Prince Missed Suboxone Lifeboat by 12 Hours

One of the links from this page connects to the ‘OD Report‘.  I set up the connection to highlight the epidemic of overdose deaths, not to sensationalize the issue.  But the Prince story is sensational and tragic at the same time. And the connection to buprenorphine only magnifies the tragic circumstances that are wrapped around the use of a potentially-life-saving medication.

I read some time ago about Prince’s chronic pain problems, primarily involving his hips and secondary to years of dancing in high-heeled shoes.  Shortly after his death, TMZ reported that Prince’s plane made an emergency stop in Moline Illinois on his way home from Atlanta.  They reported that he received Narcan at the airport after landing, and then was treated and released at the hospital before flying home to Minneapolis.  TMZ later reported that Prince was taking large amounts of prescription opioids that contributed to his death.

The OD Report contains newsfeeds about opioid overdose.  An article published today describes the circumstances surrounding the discovery of Prince’s body by Andrw Kornfeld, the son of an addiction doc from Mill Valley, California.   According to the article, an emergency addiction treatment plan was arranged with a program called ‘Recovery Without Walls’ based in Mill Valley, California.   The physician who founded and medically directs that program, Dr. Howard Kornfeld, was not able to make it to Prince and instead sent his son, Andrew Kornfeld, a premed student who worked as a ‘spokesman’ for Recovery Without Walls.

Here is where it gets interesting…  Andrew Kornfeld travelled to Prince’s home with a small supply of buprenorphine.  The intent of the people involved cannot be known, of course, but one could surmise that the buprenorphine was provided in order to get Prince started on the medication.  Andrew Kornfeld was the person who reportedly called 911 after he arrived at Paisley Park, prompting security personel to summon the singer and eventually find his body in an elevator.

Putting aside for a moment the legal and ethical lapses of a premed student delivering buprenorphine to a person in another state. one thing is clear:  Had Prince taken the two tablets of buprenorphine found with Andrew Kornfeld, he would never have died from opioids– unless, at some point, he decided to stop taking the medication.  If you have trouble believing that simple fact, then I suggest you do some more research about buprenorphine treatment.  You’ll find that while 30,000 people die each year from opioids without buprenorphine in their bloodstream, only 40 die with buprenorphine in their system– and almost all of those people died from other agonists, and would have lived if more buprenorphine was present.

It is almost impossible to die from opioids if a person is taking buprenorphine or the combination drug, buprenorphine/naloxone.

I don’t know how the media will interpret the story, or who society will hold at fault.  From my perspective, the story is tragic in how predictable things played out.  Prince had the resources to determine the truth about opioid dependence– i.e. that abstinence-based programs rarely work, especially for patients with chronic pain.  He likely learned that his options included 1. a stay in rehab, including a painful withdrawal, followed by a high risk of relapse, or 2. finding a doctor to treat his chronic pain and opioid dependence using buprenorphine or a buprenorphine/naloxone combination medication (as they are essentially identical), which would almost immediately place his ‘opioid problem’ in remission.   It is not clear how much of his problem was ‘addiction’, and how much was ‘pain treatment plus tolerance.’  The difference between the two conditions is often in the eye of the diagnosing physician.  But the good news for such patients is that is doesn’t really matter.  Buprenorphine products provide almost immediate resolution for pain patients tolerant to opioid agonists, removing cravings and providing relief from withdrawal.

In a sane world, Prince would have called the doctor down the street to get started on buprenorphine immediately.  But doctors who prescribe the medication are hard to find, and the few doctors who do prescribe the medication are stuck at the 100-patient cap, waiting for President Obama to make good on his promise to change the rules so that more people can be treated.

Instead, the 100-patient limit remains in place– and patients desperate for help search throughout the country for doctors with openings.  I myself receive several emails and calls every single day from people across the country who are begging for help.  I tell them the same thing I would have told Prince:  I’m stuck at the cap.  I wish I could help.