black” as an essential component of our football team’s pre-game locker-room pump-up playlist.
So it was with shock and sadness that I read in the New York Times this morning that Weiland had “died in his sleep” on Thursday during a tour stop in Bloomington, MN. He was 48.
My years practicing sleep medicine make me wonder if sleep apnea may have been a factor in Weiland’s demise.
I Don’t Like the Drugs but the Drugs Like Me
Weiland’s struggles with drugs, particularly with heroin, were well known. He had several run-ins with the law as a result of his substance abuse and is known to have attended rehab on at least one occasion. He reportedly suffered a near-fatal heroin overdose in 1999.
During a 2010 interview with MTV News, he stated that he hadn’t used heroin since 2002. In April of this year, however, after a dismal concert performance, rumors began circling in the music community that Weiland had gone back to using heroin, which he denied.
How Opiates Kill and the Sleep Connection
Besides pain control, opiates have multiple effects on several organ systems. The major danger with them is that they can decrease respiratory drive, slowing respiratory rate. Too much of these drugs will cause complete cessation of breathing, known as a pulmonary arrest, where the lungs stop working completely.
This, in turn, if not immediately treated, will shortly devolve into a cardiopulmonary arrest where both the lungs and heart cease to function. Death follows quickly after that.
During sleep, our respiratory drive naturally diminishes and our bodies are less sensitive to physiological problems caused by abnormal breathing. These factors, combined with opiates’ effects on breathing, can create a toxic combination, resulting in a condition called central sleep apnea, or CSA, where the brain essentially forgets to tell the body to breathe, increasing the risk of stopping breathing permanently.
Scientific research indicates that CSA in opiate users is quite common, with one study showing a rate of approximately 25% with the disorder. This particular type of sleep apnea is very difficult to treat, often not improving with CPAP. What’s worse, many physicians are not aware of this disorder and it often goes undetected.
The Cure Can Be Worse Than the Disease
The prevailing approach to treating opioid addiction is transitioning patients to a “safer” alternative such as methadone or Suboxone.
Methadone is an opiate with an extremely long half life and therefore has low abuse potential. Suboxone, a newer drug, is a mixed partial opiate-receptor agonist and antagonist. What that means in plain English is that it produces a watered-down opioid effect without allowing things to get out of hand.
It is possible that Weiland was telling the truth, that he really was off heroin. In that case, he may have been taking one of these “maintenance” drugs to help prevent relapse.
Doctors often think of methadone and Suboxone as less dangerous than other opiate compounds but methadone has been implicated in one third of opiate-related deaths nationwide, despite accounting for less than 5% of prescriptions .
Suboxone is felt to be safer but it is a relatively new drug and there are limited data on mortality rates with prolonged use. Anecdotally, the vast majority of sleep studies that I have ordered on Suboxone-using patients with sleep-related complaints have demonstrated central sleep apnea.
A review of the medical literature reveals that there is only one paper on the topic which seems to support my experience as the reported incidence of CSA in this patient population was 63%. More research studies in this area are clearly needed.
We may never know exactly what took Scott Weiland’s life. But the chances that an otherwise healthy-appearing 48-year-old with a long history of substance abuse died from substance-related causes are quite high.
The New York Times article mentioned that authorities found a small bag of cocaine in Weiland’s tour bus. It is possible that he died of cocaine-related causes – a massive heart attack or stroke, or maybe a fatal irregular heart rhythm.
What is certain is that, as we’ve seen so many times in the past after beloved artists have passed in the night, there will be a short-term increase in the chatter about drug-related mortality. It is my hope to interject the potentially under appreciated role that central sleep apnea could be playing in these deaths into the conversation.
Dark bedroom photo available from Shutterstock