Was Prince the Latest Opioid Casualty?

The autopsy results from Prince's unexpected death are not in yet, but it has been reported that the musical star had the prescription opioid painkiller Percocet in his possession when he died. Unconfirmed reports suggest Prince not only used prescription opioids for pain but may have had an addiction.

If so, Prince is like millions of other Americans who have become opioid addicts through a Pharma-backed prescribing spree that is still going on. The government has made efforts to better "educate" doctors about opioid dangers, and added better warnings on some drugs. Regulatory agencies have cracked down on pill mills, traffickers and even the shipping giants Federal Express and United Parcel Service (who knowingly delivered "controlled substances and prescription drugs from online pharmacies to individuals who subsequently died or accidentally caused the death of others" said a federal lawsuit).

But here are two things the government has not done. It hasn't acknowledged that the opioid addiction epidemic was created by Big Pharma. And it hasn't stopped waving through its continuing stream of new dangerous drugs.

In fact, on the same day the U.S. Food & Drug Administration (FDA) announced plans to tighten restrictions on hydrocodone combination products like Vicodin, the agency also approved the long-acting drug Zohydro with five to 10 times the abuse potential of OxyContin. The opioids Actiq (fentanyl) and the long-acting hydrocodone (Zydone) are also readily available.

Don't blame users, blame Pharma

Pharma fostered the opioid addiction epidemic in four ways. It introduced long-acting opioids like OxyContin that could be crushed and snorted, or shot for heroin-like highs. Industry also changed pain condition guidelines so that opioids were the first choice in conditions like lower back pain--conditions that never used to justify prescribing opioids.

Pharma also pushed and promoted the long-term use of opioids though no studies show such use effective or safe according to respected medical groups, including the Cochrane Collection. And finally, the industry misinformed doctors, patients and the public, claiming that only "some" people become addicted to narcotics--when in fact narcotics are addictive, period. In fact, until Pharma's opioid revival, narcotics were administered only after surgery, accidents and for palliative care in the chronic and terminally ill.

The result is what anyone familiar with the history of narcotics could have predicted. Over 47,000 people in the U.S. die each year from drug overdoses, mostly opioids, says the CDC. Opioids are now prescribed for almost all "causes of human suffering," wrote Businessweek in 2012. "Back pain, fibromyalgia, toothaches, cancer, depression, divorce, boredom, mental illness, unemployment, hip replacement or withdrawal symptoms."

So many Americans are taking opioids, an ad for opioid-related constipation ran during the 2016 Super Bowl.

The opioid use epidemic has created confusion between real pain patients, false "patients" reselling drugs and "real" patients who became addicted through being kept on opioids for longer than a short time--in other words, inappropriate medical care. Pain clinics and pill operations "cut off" such patients despite often being largely responsible for their addiction. It's a classic case of blaming the victim. Patients who legitimately fear withdrawal symptoms and a return of their pain when cut off from opioids often turn to heroin. That's why we now have a parallel heroin addiction epidemic.

How Pharma 'sold' opioids

It is no secret that the drug industry pays doctors and medical associations to promote drugs. So many doctors receive payments from Pharma, that in 2012, when the FDA considered loosening its conflicts-of-interest standards so doctors could participate on advisory committees, the agency couldn't find enough doctors not taking Pharma money! A few years ago, a marketing partnership between drug maker Merck and the American Academy of Pediatrics showed that even children's medicine marketing is riddled with conflicts of interest.

So it is no surprise that opiate makers have paid doctors, associations and even universities to help sell opiates. According to investigative reporter John Fauber, half the American Geriatrics Society panel's experts who revised opioid guidelines in 2009 "had financial ties to opioid companies, as paid speakers, consultants or advisers." What changes did the experts make to the guidelines? "That over-the-counter pain relievers, such as ibuprofen and naproxen, be used rarely and that doctors instead consider prescribing opioids for all patients with moderate to severe pain," declared the American Geriatrics Society. The University of Wisconsin's Pain & Policy Studies Group received $2.5 million from opioid makers, too--as the group pushed for looser opioid use guidelines reports Fauber.

To facilitate approval of new opioids, a Pharma lobbying group called IMMPACT pushed through what it calls "enriched enrollment" which allows Pharma companies to weed out, before a clinical trial begins, subjects who won't respond well or tolerate a drug. This makes approvals quicker and cheaper for Pharma. But of course this practice ensures that we won't know what happens when the general public uses the drugs.

To assure doctors and patients that addictive drugs won't addict, a pain guide called "Finding Relief: Pain Management for Older Adults," funded by opioid maker Janssen with the American Geriatrics Society and American Academy of Pain Medicine listed as "partners" actually says:

Myth: Opioid medications are always addictive.
Fact: Many studies show that opioids are rarely addictive when used properly for management of chronic pain.

Overdoses aren't the only problem

Despite Pharma's promotion of long-term use of opioids for chronic pain, the pills actually make patients worse, say experts. Opioids increase patients' "disability conviction," keeping them dependent on the healthcare system and doctors, and discouraging them from pursuing more effective multidisciplinary treatment for their pain, including treatments offered by physical therapists, psychologists and other professionals says, Sridhar Vasudevan, M.D. an internationally known pain specialist. Opioids also decrease testosterone and immune responses, and cause personality changes like irritability, depression, amotivational syndromes and actual antisocial or law-breaking behavior, according to Dr. Vasudevan.

In Responsible Opioid Prescribing, Scott Fishman M.D. says opioids pose many risks including "heightened fracture risk related to effects and bone metabolism and from falls," and increased risks for the elderly and "those with impaired renal or hepatic function; individuals with cardiopulmonary disorders, such as chronic obstructive pulmonary disease (COPD); congestive heart failure (CHF), sleep apnea, or mental illness; and in patients who combine opioids with other respiratory depressants such as alcohol, sedative-hypnotics, benzodiazepines, or barbiturates."

There is another danger associated with opioids such as Percocet, which Prince was reportedly using. Such short-acting opioids contain acetaminophen (Tylenol), which in large doses or after extensive use can cause liver damage and even liver failure. The risks are greater than once thought, prompting government agencies to issue increasingly strong warnings.

Ironically, long-acting opioids like OxyContin were meant to spare patients such liver risks. "Because short-acting drugs, which are taken as needed, require 20-30 minutes to work and last only 2-4 hours, the patient's peak of pain is often missed. This can lead patients to exceed their doses and risk abuse and toxicity," writes Dr. Vasudevan. "Secondly, most short-acting opioids are combined with acetaminophen (Tylenol) which causes liver damage at high doses. Long-acting opioids lacked Tylenol, so if patients had to take 'rescue doses' of short-acting opioids for 'breakthrough' pain, there were less risks."

A final irony

There is a final irony in Pharma's promotion of addictive drugs for long-term use in pain conditions. The pills only produce 20 - 30 percent pain relief. "If you give an antibiotic for a UTI [urinary tract infection] and it doesn't treat the infection, you stop it," wrote Richard W. Rosenquist, M.D. in a pain newsletter from the Cleveland Clinic. "The same principle applies [to opioids]. Many patients are on opioids for a long time without ever achieving a good outcome, yet their providers fail to question it and try something different."

And there is a bigger irony with long-term use. Opioids are often perpetuating patients' pain through an underreported phenomenon known as "opioid-induced hyperalgesia" or OIH, not much discussed by Pharma. "If you took a hundred patients who are on chronic pain medication and take them off the medicine and move them through three physical therapy pool exercises a day, a lot of them are going to feel better. The reason is the opioids are usually causing the pain through opioid-induced hyperalgesia," says Harry Haroutunian M.D., physician director of the Licensed Health Professionals Program at the Betty Ford Center.

Clearly the millions of patients on opioids today do a lot more for Pharma's "health" than Pharma does for theirs.