The Medical Report Shows Fentanyl—And That Media Narratives Around Prince’s Death Are Deadly

Jun 03 2016

The Medical Report Shows Fentanyl—And That Media Narratives Around Prince’s Death Are Deadly

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

  • The Times markets moral panics quite well. They are the arbiters of disease. The disease of not thinking for oneself and believing everything one reads uncritically. The media are more dangerous than any drug.

  • Maurice Dutton

    This is great article.

    • Stanton Peele

      thanks

      • Maurice Dutton

        Cheers have a great weekend !!

  • painkills2

    “Prince was unlikely to have been prescribed fentanyl, a very powerful synthetic opioid originally created for palliative care…”

    As a long-term intractable pain patient, I was prescribed fentanyl, because pain doctors prefer to prescribe pain medications that last longer than 4-6 hours. But the nausea was so bad, I only tried the patches a couple of times. I didn’t get any pain relief from fentanyl, only nausea and dizziness.

    It seems that Prince was using painkillers as a way to combat his shyness, social awkwardness, and stage fright. And then later, for his chronic pain. While I don’t agree with treating anxiety with painkillers, I’m guessing that anti-anxiety medications probably slowed Prince down — if he ever tried them — which would seriously interfere with his ability to perform.

    After 25 years of treating my pain within the medical industry, I’ve given up on doctors, too. So, I understand Prince’s phobia about doctors, as I now avoid them at all costs. I also understand Prince’s need to manage his pain on his own, not relying on whether a doctor would disagree with Prince’s own choices to treat his pain. I think many pain patients try to hoard their medications as much as possible, knowing that at any time, they could be cut off. The treatment of pain has nothing to do with the individual in this country — doctors make decisions based on their own fear of the DEA and decisions by insurance companies.

    What killed Prince? I think his inability to manage his pain killed him. He tried for so long to do this on his own, but his decisions were based on the amount of relief he obtained, not medical science. As many pain patients can tell you, Prince was addicted to pain relief, not the drugs. And I think he would be horrified at how his pain is being exploited by the opioid war.

    Rest in peace and pain-free, Prince Rogers Nelson. And tell Robin Williams we miss him.

    • Stanton Peele

      Thoughtful and heartfelt, and thanks for reminding us that there is a purpose for fentanyl prescription and use. We have yet to know the process Prince went through in seeking painkillers, although I tend to agree with you it likely involved extra-medical sources, for whatever reason.

      And I especially appreciate, given your own pain experiences, your noting what I also believe — that despite his evident physical pain caused by years of high-energy stage performances, equally present in his drug use were shyness and social unease.

      I think where our bottom lines are similar is that, whatever reason or reasons Prince sought whichever painkillers (fentanyl and beyond, that is), which may have included unwise choices on his part, that such missteps should not be a death sentence — that there must be some place a human being can turn for help with their drug use without fear of rejection, punishment, deprivation, or dying..

    • Maurice Dutton

      Your last line says more than readers realise. Physical pain is just one way of suffering. Emotional pain of depression is just as debilitating and harder to have others believe. To be at the absolute bottom of despair can be just as serious as any physical encumbrance.

      • painkills2

        A lot of people think that physical pain is somehow worse than mental pain, but I disagree. I’m no expert, but I think both emotional and physical pain are treated the same way by the brain. And with both kinds of conditions, there is a lack of pain-relieving responders in the brain, which is why opioids can work for both, by replacing this deficiency.

        • Maurice Dutton

          Yes that is so true and the best way to treat is self medication. If you are an adult with years of wondering about the best treatment for yourself then don’t let the docs tell you otherwise. There is every chance that they may be influenced by the big drug companies and this is why you have the explosion in opioids and anti depressants. Yes cross medicating is fine in my book. Its what ever spins my wheels is good for me.

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  • Paul

    Does anyone have a link to the actual M.E.’s report? I am gonna magic 8-ball a guess here that in addition to whats been mentioned, that they find benzos in his system also.

    Everyone I’ve known who has died from an overdose were regular opioid-users. Each one never had any OD-risk until that fateful day combining their normal opioid doses with handfuls of benzos that an overdose happens. Those damn things are so cheap per pill compared to opioids, many users end up unknowingly taking an obscene number of them.

  • “the ratio of a fatal to a standard dose is around 50-1” – Obviously suicide. The solution? Explain overdose as ‘chaotic use’ and patiently explain to people how much drugs they need to take to die. Hm…..

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  • Laura4444

    Thank you for a well-needed, nuanced article on Prince. As a chronic pain patient for the last four years, I’ve watched the increasing hysteria over opioids while trying to retain access to prescription opioids that allowed me to keep working and to salvage the shambles of my life left to me after a terrible accident. I’ve also lost a family friend to an overdose so I’ve experienced the devastation that drug abuse can cause. I do know that my friend never obtained prescription pain pills legally and as most other lethal ODs had mixed several different drugs.

    Another potentially devastating aspect of this newest ‘war on drugs’ is the push to prescribe the anti-convulsants, Neurontin (gabapentin) and Lyrica (pregabalin) for pain instead of opioids. Gabapentin is one of the most prescribed medications and is viewed as almost completely innocuous, which was far from the case, in my experience. I’ve taken both it and Lyrica as well as many different prescription opioids at different times (oxycodone, norco, oxycontin, MS contin, dilaudid). In my experience, opioids have far less side effects and are pretty easy to wean off of when no longer needed. A slow steady tapering off of oxycodone caused me to feel a little over-caffeinated and gave me minor intestinal problems. Gabapentin and the more potent and more awful Lyrica turned me into a brain dead zombie. I lost the majority of my personality, drive, work ethic, and emotions. Both of these drugs inhibit memory formation in the brain so I couldn’t retain new information. Weaning off of them was absolute hell. Lyrica withdrawal (with tapering over four months) caused massive panic attacks, dropped me into a deep depression, and was the cause of a suicide attempt. None of my doctors believed me when I told them about major side effects or withdrawal symptoms. I’m part of an online support group with well over 1000 others who have had similar horrifying experiences including a number of family members reporting successful suicides.

    All medications are subject to individual variability. For some like me, opioids are a reasonable, low risk treatment while for others anti-convulsants are the answer. Treatment should be based on a collaboration between doctors and patients. Politics, Puritanic moralizing, and yet another drug war hysteria has no place in pain management. As for those dealing with opioid addiction, Switzerland has found a solution in providing safe access to heroin maintenance for those who can’t shake their addiction, allowing them to lead normal and productive lives. I can’t help but think that my friend would be alive today if he had safe access to heroin and accompanying medical support instead of whatever he bought on the street.

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