Justice

Prince's Death Highlights a Debate Within the Drug Treatment Community

June 2nd 2016

By:
Alex Mierjeski

On Thursday, a Minnesota medical examiner reported that Prince's death in April was linked to an accidental overdose of the powerful opioid painkiller, fentanyl.

prince

The singer's death has already spurred discussion about America's opioid addiction epidemic, which includes drugs like heroin, as well as prescription painkillers such as Oxycodone, Vicodin, and Percocet. But it has also highlighted a troubling lack of adequate treatment for addicts — a systemic failure that, in many cases, can lead to deadly overdoses.

Shortly before his death, Prince was administered the overdose-reversal drug Naloxone after overdosing on Percocet. But like many other non-fatal overdose patients, he was subsequently released from the hospital.

Naloxone, law enforcement and health officials say, is a wonder drug that can bring overdose victims back from death's edge. But its effects wear off within 90 minutes, leaving addicts susceptible to using again — and to using too much.

It's a predicament that has experts at a loss over how to manage patients navigating life after an overdose.

Painkillers

"By and large, most hospital and other emergency care settings do not have a protocol to make sure that the person who shows up with a non-fatal overdose is offered the kind of resources that can encourage them to enter treatment," or given tools that might otherwise mitigate future, fatal drug use, Leo Beletsky, associate professor of law and health sciences at Northeastern University School of Law, told ATTN:.

Opioid overdoses have seen staggering increases in recent decades, with prescription painkillers standing out; in 2014, more than 14,000 fatal overdoses were reported — nearly quadruple the amount in 1999, according to the Centers for Disease Control. But across the country, health care and addiction treatment providers have struggled to find a comprehensive strategy to address the crisis.

"There are varying degrees of piecemeal resources that are available, but by no means is there a comprehensive, best-practices approach," Beletsky said. "That's extremely rare."

To fill the void of treatment options, some have proposed methods that experts say take the wrong approach.

One of these treatment methods is expanding what's known as coercive treatment.

opioids

Some states have proposed expanding the ability of hospitals to hold addicts against their will, and impose mandatory addiction treatment if they pose harm to themselves or others, as one provision of a recent bill in Massachusetts allowed. (That provision, which included a three-day holding period, did not make it to the final law.)

The idea is that forcing a patient into treatment will, by virtue of them being held in one place for longer than they might otherwise be there, ultimately could coerce them into addressing their drug use problem. And while retention rates might be better in some compelled settings, it's less clear whether the method is effective in the long run. Research suggests, for example, that treatment forced upon individuals is less likely to stick than programs sought out voluntarily.

drug-syringe

The challenge, according to Beletsky, is that the infrastructure to support coercive treatment isn't even in place to begin with.

"The idea that the problem right now is in the inadequate authorization or legal tools to hold people down when they show up with an overdose so that they can receive care is really misguided. We don't have the services, the capacity, or the expertise right now to provide them even with voluntary services," he said.

One promising addiction treatment option is a controversial drug called Suboxone.

Suboxone

Suboxone, which helps soften cravings, outpaces methadone as an addiction treatment drug, The Washington Post reported. It also has a lower risk of overdose and abuse, but it's still difficult to get. For the few doctors who are licensed to prescribe it, each is allowed to treat up to only 100 patients with Suboxone, according to The Post.

Critics resist efforts to expand access to the drug, since it commands a street price, and can be fatal if mixed with other substances. Others also say that because patients can take Suboxone themselves at home, they are more at risk for abusing the drug.

Those concerns are certainly legitimate, but they run the risk of encouraging older abstinence-based drug abuse prevention strategies, FastCompany notes, which have not necessarily delivered on their promises — especially in the case of opioids.

In cases like Prince's, some have speculated that a drug like Suboxone — which patients can use to both help reduce their substance addiction, and safely take in prescribed doses — might have changed the outcome. But while access is still limited, experts say other, deeper problems still exist.

"We don't have a patient limit for anything else we do," Darius Rastegar, one of five Johns Hopkins Bayview Medical Center doctors that can prescribe Suboxone, told The Post. "I can prescribe oxycodone to a thousand patients."