From Next Avenue — where grown-ups keep on growing.
A California addiction specialist was scheduled to meet with Prince on April 22 — the day after the singer died suddenly — and Prince representatives called on the doctor April 20, saying he “was dealing with a grave medical emergency,” the Star Tribune of Minneapolis reported Wednesday.
The newspaper attributed the information to a prominent Minneapolis attorney, William Mauzy, who was hired by Dr. Howard Kornfeld of Recovery Without Walls in Mill Valley, Calif. Kornfeld “could not clear his schedule” to get to Paisley Park on April 20, but set up a meeting with Prince that was to take place April 22, the Star Tribune said. Kornfeld sent his son, Andrew Kornfeld, to explain the treatment program; Andrew Kornfeld took a red-eye flight Wednesday night. He was at Paisley Park when the singer was found dead the morning of Thursday, April 21, the paper said.
Autopsy results have not yet been released. But the recent news is more evidence that Prince died from an overdose of opioid drugs, and it is another grim reminder of the toll that drug overdoses are increasingly taking among Americans.
According to a law enforcement source who spoke on condition of anonymity, an overdose of a powerful painkiller is one of the things investigators are exploring in the legendary musician’s death at age 57, the Associated Press reported.
We physicians have few alternatives for patients who have already tried non-steroidal anti-inflammatory medications and acetaminophen without relief.
— Dr. Mitchell H. Katz
The same source confirmed that Prince was given a shot of Narcan, a drug that reverses the effects of an opioid overdose, during an emergency landing of his plane in Moline, Ill., on April 15. He was on his way back to Minnesota after performing two shows in Atlanta. At home the next day, he hosted a dance party at Paisley Park, his studio residence, but did not perform.
On May 1, the Associated Press reported that Prince’s personal chef Ray Roberts noticed he “wasn’t himself probably the last month or two.” Roberts had cooked for Prince nearly every day for almost three years and said he saw no signs of a drug problem. But Prince was “sick a lot” with sore throats and upset stomachs, and often requested smoothies and fresh juices in place of his regular meals, the AP quoted Roberts as saying.
Unlike many other star musicians, Prince was known for his avoidance of drugs. But he may have been in pain; Sheila E., his ex-fiancee and former drummer, told ABC’s Good Morning America that he had hurt his hips while performing in past years with stunts like jumping off risers in high heels.
A Scourge of Drug Deaths
“The United States is in the midst of a drug overdose epidemic,” the Centers for Disease Control (CDC) says on its website. More Americans died from overdoses in 2014 than in any other year on record, and more than three out of five of those deaths — a total of 28,000 – involved an opioid, the agency says. Opioid deaths have nearly quadrupled since 1999.
Those fatalities include deaths from prescription painkillers such as oxycodone, hydrocodone and morphine as well as heroin and other illegal opioids. Percocet, which TMZ reported was the cause of Prince’s alleged overdose on the airplane, is a combination of acetaminophen (Tylenol) and oxycodone. The CDC estimates that 19,000 people, or 52 per day, died from prescription opioids in 2014.
Many opioid users become addicted to the drugs after an illness or injury results in chronic pain. The 2012 National Health Interview Study revealed that 11.2 percent of adults report having daily pain. And the treatment of chronic pain has been fraught with complexity for both patients and their doctors.
Urine Testing Included in Recommendations
On March 15, the CDC revised its guideline for prescribing opioids for chronic pain outside of palliative care or treatment for cancer.
“This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death,” the CDC wrote.
Among its 12 recommendations are some that seem obvious, and not particularly helpful: “Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient,” and “discuss with patients known risks” of opioid therapy.
Others are more specific, even surprising: Before starting chronic pain patients on opioids, doctors should do urine drug testing and consider renewing those tests “at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs,” the CDC said.
It also recommended that physicians prescribe immediate-release opioids instead of extended-release/long-acting opioids; prescribe the lowest effective dose for the shortest time possible for acute pain; consider offering patients naloxone (Narcan) when they have a history of overdose, a history of substance use, higher opioid dosages or also use benzodiazepine (Valium, Xanax) and review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data.
Doctors have responded to the recommendations.
‘Little Relief in Sight’
“Four of five persons newly initiating heroin use now report starting with a prescription opioid, a near complete reversal since prior to 2000,” wrote Dr. Yngvild Olsen in an April 21, 2016 JAMA editorial on the new CDC guidelines. “Despite multiple, laudable efforts across the country aimed at curbing the opioid epidemic, there seems to be little relief in sight.”
The recommendation on acute pain — to prescribe low doses for the minimum number of days necessary — is clearly an attempt to keep patients from falling into long-term use, yet it’s complicated, wrote Dr. Mitchell H. Katz, in a separate JAMA editorial.
“The care of such patients is challenging, because whatever you believe about the efficacy of opioids for chronic pain, you cannot tell a patient who says that his pain is relieved by opioids that it is not,” he wrote. Even when their patients have not yet tried opioids, “we physicians have few alternatives for patients who have already tried non-steroidal anti-inflammatory medications and acetaminophen without relief.”
Officials suspect that a significant proportion of the rising death toll is due to a surge in illegally made fentanyl, which is increasingly used to heighten the effects of other drugs, like heroin. Fentanyl-laced heroin killed Oscar-winning actor Philip Seymour Hoffman in February 2014. He was 46.
Other Facts About Opioids
Statistics reported by the CDC include the following:
- The most common drugs involved in prescription opioid overdose deaths include methadone, oxycodone (such as Percocet and OxyContin) and hydrocodone (such as Vicodin)
- Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids
- Of those who died from prescription opioid overdose between 1999 and 2014, overdose rates were highest among people aged 25 to 54 years.
- As many as one in four people who receive prescription opioids from their doctors long-term for noncancer pain struggles with addiction.
From Next Avenue — where grown-ups keep on growing.
© Twin Cities Public Television - 2016. All rights reserved.
Read Next