Prince’s Death May Have Been Related to Opioid Addiction…
The news this week that Prince’s death may have been related to opioid addiction raised many important questions in the public dialogue. How could this happen to such a talented person with unlimited resources? Why did he apparently wait so long to seek medical treatment for his addiction? How could he hide his pain so well? How can people safely relieve pain? Why do doctors prescribe opiates?
I found the answer to these questions back in 1990, when I was a respected anesthesiologist and the founder and director of the USC Pain Management Department. Before college, I had served in the US Army and I fought in the Vietnam War, and after divorce became an addict. I self medicated with alcohol and drugs to treat PTSD. My addiction led to a domestic altercation I deeply regret, a criminal conviction, and the revocation of my medical license. I have been sober since that terrible day. In the years after being released from prison, I received a doctorate in drug counseling and developed an addiction treatment program called The Next Good Step. It took me almost 20 years to get my medical license reinstated by the Medical Board of California, following a five-year probation and almost 2 years of retraining. Now, I am again practicing medicine as a pain management and addiction medicine specialist.
Neither my story nor Prince’s story of addiction is uncommon. I see it every day at my Orange County clinic. According to the CDC, someone dies almost every 30 minutes in the United States from prescription opiate overdose, which is more than the amount of people who OD from cocaine and heroin combined. Why do physicians keep prescribing and overprescribing opiates?
The answer is complicated, but last month the CDC published a wonderful document that provides an answer and a roadmap to defeat the opiate epidemic, which needs to be publicized and followed.
Let’s start with the terminology. Pain is an unpleasant sensory or emotional experience described in terms of actual or perceived physical damage. This is why a divorce’s broken heart and water boarding hurt. Suffering from pain should be relieved, but treatment should focus on the cause of pain. Opiates are in fact excellent, and the standard of care, to prevent suffering from pain caused by some underlying problem. But opiates do not fix the problem. This is where things get tricky.
Although prescriptions are the standard of care to prevent suffering from pain, medications must be taken properly. No script will kill a patient, if used as directed. Patients who overdose do so because they are not following directions. Once the patient, and phsyician, determine the daily amount of opiate needed to prevent the patient suffering from pain, if they find a time where they are suffering when they have already reached their daily opiate allotment, they need to go to the ER to make sure nothing else has gone wrong. This is one way physicians can follow the progress of the underlying problem. Because pain is not static, it varies hourly; opiates should be taken on a sliding scale to match the pain, with a maximum built in. If a patient uses all their tools to treat pain, for most patients, there should be days where opiates are not needed at all. This is why the CDC’s Opiate Guidelines also recommended not using extended release opiates. If we prescribe opiates appropriately, they are an excellent way to prevent suffering while minimizing the risk of overdose and physical dependence. They are great medications with few side effects, when taken as directed.
The goal of pain management is to identify and provide a diagnosis, prognosis, and treatment plan within three months of the injury. Why three months? Mother Nature and a little rest will heal most injuries within 3 months. When the pain lasts longer than 3 months anatomical changes begin in the brain that intensifies the perception of pain. Now the patient is a chronic pain patient and, by definition, faced with a long term, if not lifelong, pain problem. If pain does not decrease on its own within a few weeks, then a team of health care providers should enter the picture and complete a total mind and body assessment.
Overlaying this complex scenario are drug tolerance; over time our bodies need more opiates for the same pain relief, undiagnosed and untreated psychiatric conditions, depression, and unscrupulous physicians. The CDC again has answers. Refer treatment of pain to an integrated multidisciplinary pain management clinic, where the patient will receive non-opiate medications, physical therapy, indicated injections, behavioral therapy, and opiates. We need to embrace the multimodal approach already provided by medical, behavioral, and physical therapies. Treat the Mind AND the Body, so you can prevent chronic pain and suffering.
Medicine is a beautiful thing, and my life’s devotion. But, let us engage in its proper practice.
About the Author:
Robert Kutzner, M.D. is an Addiction Medicine & Pain Management Physician at MD Health Clinics located in Orange County, California.