Prince's death, pills and pain

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If the rumors that Prince died from an overdose of Percocet are ultimately confirmed, it will put a very common conclusion to the life of an extraordinarily talented man who had so much more to give.

It’s a more common conclusion than I, as a practicing physician who deals with pain and treatments for pain every day, would like to believe.

But the facts are sobering. In the end, Prince would be no different from the more than 2 million Americans who are addicted to prescription opioids, including Percocet, 14,000 of whom die every year from overdoses. Another 14,000 die from heroin overdoses, which often occur when these sufferers can no longer obtain prescriptions.

That’s an epidemic – 77 deaths every day, a tragedy that can and must come to an end. It calls for a drastic change in the medical culture, where patients reach easily for pain pills instead of physical therapy, weight loss and heat treatments. And it calls for an honest discussion about destigmatizing pain pill addiction so that we can treat it as an illness, not a sign of moral weakness.

Pain can be crippling, and when it is tied to arthritis or musculoskeletal injuries or surgeries, it can be debilitating. Instead of blaming or marginalizing the sufferers, we need to feel empathy for them. Heroin is not the first stop here, though it is too often the last. We should think of sufferers who use it as victims, not as criminals.

Those desperate for relief frequently don’t realize how much these medications suppress breathing and lower blood pressure. They also may not realize that Percocet or Vicodin or codeine or heroin stays in the system far longer than naloxone, the “safe shot” that is used to counter them. TMZ reported that this was the case with Prince, though the autopsy results won’t be released for several more days.

Percocet abuse and overdose aren’t pretty, but what can be done about them? We can start by taking the stigma away from the sufferers and placing it squarely on the shoulders of those who enable the abuse, namely the doctors. Patients in pain aren’t always thinking clearly when they demand a prescription for Vicodin or Percocet, but the doctor who prescribes it doesn’t have that excuse. And the problem isn’t just catering to celebrities. Sometimes it’s just too much easier for a busy doctor to refill a pain pill prescription than spend time explaining the benefits of physical therapy or weight loss. These drugs also frequently end up in the hands of someone other than the person for whom they were prescribed.

I applaud New York State’s effort to clamp down on this problem by instituting the ISTOP system, which requires physicians who prescribe controlled drugs to see their patients more frequently and to obtain a number for each prescription from a state website.

Though few people have Prince’s rigorous performance schedule, millions of Americans can relate to trying to function on damaged and unforgiving limbs, leading to a funnel of attempted pain relief. But narcotics provide a solution that is worse than the problem. That is a huge medical concern, not a social stigma.