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Image: Conrad Murray
Irfan Khan  /  AP file
Dr. Conrad Murray's defense team claims Michael Jackson, desperate for sleep, swallowed an additional dose of propofol when his doctor was out of the room.
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updated 9/28/2011 4:00:17 PM ET 2011-09-28T20:00:17

Michael Jackson was physically exhausted from a day of grueling rehearsals for his marathon 50-night comeback tour. But his nightly battle with insomnia had just begun. After showering and getting into bed, he called for his "milk," a powerful drug he had been using to escape into unconsciousness.

Jackson saw the anesthetic known as propofol as his salvation. On June 25, 2009, it became the King of Pop's death potion.

How he overdosed in his mansion on a drug intended for hospital use is at the center of the manslaughter trial this week of the doctor he hired to be his highly paid personal physician for the "This is It" tour.

Testimony about the drug is expected to dominate the trial of Dr. Conrad Murray, a Houston cardiologist who has pleaded not guilty to a charge of involuntary manslaughter in Los Angeles Superior Court.

The prosecution claims Murray was grossly negligent in giving Jackson propofol at home without proper lifesaving equipment available and then left the room long enough to find his patient not breathing when he returned.

His defense team claims the singer, desperate for sleep, swallowed an additional dose of the drug when his doctor was out of the room.

Getting to the truth of it will come down to sometimes technical testimony from an array of medical experts, pathologists and even the police officers and paramedics who inspected Murray's equipment in the bedroom where Jackson went into cardiac arrest.

The defense theory, based on evidence that a trace amount of propofol — .13 milligrams — was found in Jackson's stomach, may be a hard sell.

The drug is administered intravenously, usually during surgery. Scientific witnesses may be asked to explain how it could have gotten into his stomach. Some doctors say ingesting it orally is almost unheard of.

"It's an odd, on-the-edge defense theory," said Dr. Gil Tepper, chief of staff at Miracle Mile Medical Center in Los Angeles. "It would not put you to sleep and it would move through the system very rapidly, causing awful diarrhea."

There are few authoritative studies and few statistics on deaths caused by the drug. It remains uncertain if the judge will allow a Chilean doctor's study of students who voluntarily drank the drug or a study of pigs who received it rectally.

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The prosecution has a key expert witness, as well as forensic experts from the Los Angeles County coroner's office who are considered at the top of the field.

The defense boasts an advantage in one of its lawyers, J. Michael Flanagan, who says he is the only California attorney ever to try a propofol death case.

Flanagan represented one of a pair of nurses charged with killing a cancer patient who died after propofol was allegedly given without proper authorization by an anesthesiologist. Flanagan's client was acquitted and the other nurse pleaded no contest to a lesser charge.

Abuse of the drug is said to occur among medical professionals but rarely among patients.

In anesthesia, propofol is known as something of a wonder drug. Tepper said it's ideal for short term procedures such as colonoscopies or cataract surgery. Patients report feeling energized when they come out of it and there is no grogginess.

"But it's absolutely not recommended as a sleep aid," said Tepper. "You would never reach restful sleep and you would have to have constant monitoring."

In a hospital setting, Tepper said the doctor would have heart and blood oxygenation monitors as well as surgical equipment to do intubation if the patient stops breathing. Witnesses have said no such equipment was in Jackson's bedroom.

"It's a very dangerous drug," said Dr. Mark Schlesinger, head of anesthesiology at Hackensack University Medical Hospital in New Jersey, who said he has administered it thousands of times in his 25-year career. "The difference between unconsciousness and no longer breathing is a very slim margin of safety."

In the hands of a trained anesthesiologist, he added: "It's a wonderful drug and a very safe drug. It's not the drug that kills somebody. It's the way it is used."

Murray was not the first doctor to give Jackson the drug as a sleep aid, although others have not been publicly named.

Jackson's reliance on propofol was first disclosed to The Associated Press days after Jackson's death. Cherilyn Lee, a nurse nutritionist who treated Jackson with vitamins, said he pleaded unsuccessfully with her to get the drug he knew as Diprivan. He said his doctor told him it was safe and he described falling asleep as soon as the drug dripped from an IV into his vein.

"I said, 'Michael, the only problem with you taking this medication,' and I had a chill in my body and tears in my eyes ... , "'You're going to take it and you're not going to wake up.'"

Lee, who said she treated him from January to April 2009, is on the trial witness list. She said she never saw Jackson use other drugs.

"He wasn't looking to get high or feel good and sedated from drugs," she said. "This was a person who was not on drugs. This was a person who was seeking help, desperately, to get some sleep, to get some rest."

Murray, who had been consulted by Jackson in his Las Vegas office, was promised $150,000 a month when he signed on as Jackson's personal physician six weeks before he died. He closed the doors of his offices there and in Houston to devote himself to the singer.

An autopsy report showed that Jackson was generally healthy, indicating his key problem was insomnia. Murray has told police he administered other drugs known as benzodiazepines, which are also used as sleep aids. But when they did not work, Jackson demanded propofol.

Murray told police he was trying to wean him from the drug and gave him a minimal dosage, then left the room for five minutes to use the bathroom. However, cell phone records suggest he was making phone calls for a longer time. His actions after he found Jackson not breathing are also central to the case.

In the two years since Jackson died, doctors have been known to refer to propofol as "The Michael Jackson drug." Some fear a backlash for its use.

Dr. Lawrence Koblinksy, head of forensic science at John Jay College in New York, said the situation of a famous man demanding propofol is an anomaly and should not cast doubt on its effectiveness in hospitals.

"If you have a drug that is wonderful, just because a celebrity dies doesn't mean you take it off the market," he said.

Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Video: Jackson wasn’t addicted to Propofol, brother says

Photos: Michael Jackson’s life and career

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  1. Little boy Michael

    Jackson was just 12 when this picture was taken in May 1971, but his career was already stratospheric. Berry Gordy had signed the Jackson 5 to Motown Records in 1968, and Michael and his brothers had already topped the charts with "ABC" and "I'll Be There." It was a bright start for the boy from Gary, Ind. (Henry Diltz / Corbis) Back to slideshow navigation
  2. Signs of success

    Michael Jackson, far left, and the rest of the Jackson Five; the five brothers from Indiana were signed to Berry Gordy's Motown record label pose in 1972. (Frank Barratt / Getty Images file) Back to slideshow navigation
  3. All in the family

    The Jackson 5 performs in Los Angeles on a 1970s Bob Hope TV special. Michael continued to front the band, but his solo career was already on the rise, starting with 1971's "Got to Be There." (Neal Preston / Corbis) Back to slideshow navigation
  4. A wonderful Wiz

    Michael Jackson at the opening of "The Wiz." The 1978 movie musical was the first time Michael worked with legendary producer Quincy Jones, who would soon produce Jackson's breakout solo album, "Off the Wall," and eventually the "Thriller" album as well. Jackson's "Wiz" co-star was friend and mentor Diana Ross, who had introduced the world to the Jackson 5 back in 1969. (Bettmann / Corbis) Back to slideshow navigation
  5. Wanna be startin' somethin'?

    Michael Jackson performs in concert during a 1981 tour with his brothers. During the tour Michael began writing down ideas for a solo project that blossomed into the highest-selling album of all time. (Susan Phillips / Corbis) Back to slideshow navigation
  6. Michael Jackson and Diana Ross hold their American Music Awards in L.A. Jackson won for favorite soul album and Ross won for favorite female soul vocalist. (Juynh / AP) Back to slideshow navigation
  7. Fright night

    Michael Jackson stands with a group of dancers dressed as zombies while filming his 1983 video "Thriller." "Thriller" was revolutionary in the music industry. The zombie-themed minimovie put MTV on the map and essentially confirmed music videos as an art form of their own. The album sold 25 million copies in the United States alone. (Corbis / Sygma) Back to slideshow navigation
  8. Moment of stardom

    Michael Jackson performs the moonwalk for the first time on television's "Motown 25," a tribute to Berry Gordy. The dance move that would become Michael's trademark stunned viewers and the crowd, and marked his imminent crowning as the King of Pop. (Bettmann / Corbis) Back to slideshow navigation
  9. Handfuls of glory

    With Quincy Jones at his side, Michael Jackson holds six of the eight awards he won for "Thriller" at the 1984 Grammy Awards. His outfit, complete with epaulettes, sequined glove and dark shades, became a quintessential Michael look. (AP) Back to slideshow navigation
  10. Role model

    During a May 1984 ceremony at the White House, Michael Jackson accepts a Presidential Award from President Reagan as First Lady Nancy Reagan looks on. Jackson was honored as a model for American youth, and for lending his hit song "Beat It" to a new campaign against drunk driving. (Bettmann / Corbis) Back to slideshow navigation
  11. A scary day

    Michael Jackson, background, is seen with his hair on fire during a taping of a Pepsi TV commercial in Los Angeles on February 1984 as brother Jermaine Jackson, foreground, continues to perform, apparently unaware of the situation. (AP) Back to slideshow navigation
  12. LONDON-1985: Michael Jackson is lead through a crowd by policeman on a promotionial tour of Great Britain in London.(Photo by Dave Hogan/Getty Images)UK NEWSPAPERS OUT WITHOUT PRIOR CONSENT FROM DAVE HOGAN. PLEASE CONTACT SALES TEAM WITH ENQUIRIES (Dave Hogan / Getty Images) Back to slideshow navigation
  13. They were the world

    In January 1985, a who's-who of the music and movie worlds came together to sing "We Are The World," written to benefit famine victims in Ethiopia. Michael Jackson can be seen front and center, along with Stevie Wonder, Lionel Richie, Diana Ross, Elizabeth Taylor, and dozens of other stars. Michael's sister Janet can be seen bottom right. (Bettmann / Corbis) Back to slideshow navigation
  14. Victory lap

    Guitarist Eddie Van Halen, left, makes a July 1984 guest appearance during Michael Jackson's Victory Tour concert in Irving, Texas. Van Halen had recorded the now immortal guitar riff on "Beat It," to the displeasure of bandmate David Lee Roth, but to the delight of nearly everyone else. (Carlos Osorio / AP) Back to slideshow navigation
  15. Who's bad?

    Michael Jackson and his dancers in concert during a 1987 Tokyo concert on Jackson's "Bad" tour. The previous year, he had starred in the 3-D film "Captain EO," one of the most expensive short films ever. But Jackson had begun to draw more criticism as his albums and videos grew costlier and more infrequent. His next album, "Dangerous," wouldn't arrive until 1991. (Neal Preston / Corbis) Back to slideshow navigation
  16. A difficult year

    A cameraman photographs Michael Jackson and Oprah Winfrey in January 1993. This was the year Jackson was first accused of child molestation, and he took an opportunity on a 90-minute Oprah TV special to address the charges. The criminal allegations eventually were dropped, but Jackson reportedly paid as much as $25 million to settle the claims. (Neal Preston / Corbis) Back to slideshow navigation
  17. Black and white at the Super Bowl

    Michael Jackson gives a performance with 30,000 children during the Super Bowl XXVIII halftime show, on January 31, 1993, in Pasadena, Calif. Despite allegations against him, Jackson's career had regained momentum with hits like "Black or White" and "Remember the Time," and the "Dangerous" album was a multi-platinum seller. (Ralf-Finn Hestoft / Corbis) Back to slideshow navigation
  18. Michael Jackson and French mime Marcel Marceau clowning for the cameras at the Beacon Theatre in New York on Dec. 4, 1995. (Bob Strong / AFP - Getty Images) Back to slideshow navigation
  19. Power marriage

    Michael Jackson and his wife Lisa Marie Presley are seen at Neverland Ranch in preparation of the Children's World Summit in April 1995. Presley would file for divorce less than a year later, prompting speculation about just what had inspired the relationship. (Steve Starr / Corbis) Back to slideshow navigation
  20. Golden man

    Michael Jackson performs on stage during is "HIStory" world tour concert at Ericsson Stadium in November 1996 in Auckland, New Zealand. (Phil Walter / Getty Images) Back to slideshow navigation
  21. Marriage 2.0

    Just months after his divorce from Lisa Marie, Michael Jackson walked back up the aisle with Debbie Rowe. This wedding photo was released by Jackson's publicist minutes after the Nov. 13, 1996, ceremony in Sydney, Australia. But the pairing was less about romance and more about bearing Jackson a child, and the two would divorce three years later, with Rowe eventually ceding parental rights to Jackson. (Reuters / Corbis) Back to slideshow navigation
  22. Best of friends

    Michael Jackson and actress Elizabeth Taylor arrive at a Sept. 7, 2001, concert celebrating the 30 years of Jackson's career. The two stars had been longtime friends, and Taylor is godmother to two of Michael's children. (Jeff Christensen / Reuters / Corbis) Back to slideshow navigation
  23. (FILES) Photo dated November 13, 2002 shows US entertainer Michael Jackson testifying in Santa Maria, Calif. Superior Court in a trial in which he is accused of cancelling concert appearances, costing the promoter several million dollars. (- / AFP - Getty Images) Back to slideshow navigation
  24. Not so invincible

    Michael Jackson poses for photographers during a Nov. 2001 appearance in New York's Times Square. Jackson made his first ever in-store appearance to promote his new album, "Invincible," which was released Oct. 30. "Invincible," at the time the most expensive album ever produced, fared better with critics and fans than 1995's "HIStory," but questions began to surface about the future of Jackson's career. (Brad Rickerby / Reuters/Corbis) Back to slideshow navigation
  25. One big mistake

    Michael Jackson holds a towel-covered Prince Michael II over the balcony of a Berlin hotel on Nov. 19 2002. Jackson later called the incident a "terrible mistake," but the image of him dangling his baby son out a window shocked even many die-hard fans. And his reputation was to receive far worse damage just a few months later. (Tobias Schwarz / Reuters) Back to slideshow navigation
  26. Arresting development

    Michael Jackson is pictured in this Santa Barbara County Sheriff's Department mug shot from Nov. 20, 2003. In a February 2003 documentary, Jackson acknowledged letting boys sleep in his bed. Soon after, Santa Barbara district attorney Tom Sneddon launched a probe into allegations that Jackson had molested a teen boy who appeared in the program. Authorities raided Neverland Ranch in November, and Jackson surrended for arrest days later. (Santa Barbara County Sheriff's D / Reuters) Back to slideshow navigation
  27. Family support

    Michael, center, and sisters LaToya, left and Janet Jackson walk over to greets fans during a lunch break at a pretrial hearing in Santa Maria, Calif. in this Aug. 16, 2004 file photo. (Pool / Reuters) Back to slideshow navigation
  28. MJ's PJs

    Michael Jackson wears pajama pants and is aided by bodyguards after arriving more than an hour late to court on Mar. 10, 2005, during his trial on the 2003 molestation charges. Jackson appeared after Judge Rodney Melville threatened to revoke his bail. (Kimberly White / pool via Reuters) Back to slideshow navigation
  29. Singin' with the kids

    Michael Jackson sings with some of his young fans at the World Music Awards at Earls Court in London on Nov. 16, 2006. (Graham Jepson / WireImage) Back to slideshow navigation
  30. Fans in uniform

    Michael Jackson receives a letter of appreciation from Col. Robert M. Waltemeyer, the garrison commander of Camp Zama, on March 10, 2007 in Zama, Japan. Michael greeted thousands of U.S. troops and their family members at the U.S. Army base. (U.S. Army via Getty Images) Back to slideshow navigation
  31. Father figure

    Michael Jackson walks with kids Prince and Paris through a studio parking lot in Los Angeles in March 2009. The singer had been spotted with his entourage going to a studio on a cold rainy day in the city. The pop star stayed at the studio for more than two hours, and there were many production people working around him, suggesting that the star was filming. (Splash News / Splash News) Back to slideshow navigation
  32. Concert tour planned

    Fans take pictures of an electronic screen projecting a press conference by Michael Jackson at the O2 arena in London on March 5, 2009. The pop megastar announced he would play a series of comeback concerts in London in July, his first major shows in more than a decade. (Ben Stansall / AFP/Getty Images) Back to slideshow navigation
  33. Reaching for redemption

    Jackson, center, is shown in Los Angeles on May 6 during rehearsals for his planned concert tour in London. "He was on the eve of potentially redeeming his career a little bit," said Billboard magazine editorial director Bill Werde. "People might have started to think of him again in a different light."

    Discuss the life and impact of Michael Jackson in PhotoBlog. (Courtesy of Michael Jackson via) Back to slideshow navigation
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