"I don't know who prescribed him the Lexapro and the methadone, and I don't know if anyone has determined that," he said. "He should have just been taking one antidepressant. He shouldn't have been taking two at the same time."
If anything is certain, it is that Daniel Smith's autopsy, like that of his mother, further highlights the dangers of combining certain medications.
At the time of her death, coroners concluded, Anna Nicole Smith may have been taking or had recently taken more than a dozen different medications. This laundry list of drugs included the sleeping medication chloral hydrate, as well as three prescription drugs used for treatment of anxiety and depression.
"It's well known that even drugs, which are taken therapeutically, when mixed together, can produce intoxication as a result of their synergy," Bruce Goldberger said shortly after the release of the findings from the autopsy of Anna Nicole Smith.
"So when you start mixing drugs — one drug, then two and three and four — rather than having an additive effect, they could have an effect that's multiplied."
Worse, many patients who take multiple drugs may be unaware that their drug combinations are posing a health risk.
Wecht says the deaths of Anna Nicole and Daniel Smith may serve as further warning of this danger to people who take multiple medications.
Wecht, a coroner practicing in five counties in Pennsylvania, noted, "Two out of every five of my cases are deaths due to acute combination drug toxicity. You'd think that by now the message should have gotten out."
"The combinations are amazing — two, three, four, five drugs, often with alcohol added in. Where they get all these drugs, I don't know."
Wire reports contributed to this story.