Crime Stories with Nancy Grace - Alex Murdaugh: Behavior of an Addict

Episode Date: February 28, 2023

Alex Murdaugh admitted to jurors that he has been using opioid drugs for more than twenty years. At times, he said, he was spending as much as $50,000 a week on drugs. Murdaugh said his addiction began with a college football injury which lead to multiple surgeries and prescription pain medication.  Murdaugh said that he soon became dependent. The accused killer also told the jurors that he had tried to get help several times but relapsed each time. Murdaugh said it was his addiction that led him to steal from the law firm, clients and his own family. Murdaugh also said it was his addiction and paranoia that impelled him to lie about his whereabouts on the night of the murder.  Nancy Grace talks with addiction expert Dr. William Morrone, Author of “American Narcan,"  about how the opiates could have affected Murdaugh's actions. See omnystudio.com/listener for privacy information.

You're listening to an iHeart Podcast. Crime Stories with Nancy Grace. Hi guys, Nancy Grace here at the courthouse here in Colleton County in South Carolina. It's actually Waterboro. Guys, with me, a longtime friend and colleague, Dr. William Maroney. Now, this guy not only wrote the book American Narcan, he is a renowned medical examiner, and he is a toxicology expert. That's why, you know, I've got so many questions about the case, Dr. Moroney, but first let me tell you what happened.

So we were in court and they brought, the defense brought on two experts to counter the state's experts. One was the pathologist. He was saying, no, no, no, that's the wrong trajectory path. He mostly agreed with everything the state said, except for a little bit, like maybe one point about Maggie and one point about Paul Murdoch's death. Then they brought on a crime scene expert, but that's actually not what I want to talk about.

Dr. Maroney, when we broke for the lunch break, I ran out in front of the courthouse and did our normal box nation live program. And we were waiting and waiting and waiting for court to resume. Dr. Maroney, the weather here is like being in Savannah, Georgia. It's beautiful.

So I just took off and walked for about an hour around Waterboro. Dr. Maroney, it's beautiful. It's a lovely little town. And the houses are like, I wouldn't call them antebellum homes, but they're beautiful. They're period homes. The weather was almost hot. It wasn't really hot.

It wasn't really cold. It was like a warm bath, you know, just right. Everybody is friendly, like super friendly here. And it made me think about what all Murdoch will be saying goodbye to if he's convicted. Well, you lose a lot when you don't have insight and you drift towards criminologically active behaviors but that's because society wants to isolate those people and there's just so many questions about his behavior his past, his past experience, his manipulations, his psyche. Right there, Josh Maroney.

Have you ever known a single drug addict that didn't lie? Really? Be honest. A single drug addict that didn't lie? Well, I would say, I don't use the word lie. I would say that many of my patients lack insight and they are not valid historians. That's what I would say. Okay.

Dr. Moroni, why are you saying that to me? They're not valid historians. Okay, that's screwed up. They lie. I don't know why they lie. Well, they don't want people to find out about their habit. And they lie to get the money for the habit. They take money away from the family or whoever they love or whoever was completely lucid when police came to the home the night of the two murders. If he was up to $50,000 a week in opioids, I mean, could he have a tolerance level?

Lying about the degree of addiction. It is not uncomfortable. I mean, it is not uncommon in many of the severe addiction cases that I have been brought. People are taking 60, 70, 80 pills a day, almost 100 pills a day. And I know for sure. Wait, wait, wait. What did you just say? 80 pills a day? How can that be? Well, they have to take 10 or 15 to get out of bed and they take another 10 or 15 because these pills only last three, four, five hours. They don't last all day.

So they're dosing themselves six times a day at... Wait a minute, wait a minute. Okay, you said a pill, like an Oxy... Are we saying Oxycontin or Oxycodone? Well, they come in and they'll call it Oxycontin, but it could be the generic Oxycodone. It's a rapid... It has a very short half-life. Sometimes they chew it too.

They don't just swallow these. Okay, wait, wait, wait. Hold the chewing. He said that they can take 60 to 80 pills a day. Because each pill only lasts like three hours. But correct me if I'm wrong, there's 24 hours in a day. they each pill only lasts like three hours but correct me if i'm wrong there's 24 hours

in a day why do i need 60 pills to get through one day maroney because you start getting withdrawal and when withdrawal hits your body just gives off fluid your eyes water your mouth salivates you feel like you're going to vomit, you can't hold your bowels, you have shortness of breath. And these are terrible feelings that with that comes anxiety and really low blood pressure. And you can't stand it. So you take more opiates and then it calms you down. But that's not how it starts. That's how it is two or three years later. Okay, how does it start?

I want you to explain what I'm getting at. How can he be on 50 grand of opioids a week, number one, and how can he be so lucid when the cops show up? I mean, he's lucid on the 911 call. He's lucid when the cops get there. He continues to so lucid when the cops show up i mean he's lucid on the 911 call he's lucid when the cops get there he continues to be lucid we know according to him he had pills in his pocket illegal pills when the cops were there so he was probably so high as a kite when he went in for the interview as well would that explain why he just sat there with his legs crossed when they said, you're a double murder suspect? What we know, and it's different than the stereotype,

is that he may not be subdued and have slow speech and slow thinking because his body has become tolerant. But when the drugs work on the long-term process in his brains, there are two things that commit to this murder that come from the criminology of long-term opiate use. The number one thing is a lack of insight. He knows nothing other than the current event, the minute, what he's actually doing. And the second thing is impulsivity. So those two professionally screened events in long-term opiate use lead him to criminal behavior. And it is the lack of insight that is moral and ethical consequences and long-term planning and impulsivity. These are the two things that come when you rewire the brain

that nobody can wait. They have to have what they have and they have to have it right now. That's the impulsivity. And the lack of insight is there is no moral compasswiring the brain in that pleasure circuit that he's constantly seeking pleasure and to stay out of withdrawal. Crime Stories with Nancy Grace. crime stories with nancy grace you said something that really struck me it's almost like a child they live in that moment that moment and they don't think ahead and they don't think back. So at that moment, and he allegedly shot them dead. He wasn't thinking about the future, his law practice, this beautiful little town where he lives, the courthouse where his dad and his grandfather's portraits are hanging in the hall, his law partners, nothing. He's thinking about that moment. Nothing else matters.

But how does that tie into the opioids or the addiction? When the brain is rewired for pleasure, you no longer have a long-term plan for the future. And here's where I don't know this part of the law, so you can correct me and guide me. He may have picked up guns and seen an opportunity and decided to shoot his family members instead of planning a week ahead or a month ahead. head because his brain was rewired in that immediate pleasure circuit for impulsivity that no normal person would ever demonstrate. And when we bring people through the disease of addiction and we bring them back into society, we have to remind them that they have to rewire their brains to not be impulsive. That's part of the treatment because part of, you know, like any chronic

disease, you have a list of symptoms. In substance use disorder, when the brain is rewired, that impulsivity is something nobody can understand unless they've been through it. Now, I see it a thousand times a month in my patients, and I've seen it for 20 years. Well, what about this? What about the fact that just before the murders, Maggie and Paul had each and together found his pill stash and had confronted him about it. Has the prosecution said who was shot first?

Yeah, Paul was shot first. Okay. In the end, he may have been angry, and he shot Paul, and then he said then he said oh yeah what did I do this is terrible and and his impulsivity led to shooting his wife that he would have never done before but he did it because of this lack of insight and impulsivity well here's the fly in the ointment with that period. He lured Maggie to the hunting lodge, which shows malice of forethought, mens rea, intent.

He told her that he was worried about his father, Mr. Randolph, passing away. And she said to others that's why she was going there and that she didn't really want to go, but she was going. And that says to me, he planned this. So that completely destroys the impulsivity theory.

Well, it's not that it destroys it, but it also shows that his lack of insight reaches deep down into the moral aspect of killing another person. This is not his first rodeo. You know, he's probably been involved in traumatic deaths. So this was very easy. And that the impulsivity of killing her is something that straightforward, we see people who they look at somebody, they figure they have a wallet, they push them down, they go through their pockets, they take their money, they carjack people, they take keys, they're trying to rip people off, and all that comes impulsively because when their brain is rewired, they don't think there's any consequences.

And he is in a situation where he has got himself out of consequences before. Many times. Many times before. And when you look at the amount of him not being held accountable and him not having consequences. And then you add some criminology on top of that. And then drug use and the lack of insight. Okay, let me ask you this. And the impassivity.

Go ahead. I thought for sure that there would be girlfriends and mistresses paraded in front of the jury. All we've heard about, and the jury has not heard about it is an affair he had about 10 or 15 years ago and Maggie was still upset about it. And I don't blame her because you feel like you could never trust the person again. Let me ask

you this. Does the incredible use of opioids, what effect does that have on your sex drive? I mean, do you lose your sex drive or do you just become like a sex addict? The long-term consequences of opioids on the pituitary and testosterone

is an imbalance that leads towards lower sex drive and lower testosterone in men. Does that make sense? Yeah, this will explain why we haven't heard about a recent affair. Okay, next question. Is it physically possible to take that many pills and not kill over dead? Oh, and Jackie wants to know, if Murdoch was using that many pills and not kill over dead. Oh, and Jackie wants to know,

if Murdoch was using that many drugs, why no weight loss? Weight loss is difficult. There are some people that feel tremendous constipation, and that constipation leads you to less of an appetite because you have to have a system that allows you to eat at one end and defecate at the other. That is patient-specific. But what would be more important is, was he the wrong color? Was he pale?

Did he look ashen? And maybe he didn't lose weight, but those are signs of toxicity in the liver, which come from all of the things in those tablets. One of the things, and I'm not purporting to say that any drug use, IV use, snort use, smoking, or oral is better. But one of the reasons why long-term drug users stop taking pills and go to injecting is they bypass the stomach. And they get what they need because they bypass the stomach and they go straight IV. There's no reports of him injecting at any time. And he stayed with oral meds, which means he's taking a lot of calcium filler. He's taking sucrose. He's taking lactose. He's taking other binders. He's taking dyes. And all that stuff, it's toxic to the liver in the long term. It makes the liver work too hard. And then you don't make as much red blood

cells. You don't make as much hemoglobin. Your chemistry's off and you look sick. You're the wrong color. He says his addiction is to, quote, opioid painkillers, specifically oxycodone and oxycontin. I mean, can you take that many pills and live? A 60-day appeal oxy habit. 60 pills a day. I mean, wouldn't that cause emotional numbness, severe depression with y'all? I mean, no, because those pills are giving him his energy. He's getting energy. They, across the board, OxyContin users have said for 15 years, those pills gave me energy. There's something about the OxyContin, the Oxycodone

molecule that is different than a lot of the other opioids. Sometimes we think that they're all the same and high doses of morphine and heroin and opium, they make you sleepy. Anybody that knows people who've been OxyContin users know that they're buzzed. They're wired. It's a totally different opioid. He says he's 67 Oxycodone pills a day. Yeah. And I would say, you know, if you're taking 15 or 20 of those three or four times a day, that would keep you wired like that.

Physically, I have seen... I mean, does he still function as a lawyer? Because it starts slow and it goes up to that dose over a year or two, yes, you can function at that level. Your body still functions. But when I tell you that you lose the insight, you no longer make the same moral decisions and impulsivity drives you to criminal behavior that when you're sober,

you would never go in that direction. Crime stories with Nancy Grace. Well, that caused an outburst like one that may have resulted in Maggie and Paul's murders. I mean, look, I know that pot makes you typically sleepy and lethargic. Not everybody, but most people. Meth makes you crazy and you imagine monsters and you attack people and chew their faces off. And just you imagine that bugs are crawling all over your body and you

lose your teeth i don't know i mean do opioids could they cause an emotional outburst that would end in the murders of two people all the opioids are different they're not exactly the same same. But we have known for 20 years that people who use OxyContin excessively outside of the FDA approved range have all said they got energy. They got a buzz. It got them through the day. I had a very nice lady that you would have never guessed that was in the stronghold of addiction, look at me and say, if I take my OxyContin, I can work on the farm. I get up at five o'clock and I go to work and I work till 10 or 11. Then at noon, I go to work in the factory and I worked second shift, she held down two jobs as a farmer and as a factory worker. And at one point she gave up the factory worker to become a roofer. These are physically very hard jobs. And she said, I didn't have any problem do that when I got my exocontin.

When I got my exocontin, I do everything. I do anything. I had energy all day. And for 20 years, that's one of the detrimental things in the opioid crisis. And a lot of people think, well, you know, they're all the same. Oxycontin got people through the work at factories. It got older people pushing 50 and 60 to keep up with the 30-year-olds. That's why it was a crisis because sooner or later, the government and the states and the insurance cut all those people off, and now they feel those pains. I don't know that it gives you the energy, but if it takes away your pain,

then what you're doing is you're able to function without pain. You start building up a tolerance. So where you used to be able to take one pill three times a day, suddenly you need two, then you need four, then you need eight. And if you don't take that many, you start going into withdrawal because let me understand this opioids bind to opioid receptors in your brain and your spinal cord and other parts of your bodies now to me a receptor is an object or an entity that receives. So opioids bind to your brain, spinal cord, and other areas of your body.

When those opioid receptors are full, then they start emptying out, and you have withdrawals. So you have to take more and more and more to get that feeling of euphoria or pleasure, right? Is that how it works? It is, and here's what ends up happening. Let's say the number of receptors you have in your brain that just get pain management, you know, 10 or 20% of your opioid receptors. Well, as the brain accommodates, it may lower those number of

receptors because it doesn't want too many. It's a reflex. It's called receptor down regulation. So then later on, you need more drug to fill more receptors. as the brain lowers the number of receptors, you have to take more to fill the same receptors. And he's been doing this over a decade. Yes. Absolutely.

Now, let me understand. Opioid addictions can trigger it sounds like a dementor. Have any of your children read Harry Potter? We went to Harry Potter parties. We have Harry Potter ornaments on our Christmas tree. You have to read the books.

While the movies are wonderful, they're not the same as the books. I've read every single one to the twins. And you need to know what a Dementor is. A Dementor is something that comes along, it flies up, it's dark, it really doesn't have a face. And it is like a dark ghost. And it flies up, usually in a group, and they suck all the joy out of you. And you're just left as a shell of what you were before you'd rather die.

So my point is, I think opioids act like a dementor. They trigger feelings of intense sadness and hopelessness when you can't get your fix. So, you know, to even keep your spirits up, you just have to keep taking it in order to get any kind of happiness. That's a very good description. And it's very visual. And people that have seen that in Harry Potter of opioids and to get sober what they say.

Because their normal emotions are gone. But what about violence? Is it like PCP or other drugs that make you more prone to violence? They don't drive you to violence like psychosis, but they would drive you to violence with the fact that a return, that you have the lack of insight there are other answers that are non-violent. So you have no impulse control, you have no insight, you're only living in that exact moment like a child. And if someone threatens to take away your opiates, it's like the dementia sucking the joy out of you and you'll do anything to avoid it. some people have said to me when they come to me and they say, I got to get off this stuff.

If I don't, I'm going to die or I'm going to go to jail because I just don't feel right. And I'm doing things that I know are wrong, but I'm still doing them. Dr. Maroney, it's just, it's of course not a defense, but when I look at him, he looks so pale and especially around the times of the murders, his eyes just look out at you like there's nothing behind them. I tell people who start opioid treatments with us to opioid disorder treatments, I say, this doesn't change overnight, but you're going to have this lack of insight and you're going to have this impulsivity that you want it now. And part of you going to therapy with a therapist is to learn to be patient and slowly. Nobody's ever put a finger on the number. When you're drug-free from the opiates and you're on our treatment and counseling, it takes about two years for you to get back the joy and the understanding and the impulse control.

And that's counseling every month. I'm just so glad for people that are tangled up in drugs and they can't get out and they have no real joy in their lives. Dr. Moroney, I didn't mean to take all your time. It's just so good to talk to you. You make it so easy to understand. Guys, with me, Dr. William Moroney, my longtime friend, colleague. His most important title, however, is Husband and Dad to Awesome Children. Please send me some more pictures, Dr. Maroney. I will. And you send me yours. I will. Bye, buddy. Thanks, man. Bye, friend. You're listening to an iHeart Podcast.