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

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.