The Prince Frenzy

Pharmacy Times, August 2016 Pain Awareness, Volume 82, Issue 8

Much of the turmoil over the death of Prince has subsided, but the news about his death and the public's response have been interesting, especially when it was revealed that fentanyl and other controlled substances were determined to be part of the cause of death.

Much of the turmoil over the death of Prince has subsided, but the news about his death and the public’s response have been interesting, especially when it was revealed that fentanyl and other controlled substances were determined to be part of the cause of death. Individuals who villainize all opiate medications and call for greater prescribing controls came out of the woodwork again.

My view all along, as the prescribing pendulum of controlled substances swings from high to low, is to try to achieve balance. Remember that the vast majority of prescribers are incredibly honest and primarily prescribe these medications to patients with legitimate pain. Therefore, it’s amazing to me that, for the sake of the 10% to 15% of individuals to whom these medications are prescribed and who abuse them, we are willing to drastically reduce prescribing. In some cases, physicians promote the “suck it up” approach, encouraging no prescribing of opiates, no matter the pain level.

When the media, including a prominent physician whose opinion is not always overburdened with facts, reported that Prince had overdosed on fentanyl, the antiprescription drug cry was rekindled. It was assumed that the fentanyl was pharmaceutical-grade, and there is a chance it was. However, the media either don’t know what is really happening on America’s streets, in terms of drug abuse and overdose deaths, or is taking an opportunity to once again “beat the drums” for less prescribing of prescription painkillers.

The truth is that obtaining pharmaceutical-grade fentanyl is not easy. Duragesic patches are likely the most prevalent form of the drug, and placing multiple patches on the body can certainly cause overdose and even death. There are also lollipops for breakthrough pain, as well as the injectable liquid found in operating rooms for use during surgery and other procedures.

Unfortunately, the easiest form of fentanyl to obtain in America right now is the clandestine one from China or Mexico. Mexico has various labs making illicit fentanyl that was first used to boost weak heroin; the labs now produce it as pure powder or add it to what look like legitimate oxycodone products. Clandestine labs have also popped up recently in California, likely forecasting the future of the drug’s abuse in America.

Both forms of fentanyl are potentially deadly and are causing countless unintentional overdose deaths in the United States. My area of the country, southwest Ohio, is the “poster child” for this abuse. We lose individuals daily, even with nasal naloxone being used by some law enforcement agencies.

The point here is something I learned many years ago: jumping to conclusions about a complex problem is always dangerous, and many times, it can be devastating to a person’s reputation. It’s tempting for some individuals to spout off as quickly as they can about an important issue, and some of the public never bothers to verify accuracy!

I can probably guess that investigators knew what form of fentanyl killed Prince within a day or 2 based on evidence found at the scene and statements by those closest to him. That kind of investigation takes time, but it doesn’t mean the authorities don’t know some of the facts almost immediately. Once the entire investigation is completed, more information will likely be revealed, including which form of fentanyl was involved.

I commend individuals who have urged caution on jumping to conclusions about which type of fentanyl was involved. Several have explained the potency of the drug and how easy it is to overdose and die, no matter which form is used.

When these things happen, I would like to think that individuals who turned out to be wrong due to their knee-jerk reaction will temper their response when the next hot topic pops up and we don’t have all the facts. However, I am way too old to be naïve, so I expect those folks won’t learn anything. But their ignorance will help me write another article down the road!

Cmdr Burke is a 40-year veteran of law enforcement and the past president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at burke@rxdiversion.com or via the website www.rxdiversion.com.