June 3rd, 2016
The medical examiner’s report released yesterday said that Prince died from an accidental overdose of fentanyl. Prince was unlikely to have been prescribed fentanyl, a very powerful synthetic opioid originally created for palliative care (an investigation into how he obtained it is ongoing). The report, which lacks all kinds of important details, left blank questions such as how long Prince had been using it for, and what were other contributory conditions in his death. Whether other drugs were present in his system—the large majority of “overdose” cases involve combinations of drugs—is also unknown.
The news follows alarmist after alarmist article in which the media—chief among them our paper of record, The New York Times, as I reviewed in The Influence last month—claimed Prince’s death showed the straightforward misuse of prescribed opioid painkillers.
Virtually every news source, even in the minutes before the release of the examiner’s report, cited percocet, a typically prescribed painkiller, as being involved in Prince’s death. One source, the Daily Mail, told a different story a little over a month ago, one seemingly much more accurate in its inclusion of fentanyl: “Prince’s former drug dealer tells how the legend spent $40,000 at a time on six-month supplies of Dilaudid pills and Fentanyl patches—highly addictive opioid pain killers—for 25 years.” The sources in this article stated that the drug was not prescribed, that sudden overdose was an unlikely diagnosis after all those years of use, and that Prince combined different opioid painkillers.
The full story remains to be told. But what is clear is that Prince does not fulfill the standard narrative framework of rampant addiction and overdose directly resulting from prescribed painkiller medications, as promoted by the Times.
Once again, reality has made a mockery of The New York Times’s coverage of drugs: In the aftermath of Prince’s death, their narrative was not only at odds with reality, but with the data cited by the Times articles themselves.
Times health writer Jan Hoffman began the procession by linking Prince’s death to the epidemic of addictions to and overdoses on prescribed drugs that the Times believes the US is undergoing:
“A patient undergoes a procedure to address a medical issue—extracted wisdom teeth for example, or, as Prince did, orthopedic surgery. To help the patient get through recovery, a dentist or surgeon writes a prescription for opioid painkillers, like Percocet or Vicodin.”
Then he’s off to the addiction races and dies!
Former FDA commissioner David Kessler quickly jumped on the Times bandwagon:
“Beginning in the late 1990s, pharmaceutical companies selling high-dose opioids seized upon a notion, based on flimsy scientific evidence, that regardless of the length of treatment, patients would not become addicted to opioids. . . .An epidemic of prescription drug abuse has swept across the country as a result, and one of the latest victims, according to The New York Times, may have been Prince.”
Yet, as I and data cited by the Times in these same articles made clear, only a small number of prescribed opioid users are addicted, and a microscopic fraction of such users dies from prescribed use of painkillers.
The Prince case, contrary to the Times narrative, was the result of chaotic off-script use of pharmaceuticals.
My fellow Influence harm reduction commentator, Kenneth Anderson, instead got the Prince story right:
“We haven’t seen great increases in non-medical opioid users or those dependent on prescription opioids. We have seen great increases in chaotic drug use and high-dose use among non-medical users as well as drug mixing thanks to heavy handed prescribing.”
Portraying prescribed use of opioids as the bad guy contributes to untold suffering among medication-deprived pain patients. But the Times, which I’ll continue to use as emblematic of the failings of the wider media, will not be in the least daunted by its harmful inability to fathom Prince’s case. Indeed, the publication has been unapologetically misreporting about drugs for decades.
Remember “China Cat”?
Back in 1994, I traced the Times’s stunning fabrication, the fable of China Cat:
“On August 31, a headline on the front-page of the New York Times reported, “13 Heroin Deaths Spark Wide Police Investigation.” The article began: “They call it China Cat, an exotic name for a blend of heroin so pure it promised a perfect high, but instead killed 13 people in five days.”
But, it immediately turned out, the men had not all been using China Cat, necessitating a quick follow-up entitled “Potent New Blend of Heroin Ends 8 Very Different Lives.” The article presented in a remarkably self-congratulatory way the Times’s inaccurate initial reportage:
“At first, the police suspected that the men . . . had all died after using an extremely potent blend of heroin called China Cat . . . . Now the police and the New York City Medical Examiner, Dr. Charles Hirsch, say the men may have been victims of that brand or some similar, equally powerful blends of heroin . . . . But as one police officer put it: ‘They’re all still dead.’ In the end, drug experts said, the brand name probably has little significance.” [my emphasis]
So what was the point of the original headline story about China Cat, then?
But the Times’s coverage was far worse than merely a fake headline. In a further correction, “Officials Lower Death Total Attributed to Powerful Heroin,” buried far inside the paper, the Times revealed that it had no idea what it was talking about:
“authorities yesterday lowered from fourteen [another fatality had been added] to eight the number of deaths in the last week that the police believe are related to highly concentrated heroin. . . .two of the 14 men originally suspected of having died from taking the powerful heroin had actually died of natural causes. Four others died of overdoses of cocaine . . . . Of the eight whose deaths apparently did involve heroin, seven also had traces of cocaine in their system.” [my emphasis; it is hard to believe that alcohol and other drugs were not also present in some of these cases—the emphasis on cocaine along with heroin seemingly reflects the Times’s and the police’s illicit drug phobia]
Thus, the “newspaper of record” ran a front-page story about a super potent form of heroin laying waste to the city, then discovered that exactly one man had “apparently” died from taking some type of heroin by itself, without reflecting on its own conduct.
The Evidence Is Widely Available, Largely Ignored
A half-century of research (detailed in Edward Brecher’s uncanny, now ignored, 1972 book for the Consumers Union, Licit and Illicit Drugs) makes clear that it is very difficult to die from taking pure heroin alone, since the ratio of a fatal to a standard dose is around 50-1. (This fact helps us understand how heroin deaths have achieved record levels while heroin purity has declined since the 1990s.)
The Times hasn’t always been merely a repository for drug myths. I have described how something I read in the Times by Charles Winick, the author of the classic 1962 study, “Maturing out of Narcotic Addiction,” changed my view of addiction and my life’s trajectory.
Winick, interviewed in 1968 for his knowledge about heroin use and users, told the Times, “opiates are usually harmless, unless they are taken under unsatisfactory conditions.”
In his statement, Winick anticipated the modern harm reduction movement, which the Times has consistently shown itself incapable of grasping.
Instead, the Times has lodged itself squarely behind cultural misconceptions about heroin, addiction and overdose that Brecher and Winick laid to rest 40 to 50 or more years ago. Indeed, the misconceptions Winick and Brecher tried to dislodge from our consciousness have been cemented into our national psyche in good part with mortar provided by the Times and the rest of the mainstream media.
What these outlets can’t grasp is the stupidity of aiming at a succession of particular drugs, as opposed to far more dangerous mixtures of these drugs and—above all—the economic, social and psychological circumstances in which people use drugs.
China cat, regular ol’ heroin, prescribed OxyContin or Percocet, and now fentanyl: Aiming at these targets actively contributes to ignorance, suffering and death—preventing us from acquiring the skills needed to use drugs safely in a world in which their use is already normal.
Stanton Peele is a columnist for The Influence. His latest book, with Ilse Thompson, is Recover!: An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life. He has been at the cutting-edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has since written numerous other books and developed the online Life Process Program. His website is Peele.net. Dr. Peele has won career achievement awards from the Rutgers Center of Alcohol Studies and the Drug Policy Alliance. He is currently working on an e-book: How to Use Drugs. You can follow him on Twitter: @speele5.