NEW YORK -- Heath Ledger died of an accidental "abuse of prescription medications," the New York City medical examiner's office said Wednesday in releasing the results of toxicology tests performed on tissue taken from the actor's body two weeks ago.
Some type of overdose had been the expected cause of death since a masseuse found the 28-year-old Australian star's unconscious body in his Soho loft Jan. 22, with sleeping pills near his bed and other prescription drugs around the apartment.
The lab tests were conducted after an autopsy the next day proved inconclusive.
"Mr. Heath Ledger died as the result of acute intoxica- tion by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine," the medi- cal examiner's spokeswoman, Ellen Borakove, said in a written statement. "We have concluded that the manner of death is accident, resulting from the abuse of prescription medications."
The list of generic names refer to drugs more commonly known as the painkillers OxyContin and Vicodin, the antianxiety medications Valium and Xanax, and the sleeping pill Restoril, while Unisom is an antihistamine commonly used as a sleeping aid.
New York police reported at the time of his death that Ledger was found to be unresponsive after he failed to answer knocks on his door and cellphone calls from the masseuse, Diana Wolozin. A spokesman said that, though the sleeping pills and other prescription drugs were found at the scene, there was no sign of foul play and the actor, who was nominated for an Oscar for his portrayal of a repressed gay cowboy in "Brokeback Mountain," left no note.
Ledger had rented the luxury loft following his split last September from actress Michelle Williams, with whom he had lived in Brooklyn along with their infant daughter.
Though a call to 911 was delayed while the panicked masseuse tried to revive Ledger herself and used the actor's phone to call actress Mary-Kate Olsen in California, authorities have said they do not believe he could have been saved had an emergency crew immediately appeared.
Ledger's father, Kim, issued an emotional statement urging others to use prescription drugs with caution and appealing again for privacy for the actor's family.
"We remain humble as parents and a family, among millions of people worldwide who may have suffered the tragic loss of a child," said the statement. "Few can understand the hollow, wrenching and enduring agony parents silently suffer when a child predeceases them. Today's results put an end to speculation, but our son's beautiful spirit and enduring memory will forever remain in our hearts.
"While no medications were taken in excess, we learned today the combination of doctor-prescribed drugs proved lethal for our boy. Heath's accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage."
Medical experts also warned of the dangers of mixing prescription drugs. "All the medications listed are narcotic painkillers or are used as tranquilizers, antianxiety drugs or sleeping medications. Those medications can have a synergistic effect and can reduce the breathing rate to bring on death," said Richard A. Rawson, a UCLA professor of psychiatry and associate director of its Integrated Substance Abuse Programs.
"For someone taking medication for sleep and pain on a regular basis, it is possible to take them and to become intoxicated," he said in a telephone interview.
"Those drugs are very widely used, prescribed and considered to have a relatively good safety profile. But if you take enough of them, taken in combination with opiates, you can get an overdose death. In this case, someone had legitimate prescriptions and simply made an error in dosing himself, a tragic error."
About 850,000 people annually misuse sedatives, including sleep aids, according to the Centers for Disease Control and Prevention. All totaled, 14 million people misuse prescription drugs, including pain relievers, tranquilizers and stimulants, the CDC estimates.
Other sleep drugs, even those sold over the counter, as well as prescription tranquilizers, pain medications and alcohol, are especially dangerous in combination with prescription sleeping pills, doctors say.
Ledger had made no secret of his use of prescription drugs to help him manage a life that was stressful and hectic, for all his fame.
He had just gotten back from London, where he was filming Terry Gilliam's "The Imaginarium of Doctor Parnassus," and recently finished his work on "The Dark Knight," the new Batman film opening July 18, which has him following in the on-screen footsteps of Jack Nicholson as the Joker.
It was a difficult and physical role for Ledger, who told the New York Times in November that he was having trouble sleeping as he was finishing the shoot: "Last week I probably slept an average of two hours a night," he said at the time. "I couldn't stop thinking. My body was exhausted, and my mind was still going." He also described taking two Ambien sleeping pills and falling into a stupor, then waking up an hour later.
That same month, in a videotaped interview with The Envelope, the Los Angeles Times' award show website, Ledger was clearly slurring and unfocused as he discussed his role in "I'm Not There," a film in which a series of actors portray Bob Dylan personas.
In a 2005 Times interview, Ledger noted that his art came from a place of discomfort: "I like to do something I fear. I like to set up obstacles and defeat them. I like to be afraid of the project. I always am. When I get cast in something, I always believe I shouldn't have been cast. I fooled them again. I can't do it. I don't know how to do it."
Since Ledger's death, memorial services have been held for him in New York and Los Angeles.
His body was flown to his hometown of Perth, Australia, for burial in a family plot.
Williams issued her first public comment on the death last Friday, saying that part of Ledger's legacy would be their 2-year-old daughter, Matilda, "the most tender-hearted, high-spirited, beautiful little girl, who is the spitting image of her father. All that I can cling to is his presence inside her that reveals itself every day," Williams said in a statement.
Meanwhile, officials of the Drug Enforcement Administration in Washington said they were conducting a "routine" investigation, as they would in any prescription overdose case, into how Ledger got the drugs that killed him.