May 12th, 2016
Immediately on learning Prince was taking Percocet, the addiction commentariat held forth: Opioid use causes addiction, which causes overdose!
This is bull—dangerous, cruel and false.
TMZ originally reported that Prince had been removed from a plane unconscious and revived with naloxone, and that he was receiving a Percocet prescription.
I then wrote about Prince’s death in The Influence—noting that its suddenness and the apparent absence of other illness or risk factors made it most likely to have been drug-related.
One important ingredient further suggested this—a report from the Daily Mail from a man purporting to have supplied drugs to Prince that, in addition to taking Percocet for hip pain, he was also using dilaudid pills and fentanyl patches to cope with stage fright. This, if true, could be crucial, since more than 90 percent of such deaths involve several drugs, nearly always depressants (including alcohol and tranquilizers) or multiple opioids.
And then the forces of addiction mythology rushed in with their version of events: Opioid use predictably causes addiction, which causes overdose.
These narratives were most apparent in the newspaper of record, The New York Times, a primary force in maintaining the American drug addiction disease mythology.
First was the lead news story: “Prince’s Addiction and an Intervention Too Late. Prince appears to have had a problem with pain pills, one that grew so acute that his friends turned to an addiction doctor just before his death.”
This story did have interesting information about Prince’s state of mind:
“Yet people who knew Prince wondered whether he was in a malaise, his ailments limiting his ability to tour, and battling melancholy after the death in February of Denise Matthews, also known as Vanity, a former girlfriend and collaborator.”
State of mind is an important ingredient in how drugs are used and their repercussions (consider Philip Seymour Hoffman).
That’s about as good as it got.
The New York Times Narratives
More telling were the follow-up analyses, getting to “the truth” about Prince’s opioid use and his death.
First was “In Prince’s Battle With Opioids, a Familiar Narrative That Begins With Pain,” by Jan Hoffman:
“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.”
Prolong the prescription and, voilà, addiction and death.
How many people who receive a painkiller following a tooth extraction actually die from the drug? Jan Hoffman is a features writer for the Times who deals with a variety of health topics. She is not a clinician or a researcher. However, at the end of her article, she includes these data:
“According to the Centers for Disease Control and Prevention, opioids, which include prescription pain relievers and heroin, killed more than 28,000 people in 2014. The National Survey on Drug Use and Health said 4.3 million people were using pain relievers for nonmedical purposes that year.”
Whoa! This means that fewer than a half of a percent of nonmedical opioid users, including heroin users, died, in a record year for both heroin and opioid painkiller deaths.
But, wait a second! Hoffman has just told us that Prince had been using painkillers medically prescribed for pain relief. So Prince falls within a much larger denominator of opioid users—including tens of millions of Americans—meaning that he, as a supposed medical user, represents a tiny fraction of the tiny fraction of opioid users who die.
In writing about the myths of opioid addiction presented by public television’s Frontline for The Influence, I noted the strange ad for a treatment for opioid constipation that appeared on the Super Bowl. Who knew there were so many of these as to justify paying the exorbitant costs for a SB ad?
It turns out that there are an estimated eight million such sufferers; to seek treatment for opioid-induced constipation, a person must use the painkiller regularly. Should we rush all of these eight million people instantly into addiction treatment?
What a ridiculous, wasted—no, counterproductive—effort that would be. Yet it follows directly from Hoffman’s logic. As I’ve noted more than once, tens of millions of Americans take prescription opioids, although very few become addicted.
But Hoffman is “only” a Times writer. The next version of the opioid use-causes-addiction-causes-overdose narrative to appear in the Times was by the former director of the Food and Drug Administration, David Kessler—surely a well-informed expert from an agency that dictates prescription policies.
Here’s how Kessler’s version goes:
“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.”
Kessler doesn’t present the addiction rate for prescription opioids. Does he believe it is 10 percent of users? Five percent? In fact, the actual figure is even smaller. And how does this figure for opioids compare with the addiction rate for alcohol, or for tranquilizers?
Despite opioids’ reputation as being the sine qua non of addiction-producing chemicals, the addiction figure for alcohol is at least as high. But you can buy alcohol in a store or a bar almost any time you feel like it.
As for tranquilizers, much is now being made of their unacknowledged addictiveness and potential lethality. Benzodiazapine-associated deaths have risen faster than fatalities with any other drug. We hear little about this, however, because of our opioid fixation.
To be fair, the fact we mentioned earlier—that fatalities affect only a tiny fraction of 1 percent of prescribed opioid users—doesn’t focus on those who rely on narcotic painkillers for chronic pain. What about these people?
Another Times editorial tells us: “About one in 550 people who received opioids for chronic pain not linked to cancer died from an opioid-related overdose.” That is, fewer than two-tenths of one percent of painkiller users suffering chronic non-cancer pain die from the drugs.
Even this small number is tragic, of course. And, so, should we unilaterally declare they must take fewer painkillers? In a seemingly contradictory treatment of this subject Hoffman authored two months ago, she details the painful decisions entailed by stringent restrictions on painkiller prescriptions in a piece titled, “Patients in Pain, and a Doctor Who Must Limit Drugs.”
Alternately, habituated users may not be able to get painkillers at all. Yet another Times piece describes that scenario: “Addicts Who Can’t Find Painkillers Turn to Anti-Diarrhea Drugs.” They must take much larger doses of such drugs, of course, a process that yields its own set of drug-related deaths.
Kessler provides the following additional data:
“Figures published by the Centers for Disease Control and Prevention for the period 2008 to 2011 show that among those who were at the highest risk of overdose, 27 percent used their own prescriptions and another 49 percent either got or bought opioids from friends and relatives. Only 15 percent bought them from a drug dealer.”
To summarize: About three quarters of painkiller deaths occurred from non-medically prescribed use of the drugs—even though prescribed users far outnumber non-medical users.
Calculating deaths from opioid use (throwing in heroin) over a denominator that includes prescribed painkiller users presents us with a fraction of a fraction; in a group tens of millions strong, opioid-related deaths are actually rare. Did you or someone you know die after being prescribed a painkiller following the extraction of your wisdom tooth or surgery you received?
So what distinguishes the small population of opioid users at greatest risk from this larger, much less vulnerable one?
Here is the epidemiology of opioid painkiller drug deaths according to fellow Influence contributor, harm reductionist and author Kenneth Anderson:
“We really 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 and kids finding opioids in every relative’s medicine cabinet—it is these things which are killing people.”
As described in the very first, and best, Times piece on Prince’s death, he was apparently in psychological turmoil, as a result of which he may have been one of those multi-drug, chaotic users.
We shall see. But Philip Seymour Hoffman was such a drug taker: Hoffman died from “acute mixed drug intoxication” involving heroin, cocaine, tranquilizers and amphetamines. Meanwhile, Amy Winehouse died combining alcohol and tranquilizers.
But there weren’t front-page articles in the Times decrying tranquilizer overdoses at the time of those deaths, even as tranquilizers are now implicated in almost a third of prescription drug fatalities.
Why is the Times so shy about featuring the tranquilizer-related deaths of famous people?
What Policies Do Prince’s Death Indicate We Should Follow?
The inescapable conclusion from Jan Hoffman’s and David Kessler’s articles is that we need to limit painkiller use. Otherwise, according to them, inevitably people become addicted and die.
I am among the professionals who work with people to find alternatives to drug use in addiction. Ilse Thompson and I, in our book, Recover!, detail meditations aimed at allowing people to control painful psychological and other issues so that they can deal more constructively with them. Yet those of us who work in this way reach only a tiny fraction of painkiller users.
And for the rest, including those who may have unimaginable pain, the drug-addiction-myth-meisters’ confident policy recommendation is: Reduce/take away their painkillers, with consequences we have already seen!
As I have pointed out, this opioid myth has persisted in polluting American drug policy, as well as medical prescription policy, for a century.
Faced by such pervasive, harmful propaganda by outlets as esteemed as the Times (I’ve been pointing out drug and drug overdose dishonesty in the paper for decades—remember China Cat?), what hope is there?
Here is one contradictory opinion enunciated by someone you might know, as expressed directly to the governors of America (who subscribe fully, along with Congress, to our opioid myth):
“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said during his meeting with the governors. “In some cases, addiction is already there.”
That guy should be drug czar!
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.