Prince’s Death, Unlike His Music, Was All Too Familiar

Prince’s death was less original than his music. When Prince died of a self-administered dose of Fentanyl, he was far from the first celebrity to succumb to the use of addictive prescription drugs, and far from the first to succumb to the most dangerous of legal pharmaceutical opioids. Fame has long conferred a sense of entitlement.  The rich and famous who are powerful enough to have things they want have wanted freedom from both physical and emotional discomfort.  The list of them is long.  Their scandals nourish their admirers, often helping them feel superior to their idols. The list is long. The best news is that at least some, like Jamie Lee Curtis CITED HERE, have managed to vanquish addiction and continue with their lives. I applaud them, for I believe their public admissions inspire many.

The MEDICAL EXAMINER’S REPORT tells us little, other than Prince was 57 years old, weighed 112 pounds, and that fentanyl was the culprit. Those intrepid folks from USA Today GIVE US MORE DESCRIPTION of related circumstances. Six days before his death, Prince’s private plane made an emergency landing after a concert.  He had fallen unconscious, presumably from an opioid overdose and required an emergency (lifesaving) injection of Narcan, an antagonist (“antidote”) for opioids. Gone are the days when Opium from the poppy flower was the only available drug in the opioid family.  Far stronger medications with similar effects have been synthesized, with the noble purpose of diminishing human pain. With this noble purpose doctors have been encouraged, in the last several years, to treat Pain more liberally.  Opioid prescriptions have multiplied. Alas, addiction and illicit use have multiplied even more, as opioids that were meant to be more effective and less addictive, became more powerful and more attractive to addicts, as well as to drug dealers.

According to the government office of DEA, Fentanyl is 50 to 100 times as potent as morphine and 30 to 50 times more potent than heroin. Far more compelling than statistics about abuse and death are the tear-stained faces of those who have survived an emergency injection of Narcan, amazed they are still alive, and appearing in my office, trying to figure out how to continue with their lives. The world of abusable drugs, just like the world of prescription drugs and “legal” medicine, is run by money. Plenty of people who start opioids do so recreationally, or as a function of peer pressure. They find it hard to believe that I, who deal with drugs for a living, find them so frightening that I am not sure I like the idea of being in the same room with them, in any other than the most controlled professional circumstances. I have seen many people who received pain-relieving opioids for serious injuries and illnesses, only to convert to street heroin because it was less expensive. Fentanyl is sometimes administered in a patch, a maneuver that was supposed to make it less addictive. I have seen patients who have smoked such patches, or consumed them ground up into pills. Fentanyl is the most potent of the opioids.  Opioids not only kill pain, but make people feel euphoric.  In higher doses, they can and frequently do kill by respiratory depression. Fentanyl seems to do this in microgram doses; other opioids do so in milligram doses.  So it takes around 1/10 as much fentanyl.  Of course illicit drug dealers would want to mix it with whatever they give their clients.  It cuts down THEIR prices. The truth of the matter is that nothing makes people feel better faster than chemicals of abuse — and Fentanyl, more than any. Every year, large numbers of people try drugs for the first time.  Some get addicted; many do not.  It seems the addicts may be more likely to have psychocial misery, perhaps psychic as well as physical pain. Me, I am the optimist.  If people can understand that abuse of drug, although it feels good at the moment, can easily end in disaster. Life goals take longer to reach than a rapid feelgood feeling. I try to explain that, as best I can, to all my patients. Delay gratification. That is the best instruction I have for now. The USA Today article talks about what is likely to become a lively dispute among Prince’s heirs.  The legal wrangling may take years — or decades to untangle. The lawsuits may drag on, but will not last longer than his music.

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