Prince’s Death Reveals How Hard It Is To Escape Opioid Addiction

As Prince’s death shows, our nation faces a troubling dilemma: We’re simultaneously in the midst of a chronic pain epidemic and an opioid epidemic.

Americans spend $300 billion on pain treatment every year, with lost productivity costing an additional $315 billion, says Consumer Reports. Twenty-five million U.S. adults struggle with daily pain, according to a 2015 report published by the National Center for Complementary and Integrative Health.

How Compassionate Doctors Created A Culture Of Addiction

It all started with good intentions. Following reports from doctors in the 1980s that opioids were safe and addiction was a rare side effect, drug companies rushed to advertise them as a solution for chronic pain in the 1990s.

“There is a growing literature showing that these drugs can be used for a long time, with few side effects and that addiction and abuse are not a problem,” Dr. Russell Portenoy, then a pain specialist at the Memorial Sloan Kettering Cancer Center, told The New York Times in 1993.

Portenoy would go on to be named the president of the American Pain Society, which in 1996 classified pain as the “fifth vital sign” alongside body temperature, blood pressure, heart rate and breathing rate.

In the early aughts, everything came to a head. More than 20 percent of 20- to 25-year-old were abusing prescription painkillers in 2003, compared to only 7 percent in 1992, according to the Times. There were also reports of physicians being arrested after prescribing large amounts of pain pills that ended up on the black market.  

Doctors and drug companies came under fire — OxyContin pleaded guilty to making false safety claims and misleading regulators, agreeing to pay more than $600 million in fines in 2007. But the damage was done. 

What Happens To Your Body When You Overdose On Opioids 

It’s important for health care providers and family members to carefully watch people who are prescribed opioids, Dr. Nitin Sekhri, the medial director of pain management at Westchester Medical Center, told The Huffington Post.

Not only can patients become addicted, but they often underestimate the effect of drug interactions that can occur even with run-of-the mill medications like antibiotics, which inhibit the enzyme that breaks down some medications and can actually lead to overdose.  

Even a mild infection can have disastrous impact on opioid users. “It lowers someone’s threshold for respiratory depression,” Sekhri explained, noting that having a fever is akin to taking a narcotic in some cases, and can impact breathing. 

One of the telltale signs that someone is overdosing on opioids is that he or she becomes lethargic, sometimes to the point of being sleepy and unable to wake up.

“They start to breathe very, very, very slowly, to the point of maybe stopping breathing,” Sekhri said.

“When you stop breathing, you build up carbon dioxide and you lose oxygen content in your body. That can put a huge strain on someone’s heart, and they can go into cardiac arrest from having low oxygen,” he said. “Obviously, this can be deadly.”

From Prescription Pain Treatment To Heroin Addiction 

The risk of taking opioids isn’t limited to overdose. There’s a well-trod path from opioid use to opioid misuse to heroin addiction. 

“Our health professionals’ well-intentioned approach to treating people’s pain can sometimes lead to unintended consequences and exposing an individual to the risk of addiction or overdose,” Dr. Hillary Kunins, assistant commissioner at the New York City Department of Health and Mental Hygiene, previously told HuffPost.

The research bears this out. Forty percent of injection drug users abused prescription opioids prior to starting heroin, according to a small study published int the journal Substance Abuse and Rehabilitation in 2011. In addition, misusing prescription opioids is the strongest risk factor for trying heroin, according to the Centers for Disease Control and Prevention.

Because heroin is cheaper and produces a greater high than prescription pills, the switch is easy to make, health experts say. “The high of heroin tends to be more intense than the high of prescription pills, so people try it once and they get hooked,” Scott Krakower, a psychiatrist at Zucker Hillside Hospital in Glen Oaks, New York, told Live Science in 2014.

For recovering opioid addicts, getting treatment presents its own obstacles. Buprenorphine, which blocks withdrawal effects and craving — and which Andrew Kornfeld was en route to deliver to Prince — is one of the best treatments for opioid addiction. Unfortunately, there is a shortage of doctors in the U.S. who are certified to prescribe buprenorphine to patients. 

According to the most recent federal data, from 2012, a mere 13 states had enough doctors to prescribe buprenorphine to patients who needed it, and nearly half of U.S. counties had no doctors certified to prescribe the medication at all.