Prince’s Death Reveals What’s Wrong with Addiction Treatment

Prince had the money and resources required to recover from opioid addiction, but still couldn’t. What does that mean for the rest of us?

06.02.16 9:50 PM ET

By now you’ve read all the “I told you so’s.”

After weeks of speculation into the details of Prince’s death, and media liberally quoting defense attorneys and anonymous sources, the worst has been realized. Prince died of an accidental overdose of fentanyl, a powerful painkiller many times more potent than heroin.

Painkillers like OxyContin are measured by the milligram, but fentanyl is so strong that it is measured in micrograms. For some perspective, if a few grains of salt were fentanyl, that amount would be lethal if swallowed. Typically, it is only prescribed if a patient becomes opioid tolerant to the point other drugs no longer work. It has yet to be confirmed whether or not Prince was prescribed the fentanyl.

This news, however, does not make the details of Prince’s death any less dizzying.

The frenzy began on April 15, less than one week before Prince was found dead, when his private plane made an emergency landing in the middle-of-nowhere Illinois. Shortly after that, it was revealed the plane landed so Prince could be treated for an opioid overdose. He was then taken to a nearby hospital where he left against medical advice.

In the following days, friends close to Prince told the press he had suffered from chronic pain after a 2009 hip surgery, linked to years of high-impact performances, often in high heels. His close friend Sheila E. said “he was in pain all the time.” Fans said they noticed he no longer did the splits, that he walked with a cane, and that some concerts consisted only of Prince singing on the piano bench (which isn’t to say that those performances were anything but stunning).

Then came the story about a Bay Area opioid specialist, Dr. Howard Kornfeld, who flew his son on a redeye to Prince’s residence in Minnesota, in order to assess his health and begin a treatment plan for chronic pain and possibly addiction. But by the time the younger Kornfeld arrived, it was too late. Prince was already dead. It was eventually the younger Kornfeld who made the 911 call. The last puzzle piece to be revealed was that on the day before his death, Prince was also treated by a local doctor for opiate withdrawal symptoms. 

What’s left to be answered is how Prince obtained the fentanyl that killed him, and from whom it was prescribed—if it was indeed prescribed at all. His death is currently being treated as a criminal investigation, headed by Federal Prosecutors and the DEA.

Taking into account all of the doctor visits, an entourage of concerned friends, along with Prince’s vast resources, one cannot help but wonder how in the hell the end result was still fatal. The simple answer is he simply took too much fentanyl. But there are an infinite number of remaining what ifs, all orbiting how someone dependent on opioids is to be clinically treated.

What if Prince hadn’t left the ER in Illinois against medical advice? What if he had gone straight to treatment? Or, had the addiction doctor in California been called a day earlier, would Prince have received the care that could have saved his life? What was the hold up? What about the doctor who treated him for withdrawal? Why didn’t this doctor urge Prince to be hospitalized? If being addicted to opiates wasn’t so stigmatized, would Prince have been helped sooner?

I’ve been writing about opiates and their magical allure since 2013, ever since I kicked my own habit. But I’m not going to pretend here that my own experience qualifies me to opine about Prince’s interior life, and what kind of addiction with which he may have struggled.

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He could have been on a chronic pain regiment, and the dose to which he was prescribed no longer did the trick. Part of the reason fentanyl is so dangerous is that the lethal dose is so close to the therapeutic dose, making any margin of error deadly. In an effort to kill the pain, maybe he began taking too much.

What’s also possible is that Prince loved the feeling produced by a head high on opiates. Fentanyl, after all, is the Ferrari of painkillers. Its onset is rapid, and before you know it you’re somewhere in the clouds, so numb and weak you can’t even make a fist. I doubt how Prince felt on opiates will ever be known. Maybe he loved them.

But what Prince’s death reveals is that treating an addiction to opiates is not so cut-and-dry, especially when chronic pain is thrown into the equation. What’s sorely missing from our health care system is a standard protocol, similar to what we have for other chronic medical conditions. One sane solution would be to prescribe naloxone (brand name Narcan), the lifesaving antidote, with every bottle of painkillers. But the drug’s recent price hike will make that even more difficult. 

If you’re diabetic and your blood sugar is off, nurses can bring it back to safe levels. If you go to an ER with high blood pressure, the nurses can lower it. But when you go to an ER for an opioid overdose, or because you’re addicted to painkillers and want to get off, everyone’s hands go up. In fact, it’s likely you’ll be treated as a second-class citizen, because culturally, opiate users are judged unscientifically.

Which partly explains, as Christopher Moraff thoroughly reported for The Daily Beast already, how America has made a mess of addiction treatment. There’s still no science to it. You could be told to pet horses on a farm or live by the beach, maybe pay exorbitant prices for swanky amenities that do nothing to address one’s actual addiction. And the one effective treatment, the indefinite maintenance on methadone or Suboxone, is shunned by the professional treatment industry, who in their own self-interest cling to dated models of abstinence that may not apply to present day opiate users.

If Prince couldn’t get the help he needed in time, how in the hell are the vast majority of heroin users supposed to get better?