No Opioid Painkillers Prescribed to Prince

By Pat Anson, Editor

Nearly a year after pop superstar Prince was found dead of an accidental drug overdose in his Minnesota home, we still don’t know where he obtained the fentanyl that killed him.

Court documents released today show that none of the opioid painkillers found in Prince’s home were prescribed to him. At least one opioid prescription bottle bore the name of Kirk Johnson, Prince’s former drummer and a longtime friend. Other opioid medications were found stashed throughout Prince’s Paisley Park home near Minneapolis.

“The controlled substances were not contained in typical prescription pill bottles, but rather, were stored in various other containers such as vitamin bottles. Bottles containing these controlled substances were located in multiple areas of the complex, including Prince’s Bedroom,” a search warrant said

“Investigators have been searching for the source of the controlled substances found in Prince’s residence. Through this investigation, interviews with those who were at Paisley Park the morning Prince was found deceased have provided inconsistent and, at times, contradictory statements.” 

Assistants to the entertainer told investigators that “Prince recently had a history of going through withdrawals” and they had arranged a meeting for him to meet with an addiction treatment specialist.

Prince was found dead in an elevator at his home on April 21, 2016 and speculation immediately focused on a possible opioid overdose. A medical examiner later reported that Prince died from an accidental overdose of fentanyl, but did not say where the drug came from.

Prince did not have a prescription for fentanyl, a potent synthetic opioid that is used in skin patches and lozenges to treat severe pain. Illicit fentanyl is widely sold on the black market, where it is often mixed with heroin or used to make counterfeit painkillers.

Prince died less than a week after his private plane made an emergency landing in Moline, Illinois, where paramedics reportedly treated him for an opioid overdose.

The Minneapolis Star Tribune reported last year that Prince weighed only 112 pounds at the time of his death and had so much fentanyl in his system that it would have killed anyone.

According to the newspaper, some of the pills found in Prince’s home were labeled as “Watson 853” – a stamp used to identify generic pills containing hydrocodone and acetaminophen that are sold under the brand name Lortab. When one of those pills was tested, it was found to contain fentanyl and lidocaine.

A week before he died, Dr. Michael Schulenberg wrote an oxycodone prescription for Prince under Johnson's name to protect the singer’s privacy, according to investigators.  But in a statement released today, Schulenberg's attorney denied prescribing opioids to Johnson or "any other person with the intent that they would be given to Prince."

The Star Tribune reported that investigators turned over the results of their investigation to the U.S. attorney’s office earlier this year.  No arrests have been made and no charges have been filed.

The Addict is Not Our Enemy

By Fred Kaeser, Guest Columnist

A number of people in chronic pain support the plight of those with addiction. Yet, over the past year and a half, I have read any number of derogatory statements and comments here on Pain News Network and on its corresponding Facebook page about people who are dealing and struggling with addiction.

Even a cursory review of the comment section on different articles will reveal rather quickly any number of folks who are dismissive of those dealing with addiction. Some express a real hatred.

One person actually suggested letting “all the druggies overdose, one by one.”

Another laments that “addicts can't die quick enough for me.”

Some express a sort of jealousy over addicts getting better treatment than they: “It's good to be an addict" and "Maybe I'd be better off being an addict.”

And then there are those who got all shook up over Prince's overdose, not so much from his death, but because it was linked to an opioid and that it might make it harder for them to obtain their own opioid medications.

And to think these comments come from the same people who beg others to better understand and accept their own need for better pain care!

It wasn't very long ago that the "drug addict" was scorned and forgotten: the druggie on the dark-lit street corner or the drunk in the back-alley. Pretty much neglected and left to fend for themselves.

But that started to change in the '70s and '80s, and nowadays the person suffering from addiction is recognized as someone who suffers from a very complex disease, is quite sick, and struggles to access the necessary care in order to recover. Societal attitudes towards those with an addiction now reflect empathy and a desire to help, as opposed to denunciation and dismissiveness.

We chronic pain patients are looking for the same acceptance and understanding that addicts were desperately seeking just a few short years ago. And that struggle took many, many decades, one might say centuries, to achieve. Our struggle is similar, and my guess is if we keep our eyes and focus on reasonable and rational argument, we too will achieve success in our struggle to obtain acceptable pain care and understanding.

But if some of us continue to see the enemy as the person who has an addiction, our fight for justice will suffer and be delayed.

Why? Because the addict is not very different from us.  Irrespective of the reason why a drug or substance user becomes addicted, the addict just wants to feel better, just like us. The addict is sick, just like us. The addict wants relief from pain, just like us. Perhaps not from physical pain, but emotional and psychic pain. The addict wants proper medication, just like us. The addict needs help and assistance, just like us.

And sometimes the pain patient is the addict. Sometimes we are one in the same. A recent review of 38 research reports pegs the addiction rate among chronic pain patients at 10 percent. From a genetic predisposition standpoint, we must presume that some addicts have become addicted just because of their genes, just like some of us.

No one with an addiction started out wanting to become addicted, just like none of us wanted chronic pain. And while our government is trying to figure out how to minimize the spread of opioid addiction, it is not the addict's fault as to how it has decided to that.

In many ways those suffering from addiction are not very different from us who suffer from chronic pain. We both struggle for acceptance, we both require empathy and understanding from the world around us, and we both require treatment and proper care to lead better and more productive lives.

But, I firmly believe that as long as there are those of us in chronic pain who feel compelled to ridicule and demean those who are addicted, that we will only delay our own quest to receive the empathy we so justly deserve in our journey towards adequate pain care.

Empathy breeds empathy, and if we expect it for ourselves, we must be willing to extend it to others. And that includes the addict. 

Fred Kaeser, Ed.D, is the former Director of Health for the NYC Public Schools. He suffers from osteoarthritis, stenosis, spondylosis and other chronic spinal problems.

Fred taught at New York University and is the author of What Your Child Needs to Know About Sex (and When): A Straight Talking Guide for Parents.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Counterfeit Pain Meds Found in Prince’s Home

By Pat Anson, Editor

Counterfeit pain medication laced with fentanyl was found in the home of the late pop star Prince, a source with knowledge of the investigation into the his death has told the Minneapolis Star Tribune.

Prince was found dead in his Paisley Park home on April 21 and speculation immediately focused on a possible opioid overdose. A medical examiner later reported that Prince died from an accidental overdose of fentanyl, but did not say where the drug came from.

Prince did not have a prescription for fentanyl, which is used in skin patches and lozenges to treat chronic pain. He died less than a week after his private plane made an emergency landing in Moline, Illinois, where paramedics reportedly treated him for an opioid overdose.

Recently, the Drug Enforcement Administration reported the U.S. was being “inundated” with hundreds of thousands of fake pills made with illicit fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine. Dozens of deaths have been blamed on the fake pills.

The Star Tribune’s source said Prince weighed only 112 pounds at the time of his death and had so much fentanyl in his system that it would have killed anyone.

Despite the finding, investigators still aren’t sure how the 57-year-old musician ingested the fentanyl. However, they are leaning toward the theory that he took fake pills disguised as hydrocodone, not knowing they contained fentanyl, according to the Star Tribune.

If so, that would make Prince the most high-profile victim of the fast growing fentanyl crisis. Several states in the Northeast and Midwest have recently reported that most of their fatal overdoses are now caused by illicit fentanyl, not opioid pain medication.

A source told the Associated Press that several pills found in Prince’s home were labeled as “Watson 385” – a stamp used to identify generic pills containing hydrocodone and acetaminophen sold under the brand name Lortab. When one of those pills was tested, it was found to contain fentanyl and lidocaine.

The Star Tribune reported that Prince was found in his home wearing a black shirt and pants — both were on backward — and his socks were inside-out. Prince appeared to have been dead for several hours before his body was found in an elevator.

In addition to fentanyl, sources told the newspaper that lidocaine, Percocet and alprazolam were found in Prince’s system. Alprazolam is the generic name for Xanax, an anti-anxiety medication. Counterfeit versions of Xanax made with fentanyl have also been blamed on several deaths.

“The counterfeit pills often closely resemble the authentic medications they were designed to mimic, and the presence of fentanyls is only detected upon laboratory analysis,” the DEA warned in an unclassified report last month.

“Fentanyls will continue to appear in counterfeit opioid medications and will likely appear in a variety of non-opiate drugs as traffickers seek to expand the market in search of higher profits. Overdoses and deaths from counterfeit drugs containing fentanyls will increase as users continue to inaccurately dose themselves with imitation medications.”

Two public health researchers recently speculated that a “malicious actor” may be intentionally poisoning people with counterfeit medication made with fentanyl. However, a DEA spokesman said that was unlikely.

“If you’re a drug trafficker, you don’t want to poison people. You want a regular customer base,” Rusty Payne said.

Fentanyl Blamed in Prince Overdose

By Pat Anson, Editor

A medical examiner has confirmed widespread speculation that opioids were involved in the accidental death of pop star Prince. The surprise was the type of opioid that was found in the singer's system.

“The decedent self-administered fentanyl,” Dr. A. Quinn Strobl, chief medical examiner for the Midwest Medical Examiner’s Office, wrote in his widely awaited report, which you can see by clicking here.

The report was released six weeks after Prince's death and only covered the manner and cause of death. All other information is considered private under Minnesota law.

The medical examiner’s report is likely to focus new attention on the so-called opioid abuse epidemic, which is routinely blamed on prescription opioids. Fentanyl is a potent opioid more powerful than morphine, and when prescribed the drug is generally only given to people in severe pain.

However, the report does not state whether the fentanyl that killed Prince was from a prescription or if it was illicit fentanyl obtained through other means.

Illicit fentanyl is an odorless white powder that is typically combined with heroin or cocaine to boost their potency. In recent months it has increasingly been found in counterfeit pain medication sold on the streets.  

Thousands of people have died from fentanyl overdoses in the U.S. and Canada, but because of the nature of the drug it’s impossible to tell whether it was prescribed legally and used for medical reasons or manufactured illegally and sold as a street drug.

“Toxicology tests used by coroners and medical examiners are unable to distinguish between prescription and illicit fentanyl. Based on reports from states and drug seizure data, however, a substantial portion of the increase in synthetic opioid deaths appears to be related to increased availability of illicit fentanyl,” said a recent report from the Centers for Disease Control and Prevention, which nevertheless still classifies all fentanyl overdoses as prescription drug deaths.

Massachusetts and Rhode Island recently reported a “significant increase” in fentanyl-related overdoses, with nearly 60% of the fatal overdoses in those states now attributed to fentanyl. Rhode Island health officials say the shift to fentanyl worsened when “more focused efforts were undertaken nationally to reduce the supply of prescription drugs.”  

Prince’s body was found in an elevator at his Paisley Park estate near Minneapolis on April 21. There was immediate speculation the singer was addicted to pain medication that he took for hip pain, but the only opioid ever mentioned was Percocet.  In the days before his death, Prince reportedly sought help from an addiction specialist in California.

The singer’s use of painkillers and how he obtained them are now the focus of a criminal investigation. No charges have been filed and a judge has sealed all records in the case.

According to search warrant that was accidentally released and obtained by the Los Angeles Times, Dr. Michael Todd Schulenberg, a family medicine practitioner, treated Prince on April 7 and 20, the day before his death.

Let’s Go Crazy: Lessons Learned From Prince

By Emily Ullrich, Columnist

As many call for Prince’s death to be a “wake up call” to America about the dangers of prescription drugs, I propose a different wake up call.

If the allegations are true, and Prince did die of an overdose, I propose that we use the messages that Prince preached and lived: messages of understanding and compassion. America needs to “wake up” to the oppression and depression that keep many chronic pain patients quiet about their conditions, and the reprehensible stigma with which this country punishes pain patients.

By now, many of us have read Lorraine Berry’s insightful piece, “Prince did not die from pain pills -- he died from chronic pain.” Perhaps the most poignant statement Berry made was, “Chronic pain kills. It killed Prince. It’s time to talk about it.”

We love to find flaws in celebrities, particularly those of a scandalous nature. Instead of finding compassion for a beloved icon, we are quick to turn our backs and make the pain of loss easier by falling prey to the judgmental “celebrity druggie” stereotype.

I propose that we pay tribute to Prince in a way I think he would have appreciated, by using this tragedy to start a conversation about the differences between addiction and dependence, about the commonality of chronic pain, and the deeply rooted prejudice associated with the disease of chronic pain.

But, I also propose we take it one step further, and affect change. We need not complain to each other endlessly about “us” (those who suffer chronic pain) and “them” (the healthy), and the great rift between. We have been doing that for years, and although it’s nice to know that someone else “gets it,” it is not other chronic pain sufferers who we need to understand our plight.

As much as we may not like to admit it, there are some similarities between addicts and chronic pain patients -- neither of us get the treatment or respect we need and deserve. We tend to be equally as judgmental of addicts, deeming them lower on the social hierarchy than us, in the same way as healthy people think of us to them.

I am not suggesting we continue to blur the lines between addiction and dependence, but I am suggesting we consider fighting this battle together.

There was a time when white people who sympathized with black civil rights activists were considered “almost as bad” as the “uppity blacks,” who demanded their well-deserved, long overdue rights to equality. Eventually, most people began to understand that treating people differently, as though they were not entitled to the same liberties, was intrinsically wrong. Many didn’t like it, but they had to abide by it. Understanding would only came later.

The same can be said about the lesbian, gay, bisexual and transgender community, and other groups that differ from what society considers “normal.” On many levels, these groups still struggle with inequities, just as we do, but they are making strides. And we must, too.

As it stands, the current political and social climate surrounding pain medication and chronic pain itself, not to mention addiction, have become civil rights issues. We no longer need to worry about gaining understanding, as much as we do defending our basic human rights. Although understanding is a part of the answer and a desirable outcome, sometimes people must be pressed to follow rules against discrimination. 

I was an outsider long before I was a chronic pain patient. I am a long–time artist, activist, outspoken woman, and all-around “weirdo” in many circles. But, I’ve never been ashamed of that. In fact, I’ve always taken pride in my one-of-a-kindness, having been voted “Most Unique” in my class of ‘93 at a conservative, rural high school.

To me, Prince always seemed a kindred spirit—emotional, passionate, creative, misunderstood. Now that I know he suffered chronic pain, and that he may have had double hip replacement, I find myself even more drawn to his spirit of individuality and strength. I find myself respecting him and relating to him on an entirely different level now.

His elusive, gentle, humane, kind, pained soul was not merely the cliché tortured soul of an artist, but also the tortured soul of a human being who must present a strong face, while holding back the physical and emotional pain, loneliness, and often hopelessness that all chronic pain patients can relate to.

In the name of Prince, I propose a revolution. The play on words is not accidental. Prince revolutionized music, fashion, art, gender and sexual perceptions, and more. He was for many of us the embodiment of our coming of age and understanding. Let us memorialize him in a way he would appreciate—by standing up for who we are, and by not being afraid or embarrassed of what people will think or say.

And like his band, The Revolution, let us stand with him, and make the world see that we will not be shamed, shunned, or disenfranchised, and that we will stand up for our rights and be prepared to explain and defend our cause -- life.

“Dearly beloved: We are gathered here today to get through this thing called life. Electric word, life. It means forever and that's a mighty long time.”

In Prince’s honor, let’s go crazy and do something unheard of. Understand each other and learn from this.

Emily Ullrich suffers from Complex Regional Pain Syndrome (CRPS), Sphincter of Oddi Dysfunction, Carpal Tunnel Syndrome, endometriosis,  Interstitial Cystitis, migraines, fibromyalgia, osteoarthritis, anxiety, insomnia, bursitis, depression, multiple chemical sensitivity, and chronic pancreatitis

Emily is a writer, artist, filmmaker, and has even been an occasional stand-up comedian. She now focuses on patient advocacy for the International Pain Foundation, as she is able.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Prince Sought Addiction Treatment Before Death

By Pat Anson, Editor

The late pop icon Prince was planning to meet with an addiction treatment doctor in the hours before he died in a last ditch effort to kick an addiction to opioid painkillers, according to the Minneapolis Star Tribune.

Howard Kornfeld, MD, an opioid addiction specialist in California, was called by Prince representatives the night of April 20 because Prince “was dealing with a grave medical emergency,” according to William Mauzy, a prominent Minneapolis attorney working with the Kornfeld family.

Prince’s body was found the next morning in an elevator at his Minneapolis home. An autopsy has been performed and the body cremated, but the official cause of death has not yet been released. Foul play or suicide are not suspected.

Kornfeld, who runs Recovery Without Walls, an upscale addiction treatment center in Mill Valley, California, is considered a pioneer in the use of buprenorphine to treat both addiction and chronic pain. The medication has long been sold under the brand name Suboxone, but is usually prescribed just to treat addiction.

Kornfeld was unable to meet with Prince immediately, but planned to fly to Minneapolis for “a lifesaving mission” on April 22. 

“The plan was to quickly evaluate his health and devise a treatment plan,” Mauzy told the Star Tribune, which said several other sources corroborated Mauzy’s account.

Kornfeld’s son Andrew took a red-eye flight to Minneapolis on the morning of April 21 to lay the groundwork for Prince’s treatment program with his father. He was one of three people at Prince’s Paisley Park compound when the entertainer's body was found.

Mauzy said Andrew Kornfeld was the one who called 911 because the others “were in too much shock.” Kornfeld did not know the address and could only tell the dispatcher, “We’re at Prince’s house.”

Paramedics arrived within five minutes but were unable to revive the 57-year old Prince.

Sources told the Star Tribune that painkillers were found at the scene and have become the focus of the investigation.  Investigators are trying to determine where Prince got the pills and who prescribed them.

Andrew Kornfeld reportedly had a small amount of buprenorphine to give to Prince, but it was never administered, according to Mauzy.

The Star Tribune story appears to add credence to reports in TMZ and other tabloids that Prince suffered from chronic hip pain and was addicted to opioid pain medication. Just days before his death, TMZ said Prince’s plane made an emergency landing in Moline, Illinois, where he was briefly hospitalized for an overdose of Percocet. He left against medical advice and flew back to Minneapolis a few hours later.

Prince Treated for Opioid Overdose Days Before Death

By Pat Anson, Editor

Pop icon Prince suffered from chronic pain and was treated for an opioid overdose just days before his death, according to tabloid reports.

Prince’s body was found Thursday in an elevator at his compound in Minneapolis. A cause of death has not yet been determined.

According to TMZ, Prince was treated at a hospital in Moline, Illinois last Friday when his private jet made an unscheduled landing after a concert in Atlanta. Initial reports were that Prince was treated at the hospital for the flu, but TMZ reported he may have needed emergency treatment for an overdose.

“Multiple sources in Moline tell us, Prince was rushed to a hospital and doctors gave him a ‘save shot’ ... typically administered to counteract the effects of an opiate,” TMZ said.

A “save shot” most likely means an injection of naloxone, a life-saving drug that quickly reverses the effects of an opiate overdoses.

TMZ later updated the story to say that Prince was actually given the injection by paramedics at a local airport and then taken to the hospital.

“Our sources further say doctors advised Prince to stay in the hospital for 24 hours. His people demanded a private room, and when they were told that wasn't possible ... Prince and co. decided to bail. The singer was released 3 hours after arriving and flew home,” TMZ said.

An autopsy was performed on the body of 57-year old entertainer this morning, but preliminary findings and a toxicology analysis could take days or weeks.

"As part of a complete exam, relevant information regarding Mr. Nelson's medical and social history will be gathered," the coroner said in a statement, referring to Prince as Rogers Nelson, his birth name. TMZ said authorities were trying to obtain Prince’s hospital records in Moline.

"We have no reason to believe it was suicide," said Carver County Sheriff Jim Olson, who also refused to address reports that Prince had overdosed last week.

"I'm not able to confirm that at this time at all," Olson said. "There have been so many rumors out that I've read about. I don't know if I can dispel all the rumors that are out there."

Prince reportedly suffered from hip problems for over a decade and needed a double-hip replacement. But as a devout Jehovah’s Witness, he would not have a blood transfusion, which made surgery nearly impossible.

“Prince has suffered for years,” a source told The National Enquirer in January. “It’s harder for him to get around.”

The Enquirer said years of strutting and dancing onstage had taken a toll on Prince’s joints and he may have suffered from severe osteoarthritis. 

“If he ignores the doctor’s advice, his walking will become impaired,” said Dr. Stuart Fischer, who did not treat Prince. “He’ll need a cane or a wheelchair for the rest of his life.”

Prince appeared hobbled and used a cane during the 2013 Grammy Awards, but in the past he has also used canes as a fashion accessory.

Prince was seen leaving a Walgreens pharmacy the night before his death. It was his fourth visit to the pharmacy this week. An employee there said he looked frail, according to TMZ.