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Prince’s fentanyl overdose gives new urgency to opioid epidemic

The opioid epidemic sweeping the nation once more took center stage after law enforcement officials revealed that music icon Prince’s death in April was due to an accidental overdose of fentanyl, a synthetic opioid far stronger than morphine. Hari Sreenivasan talks to Sharon Stancliff of the Harm Reduction Coalition for more on how we can reduce opioid fatalities with better addiction treatment.

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  • HARI SREENIVASAN:

    But first: the opioid epidemic and the problems of treatment.

    Law enforcement officials told the Associated Press and The Minneapolis Star-Tribune today that music legend Prince died from an accidental opioid overdose in April. The superstar, according to reports, self-administered fentanyl, a synthetic opioid painkiller much stronger than morphine.

    It's also been reported that Prince had an earlier overdose, and was then revived with a dose of a drug called Narcan. That treatment, and Prince's later attempt to get help from an addiction specialist, have cast a spotlight on the question of treatment for addiction.

    Here to discuss this with us is Dr. Sharon Stancliff, medical director of the Harm Reduction Coalition, a national organization focusing on advocacy and the health care of those struggling with drug use.

    Doctor, when you hear fentanyl, a fairly strong drug in all the classes of drugs, what does that make you think of what Prince was going through?

  • DR. SHARON STANCLIFF, Medical Director, Harm Reduction Coalition:

    Well, I understand Prince had a chronic pain problem, and fentanyl is often prescribed either as a patch or preparations that dissolve in the mouth for chronic pain.

    We don't know if he had a prescription for that, but that's extremely likely. We also are hearing a lot about fentanyl in the news because there is illicitly manufactured fentanyl found in many parts of the country either mixed into heroin or sold as heroin.

    So, we're hearing about a lot of fentanyl overdoses. They could be from pain management or they could be from illicit preparations.

  • HARI SREENIVASAN:

    When you see these stories and hear about these stories across the country, we're seeing, we're hearing more about people who get addicted while they're being treated for chronic pain.

  • DR. SHARON STANCLIFF:

    Right.

    Well, anyone who takes an opioid on a repeated basis daily will become dependent upon the opioid. Many people will be able to, when the pain stops, taper off of the opioid and go on as though nothing had happened.

    Others find that it's really hard to taper off, and once tapered off, they continue to have craving for that — an opioid for weeks, months, even years, and so that's why we have a variety of medications to treat opioid addiction or opioid use disorders.

  • HARI SREENIVASAN:

    One of the things that people also wonder about is now there are more first-responders that have Narcan in the ambulances and there are different facilities that have Narcan.

    One of the concerns with the use of the drug is that sometimes this almost gives someone an insurance policy and it doesn't necessarily hit home how close to death they came with an overdose when they were seemingly miraculously pulled out from it.

  • DR. SHARON STANCLIFF:

    Well, the other choice might be death in many cases, so we need that perspective.

  • HARI SREENIVASAN:

    Yes.

  • DR. SHARON STANCLIFF:

    But also getting Narcan, or naloxone, when you are actually opioid-dependent is an extremely unpleasant event.

    I have heard one person described it as only slightly better than death. Someone goes from completely relaxed, unaware of their surroundings, to being in mild to moderate, even severe withdrawal. So there's very, very few people out there, if any — there's somebody in every bucket, I suppose — that would use naloxone as a safety net in the field.

    And, yes, when people are brought back from an overdose, whether they are brought back by the hospital or the ambulance services which have long carried it or by fellow drug users or family members, they kind of miss the horrifying experience that — the person that thought they were going to die that really had the intense experience.

    They just wake up feeling really awful. That being said, that moment or the next day is a good time to approach people and talk to them about what just happened and maybe see what kind of care or drug treatment that they can get.

  • HARI SREENIVASAN:

    We have in medicine established a set of protocols that say, if you have a heart attack, here's what we're going to do, here's the regimen that we're going to put you on, here's how you change your diet, here's how you add your exercise. What do we do when it comes to drug overdoses?

  • DR. SHARON STANCLIFF:

    If it is somebody that has actually an opioid use disorder, that they're using elicit opioids or getting opioids prescriptions outside of prescriptions, then we need to treat them for opioid use disorder.

    And the best treatments for that actually are giving them medicine on a regular basis. We have had methadone in methadone clinics for many years, and it has saved many lives, prevented many overdoses. And now we have a medication called buprenorphine, which has several trade names. It's commonly known as Suboxone.

  • HARI SREENIVASAN:

    Even with the amount of attention that opioid abuse has gotten in the past couple of years, do you think that we have an understanding, a perspective of the scale of this problem in America right now?

  • DR. SHARON STANCLIFF:

    I think some parts of the country are very much aware of it.

    In Erie County, they're having so many deaths. In Massachusetts, they're having so many deaths. But I don't think that there is enough of an investment on the parts of the governments, both in funding and in educating the public about the importance of medication as part of the treatment.

    We seem to still sort of function under this mythology that most people can do fine if they simply go into a detox or a 28-day rehab and they will come out and they will be fine. That's true for some number of people, but many people, once you have had a few relapses, it really needs to become a medicalized treatment, maybe with some counseling or maybe not.

    But I think we need both the funding and the impetus put into educating people about it.

  • HARI SREENIVASAN:

    Dr. Sharon Stancliff of the Harm Reduction Coalition, thanks for joining us.

  • DR. SHARON STANCLIFF:

    Thank you very much for having me.

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