We recently learned that the unexpected death of musician Tom Petty last October resulted from an accidental overdose with opioid medications used to treat severe pain related to a broken hip and other problems.

According to news reports, found in his system were:

  • fentanyl: Now the most widely used synthetic opioid in medicine.
  • oxycodone:¬†Another opioid used for moderately severe pain. Sold under the trade name Oxycontin, among others.
  • temazepam: A benzodiazepine sedative, used for sleep, anxiety. Trade names Restoril, etc.
  • alprazolam: Another benzo; trade names include Xanax
  • citalopram: An antidepressant. Trade names include Celexa
  • acetylfentanyl: A “designer” opioid, not currently licensed for medical use. Sold illicitly.
  • despropionyl fentanyl: Yet another designer opioid.

So we have four opioids– two legal, two likely not– plus two benzos and a popular antidepressant, all present in Petty’s system at time of death. The family asserts that Petty had no history of drug abuse, and the medications were used solely for the treatment of severe orthopedic pain. Some questions that popped up in my mind:

  1. Who wrote all these prescriptions? A single physician, or several?

  2. If multiple prescribers were involved, were they aware of all the medications the patient was taking, and how much and how often?

  3. If the last drugs on the list — the fentanyl analogs — weren’t prescribed, then where did the patient get them? And why? especially in view of the risks.

  4. Why was he using two different benzos at the same time?

  5. What was the purpose of the antidepressant? In view of all the depressant medications he was using, how effective could it have been? SSRIs carry their own risks, after all, especially in combination with the others.

This appears to be a classic case of polypharmacy, or simultaneous use of multiple drugs by a single patient, for one or more problems. The hazards of same are well known. Still, most physicians have been trained in managing cases where multiple meds are involved. So, what went awry in this case?

Hard to believe a celebrity like Tom Petty lacked the resources for top-quality medical care. Presumably, other factors were in play.

Also, did he have control over his own meds? For instance, were they in his medicine cabinet, or stuffed in a drawer next to his bed? Did Petty self-administer his own medications?

When someone’s taking a number of strong drugs on a regular basis, particularly depressants, it’s easy to lose track. Patients miscount, mix up dose times and amounts, or take extra doses or the wrong medication entirely. Any of those factors in play here?

By the way, I believe those two fentanyl analogs have already figured in unintended fatalities. Perhaps they did the job all by themselves. Which brings us back to the question of how they got into the mix. And why.

This incident, like the death of Prince last year, isn’t so much a result of the current opioid epidemic, as it is more evidence of a problem in medical care that began long before I ever entered the field in the ’70’s. The drugs have changed, but the outcome hasn’t. Another unnecessary death.

And in that respect, things remain the same at the top and the bottom of the socioeconomic scale.