The insane benders, the trashed hotel rooms and that briefcase full of cocaine raise a question: How is Charlie Sheen still alive?
More broadly, why is it that some people seem to be able to consume epic amounts of drugs for years, while others die from relatively little use?
According to the several doctors Life's Little Mysteries reached out to, this is a difficult question to answer for one reason: It's much easier to figure out why someone has died than it is to determine why they've survived. Still, there are a few possible explanations. The first, doctors say, is that some people just don't die easily — even individuals who have led far more abuse-ridden lives than celebrities like Sheen.
Cocaine use can certainly have fatal consequences. "Cocaine will usually kill through a fatal arryhthmia or a heart attack," said emergency room physician Raffi Kapitanyan of the Robert Wood Johnson Medical Center in New Jersey. During acute overdoses, the coronary artery contracts, there's increased oxygen demand on the heart and blood platelets clump together. Yet if the patient is young, and has clean coronary arteries, Kapitanyan said he or she may have a small heart attack, but survive. [ Slideshow: Scientists Analyze Drawings by an Acid-Tripping Artist ]
That said, younger people are far from immune to cocaine- or opiate-related deaths: A study of 8,774 fatal overdoses in New York City from 1990 through 2000 shows that 75 percent of the deceased were younger than 45 years old (Sheen, incidentally, is 45 years old). There are relatively few studies on the effects of long-term cocaine abuse on mortality, but it certainly doesn't seem to be a healthy lifestyle choice. One recent analysis by researchers at the University of California, Los Angeles showed that among heroin and cocaine users, there wasn't much difference in mortality for the first decade of use — both came in at 1 percent or less. After 30 years of dependence, however, cocaine's mortality rate jumps to 6.5 percent, while heroin users face a 16 percent chance of dying from the drug.
Yet there is tremendous variation among people, said Judd Hollander, a professor of emergency medicine at the Hospital of the University of Pennsylvania. Hollander said that individuals metabolize the drug – and, more specifically, its metabolic products, or metabolites – at different rates. Some of these metabolites can be more damaging than the drug itself, and certain people's bodies are better equipped to break down the drug into more benign metabolites. These individuals end up having a higher tolerance for the drug. "In theory, there are some people who could take all the cocaine in the world and be just fine," Hollander said.
This doesn't necessarily mean that Sheen is one of them, however. Fatal overdoses are more likely when the user increases his or her dosage significantly — doubling the amount, for example. So it may be that Sheen has survived because he has exercised a kind of restraint, never using so much to overwhelm his own system and produce the potentially fatal effects.