SMITH (on-camera): Tonight in the Michael Jackson death trial, explosive testimony from defense witness, Dr. Robert Waldman. Now, he is an addiction specialist who testified that Jackson was dependent and possibly addicted to Demerol, a pain killer so strong that it`s often compared to morphine.
Now, the defense used Jackson`s own medical records from his dermatologist, Dr. Arthur Klein`s office, to prove that he had a growing dependency. Take a look.
(BEGIN VIDEO CLIP)
CHERNOFF: Dr. Waldman, as you see, his days progress, we go from 200 to 300. Is that significant to you as an addiction medicine specialist?
WALDMAN: Yes.
CHERNOFF: Of what significance is that to you?
WALDMAN: It implies that he`s no longer getting a therapeutic effect from the prior dosage, and this is consistent with the development of tolerance.
(END VIDEO CLIP)
SMITH: Was Jackson`s possible addiction to Demerol so strong that he would do anything to get his fix, including self medicate behind Dr. Murray`s back? That`s what the defense tried to show today. And joining us right now, by the way, Dr. Klein`s attorney, Garo Ghazarian. Did I say that right?
GARO GHAZARIAN, ATTORNEY FOR DR. ARNOLD KLEIN: Ghazarian.
SMITH: Ghazarian, I`m sorry. And on the phone right now is the host of the show, board certified physician and addiction specialist, Dr. Drew. All right. Dr. Drew, thank you for being a guest on your own show.
VOICE OF DR. DREW PINSKY, HOST: Ryan, I appreciate you covering me there, but this was a story I just couldn`t resist ringing in on. I must tell you that Dr. Klein`s records of the spectacular doses of Demerol given as an outpatient are as wild as Dr. Murray having given him propofol. An addict, given an opiate on a single occasion, and especially multiple occasions, is on his way to addiction.
And in this case, clearly addicted. And by the way, they`re splitting hairs about dependency versus addiction. Dependency is what happens with addicts late in the game. So, not only is this opiate addict back on his drug of choice, he is now, in fact, as the witness suggested dependent on the drug.
And Ryan, I`ve been saying all along, this insomnia nonsense is exactly that, nonsense. Insomnia due to acute and persistent recurrent drug withdrawal. That`s why he couldn`t sleep, for sure.
SMITH: Yes. You know, Drew, I hear you, and I was stunned by all of this, because all of this comes from Botox treatments, I guess, is what they testified about today. And we`re talking about March 12th, 200 milligrams of Demerol, March 17th, another 200, April 2nd, another 200 --
(CROSSTALK)
SMITH: Eighteen different appearances.
PINSKY: Giving Michael Jackson Demerol for discomfort because of Botox injections is as wild as giving him propofol for insomnia. These are outlandish, outlandish things to give a patient, A, in the outpatient setting, B, on a recurrent basis, and C, for an addict. He was treated for opiate addiction which a lifelong condition that when re-exposed to opiates, reignites.
And nobody was -- everyone was asleep at the wheel. And that Dr. Murray allowed Dr. Klein to do that without calling Dr. Klein, questioning Dr. Klein, and by the way, in Dr. Murray`s interrogation with the police, he states he was aware that he was going to Klein and coming back, quote, "wasted," totally wasted were his words.
SMITH: Yes. I can`t believe he didn`t account for all that, but Garo, talk to us about your client, Dr. Klein. You heard what Dr. Drew just said. Why give all of this? Why all this Demerol? It doesn`t sound right for somebody getting Botox.
GHAZARIAN: Certainly, everyone seems to try and make it as though it doesn`t sound right. I`m not a doctor, I`m an attorney. But I have spoken to many other physicians, anesthesiologists, dermatologist, and other practitioners.
SMITH: Wait. Hold on. Let me let Drew jump in here.
PINSKY: I am a physician, and I`m an addictionologist and I treat addicts every day, and I am telling you, this is outlandish treatment of a patient with a history of addiction. I am a physician. I`m board certified in both internal medicine and addiction medicine. And this record was as astonishing to me as Dr. Murray giving the propofol to the patient.
GHAZARIAN: If I may respond, Dr. Drew.
SMITH: Go ahead.
GHAZARIAN: That is your opinion and you`re entitled to it. And let me respond as follows. If he was an addict, Michael Jackson that is, then explain to me how is it that if he is receiving 200 or 300 milligrams at particular visits in March or April, when we take a look at June, we have him getting 100 milligrams, not increasing from the 200 and 300 upwards, but rather decreasing down to 100 milligram. And also if you are an addiction --
(CROSSTALK)
GHAZARIAN: Let me finish, doctor.
PINSKY: Yes.
GHAZARIAN: No, let me finish.
PINSKY: Go ahead.
GHAZARIAN: If you are a doctor who knows about addiction, let me just ask you this. Then, how is it that half life of two and a half to four hours, this man doesn`t go to the doctor for seven days from June 9 to June 16. How is he addicted to Demerol? Where is he getting his Demerol in that seven days period of time? He`s not addicted to Demerol, I disagree.
PINSKY: Because I have an absolutely categorical explanation for that. That is, as I said, what you see is that as Dr. Klein or somebody in his office, who knows who it was, by the way, I`m not specifically saying it even is Dr. Klein, we don`t know that, but somebody in his office realized evidently they were in trouble and began tapering him down.
And what do you see in response to that is massive increase in his withdrawal symptoms. He starts having severe insomnia, feeling hot and cold, and what do you see in response to that? He gets a cross tolerant substance.
He starts getting midazolam, Ativan, propofol, all things that will suppress opiate withdrawal to one degree or another and help him with his sleep, but there was a marked increase in his withdrawal symptoms as they attempted to reduce his Demerol, very clearly. That`s all clear in the records.
GHAZARIAN: Well --
SMITH: Wait. Why wouldn`t your client see this? Why would your client keep him on this pattern? Because, look, the increase is taking place under your client`s watch.
GHAZARIAN: You know what, you guys have it all wrong.
SMITH: OK.
GHAZARIAN: Because my client didn`t have to see anything. My client is treating a patient for particular procedures. Injections to the lip, injections under the eyelids. Have you ever had a needle stuck under your eyelid? I beg to differ that you don`t need anything or you don`t need Demerol --
SMITH: But it`s not need anything, it`s 200, and Drew, maybe you can put this into perspective for us --
PINSKY: Let me put in perspective for you.
SMITH: 200, 300 mg of Demerol. What`s that like?
(CROSSTALK)
GHAZARIAN: Let me respond. Go ahead.
PINSKY: Go ahead.
SMITH: Go ahead, Drew.
GHAZARIAN: Well, you know -- well, no, because you should know and you do know that people have different pain threshold. They have a certain tolerance for pain and other people have certain tolerance for medications, regardless, of whether or not they`re addicted.
SMITH: All right. Now, let me let Drew respond. And Drew, can you put this into perspective for us, this 200, 300 mg of Demerol?
PINSKY: Two things. Let`s -- if you were going to have a really significant surgical procedure, really maximum pain control achieved at 100 milligrams of Demerol, it really is. That`s a massive, massive dose of Demerol.
An opiate addict who receives 100 mg a Demerol, somebody with any history of opiate addiction is in harm`s way the moment they`re exposed to that drug once. Exposed to it repeatedly in escalating doses, now we have a full blown reigniting of the addictive process.
GHAZARIAN: Well, but you never answered my remarks about seven-day gap in between, Dr. Drew.
(CROSSTALK)
PINSKY: I did explain it. That those are the days in which Michael was having severe withdrawal symptoms. He is hot, he`s cold, he`s agitated, and getting large doses of propofol and benzodiazepines which will suppress those in opiate withdrawal. We actually use those kinds of things in the hospital to suppress opiate withdrawal symptoms sometimes.
GHAZARIAN: You use what, propofol to suppress opiate withdrawal?
PINSKY: I`ve actually seen propofol suppress withdrawal, but no, we use things like Ativan. We use a midazolam. Those kinds of -- those classes of medications that he was getting in massive dosage.
GHAZARIAN: Let`s assume --
SMITH: Let me jump in for a second, because your client did speak about this. He spoke about it long time ago, and let`s get his word for it. You can talk to us a little bit about this. This is Dr. Arnold Klein appearing on "Larry King Live" back in 2009, and he talked about drugs prescribed to Michael Jackson.
(BEGIN VIDEO CLIP)
LARRY KING, CNN ANCHOR: Did you ever give him drugs?
DR. ARNOLD KLEIN, MICHAEL JACKSON`S DERMATOLOGIST: Did I ever give him medication? I used to do surgical procedures, I gave him medication. I once gave him muscle relaxant in the last seven (ph) years and that was about it.
I never gave him anything to take home that was addicting. I mean, I was aware that he used propofol, a drug we talked about a lot before which is a drug of addiction, people don`t know, and it`s very poorly controlled by the government.
(END VIDEO CLIP)
SMITH: Now, can I step away from, and I get your point, Garo, about those seven-day period where he wasn`t taking the drug. But what I`m looking at here is May 12th, May 17th, August 2nd, August 15th, August 17th, August 25th, August 27th, August 30th, 100, 200, -- I`m sorry, April, excuse me, March and April, on through may.
I just -- look, we`re talking hundreds of milligrams of a drug that drew says for a major surgical procedure maybe 100 and even that`s extreme.
GHAZARIAN: Well, I think Dr. Drew is opining without knowing Michael Jackson`s predicament. It gives syncrisis (ph), tolerance for pain, tolerance medication, and --
PINSKY: Let me just say, I`ve studied this case top to bottom. I`ve looked at all his medical records. I`ve looked at all the interrogations and the reports of what happened to Michael Jackson, and I would say roughly two weeks into those procedures where he was receiving Demerol, if that were my patient with history of opiate addiction even in the distant past, I would hospitalize him immediately, for treatment of their addiction, because that`s out of control addiction now.
(CROSSTALK)
PINSKY: He is going in. He`s motivated by his addiction.
SMITH: I see. I see. One more question for you, Garo.
GHAZARIAN: Go ahead.
SMITH: You`re saying Dr. Klein in his treatment of Michael Jackson never noticed any kind of addiction, never noticed any kind of addictive behavior, did not worry about high levels of Demerol and other drugs?
GHAZARIAN: What none of you seemed to know --
SMITH: OK.
GHAZARIAN: Michael Jackson did not go in there asking for Demerol. Michael Jackson did not specify what he would like to receive so that he can be put in a comfortable state so that this procedures on his face could be undertaken. Furthermore, I`ve seen video surveillance of him coming in and coming out and he is not staggering like others have suggested. And furthermore, who are we talking about here?
All of the medication was sitting in Michael Jackson`s bedroom with Conrad Murray there seeing all of this medication. Who should have hospitalized this man, if anybody? My client should hospitalize him?
PINSKY: Can I ring in here? Because I absolutely agree with what you`re saying.
GHAZARIAN: Sure.
PINSKY: You are categorically correct on that point. And here is where it really broke down, and actually, I feel sorry for Dr. Klein is why didn`t Dr. Murray contact Dr. Klein. Why didn`t he pick up the phone and call him and go, you know what, I think we have a problem here. That, to me, is unconscionable. And I feel bad for Dr. Klein that that did not happen.
SMITH: And you know what, not only that, didn`t contact Dr. Metzger, other people could have been contacted. And all along, part of what came out in a case today, when you have a situation like this, and Drew, I know you`ve said this many times, you bring in a team for help.
You try to get that personnel if they do have that addiction. Dr. Murray took that all on himself. Dr. Drew, thank you so much for joining us. Garo, thank you, as well. We appreciate your time.
GHAZARIAN: All right.
