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Saoirse Kennedy Hill.
Saoirse Kennedy Hill. Twitter

Saoirse Kennedy Hill, the granddaughter of Robert F. Kennedy who was found unresponsive in the family’s compound in Hyannis Port on Aug. 1, died from a toxic mixture of methadone, alcohol, and prescription drugs, according to her death certificate filed Friday.

Kennedy Hill, 22, was the daughter of Courtney Kennedy Hill and Paul Michael Hill, and the granddaughter of Ethel Kennedy and her late husband, Robert F. Kennedy. Hill, her father, was one of four people falsely convicted in the 1974 Irish Republican Army bombings of two pubs.

Rescue workers were called to the Kennedy compound on Marchant Avenue around 2:31 p.m. on Aug. 1.

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Kennedy Hill was taken to Cape Cod Hospital, where she was pronounced dead at 3:14 p.m., according to the death certificate signed by Dr. Julie A. Hull of the state medical examiner’s office.

The manner of death was listed as “accident.”

According to the death certificate, Kennedy Hill’s death was the result of mixing alcohol and several other drugs: methadone, used to treat opioid addiction; diazepam, a sedative best known by the trade name Valium; and fluoxetine, an antidepressant best known by the trade name Prozac. (The death certificate also noted the presence of nordiazepam and norfluoxetine, substances that result from the metabolism of the drugs.)

It’s not known whether Kennedy Hill had prescriptions for the medications she was taking.

Kennedy Hill died at her grandmother’s home at the storied compound, a complex of three houses along Nantucket Sound that has served as the scene of countless gatherings, celebrations, and touch football games.

She had been slated to start her senior year at Boston College this fall.

Kennedy Hill wrote about her struggle with mental illness while at the Deerfield Academy in 2016.

“People talk about cancer freely; why is it so difficult to discuss the effects of depression, bi-polar, anxiety, or schizophrenic disorders? Just because the illness may not be outwardly visible doesn’t mean the person suffering from it isn’t struggling,’’ she wrote. “I have experienced a lot of stigma surrounding mental health on Deerfield’s campus. As students, we have the power to end that immediately. Stigma places blame on the person suffering from the illness and makes them ashamed to talk openly about what they’re going through,” she wrote.

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Dr. Joshua A. Barocas, an infectious disease specialist and addiction researcher at Boston Medical Center, said that many patients with opioid use disorder also have other mental illnesses, such as anxiety and depression.

Valium is a benzodiazepine, or “benzo,” a type of drug prescribed to treat anxiety. Methadone is an opioid that, like benzos, can depress the nervous system. Still, the two medications can safely be taken together, with careful monitoring and awareness of the risk of oversedation, said Barocas, who was speaking generally and has no knowledge about Kennedy Hill’s care.

“It is a fairly common practice to have both of those medications co-prescribed,” he said.

The need to treat anxiety with benzodiazepines should not discourage patients from taking a drug like methadone, which is a standard, effective treatment for opioid use disorder, itself a deadly illness, Barocas emphasized.

“We want [to] make sure providers and patients both know that the first thing we need to do is treat the opioid use disorder,” he said.

They just need to be careful, he said, because both medications slow the central nervous system.

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And so does alcohol. Patients taking anti-anxiety medications are generally advised not to drink alcohol — but some also suffer from alcohol use disorder, Barocas noted.

A combination of alcohol, benzos, and methadone can cause a person to stop breathing. But it’s impossible to know which drug was ultimately responsible.

As for the antidepressant fluoxetine, Barocas said, it’s highly unlikely to have played a significant role in a death like this.

Data collected by the Massachusetts Department of Public Health indicate that the vast majority of people who die of opioid-related overdoses have multiple drugs in their systems. Nationally, close to two-thirds of opioid-related deaths involve another substance — benzodiazepines, cocaine, or methamphetamine.


John R. Ellement can be reached at ellement@globe.com. Follow him on Twitter @JREbosglobe.