It was hardly the first time a celebrity died from a drug overdose, but the death of superstar musician Prince at age 57 from an accidental overdose of fentanyl, on April 21 at his home in Minnesota, is particularly tragic and newsworthy: His death is, in short, the result of a perfect storm that began with chronic pain that was not successfully managed, leading to prescribed opioids and eventually to badly managed opioid use.
Authorities had not yet, by publication deadlines for this newsletter, reported how the fentanyl was obtained, and in what form Prince had taken it, although the medical record stated that Prince had administered it and that the overdose was accidental.
An earlier overdose shortly before his death, which led to an emergency landing of his plane in Illinois, had prompted a concerned friend to seek help for Prince from pain and addiction specialist Howard Kornfeld, MD. Kornfeld is founder and medical director of Recovery Without Walls in Mill Valley, California, Kornfeld's lawyer, William Mauzy, told the New York Times.1
As reported in the New York Times, "On April 20, Dr. Kornfeld sent his son, Andrew Kornfeld, who is not a doctor but works at his father's clinic, on a red-eye flight to Prince's Paisley Park estate in Chanhassen, Minn., Mr. Mauzy said. But when Andrew Kornfeld arrived on the morning of April 21, he and two members of Prince's staff found the singer lifeless. He then called 911."1
The cause of Prince's death is one that has been on the rise in the population as a whole. And with the recent appearance on the street of fentanyl disguised as oxycodone tablets, chances are there will be more deaths before heightened awareness leads to a way to reduce opioid deaths.
Still, if nothing else measurable comes from it, Prince's death will have familiarized a sizable number of people with what fentanyl is and that it is far more potent and dangerous than other "street" opioids.
Prince, whose full name was Prince Rogers Nelson, was particularly known for not using recreational drugs, both as a practicing and devout Jehovah's Witness and as a prolific artist who demanded much from himself and those who worked for him.
His showmanship included on-stage acrobatics, such as high jumps and somersaults on hard surfaces, often landing in splits. Family members and those close to Prince have reported that he had battled hip pain for more than a decade. Surgery did not alleviate the pain, and the musician began taking Percocet, which was prescribe by a physician. The medical examiner's report lists a scar at Prince's left hip and another on his lower right leg.
Family members indicated Prince had, at least at first, obtained a legal prescription for opioids.
Celebrities, Pain, and Addiction
For physicians and other prescribers who treat VIP patients-whether a megastar or a governor, or small-town bank president or school principal-Prince's death is a reminder that celebrity patients should be treated with the same precautions required for the general population. Celebrities are just as vulnerable to opioid addiction and misuse as any other patient.
Michael Jackson died in June 2009 of an overdose of propofol administered by his physician, Conrad Murray, MD, as a sleep aid at Jackson's home. Murray spent nearly 2 years in prison for a 4-year sentence handed down after he was convicted in 2011 of involuntary manslaughter for causing Jackson's death.
Actor Philip Seymour Hoffman, 46, was found dead February 2, 2014, on the bathroom floor of his New York apartment with a syringe in his left arm. The New York medical examiner ruled that Hoffman died of acute mixed drug intoxication, including heroin, cocaine, benzodiazepines, and amphetamine.2
The actor had a history of substance abuse. He may have relapsed via use of prescription opioids, although details of how he came to be taking them are not known.
The New York Times reported after his death, "Mr. Hoffman was long known to struggle with addiction. In 2006, he said in an interview with "60 Minutes" that he had given up drugs and alcohol many years earlier, when he was 22. Last year he checked into a rehabilitation program for about 10 days after a reliance on prescription pills resulted in his briefly turning again to heroin."3
Certainly, this raises the question whether a physician prescribed opioids to Hoffman despite his history of addiction.
Aside from the issue of opioids, there is also the fact that even celebrities who could have access to the best medical care still must often deal with debilitating chronic pain.
Details are still not known about the intensely private Prince and how he sustained and treated his injuries. It would be interesting to know what care he received, whether he had physical therapy, and perhaps also, whether he was told not to be so hard on his body onstage-and whether he was adherent to medical advice.
Actor Jerry Lewis has spoken publicly about dealing with chronic pain based on his many injuries sustained while performing pratfalls and other stunts as part of his physical comedy.
In 2002, when Lewis spoke about this publicly, as part of an awareness campaign sponsored by Medtronic, he said he had not had a day without pain since he fell on stage in Las Vegas and injured his spine on March 20, 1965. However, he also said at the time that there are many more ways of treating chronic pain, and that he wanted to raise awareness in the medical community and among the public that it was a serious issue. At the time, Congress was working on passing legislation to increase research, education, and awareness of chronic pain.
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