Was it really pain, not opioids, that killed Prince? That’s an argument being advanced in the media– it’s an epidemic of pain, ‘criminally’ undertreated, that we have to address– not the medications themselves.

This is not a new argument. We heard it a lot a couple decades back, from advocates for stronger opioids to treat chronic pain. It was persuasive. Of course, at that time we weren’t as aware of the risks (and their consequences) that would follow.

About Prince:  We don’t actually know much about his death as of this writing, other than it was officially attributed to unintentional overdose on opioids. We’ve read that he was a long-time prescription opiate user who suffered from hip and other pain. Somehow he apparently moved on to fentanyl, a medication notorious for overdose risk. We don’t know how recently that happened, or whether the fentanyl was prescribed by a physician or obtained by other means. We know little about his mental state at the time of the OD, other than he’d apparently been staying up very late and working.

But we do know, because that’s been confirmed, that the opioids were responsible for his death. As tired or sleep-deprived or in pain as he might have been that night, if he hadn’t taken the drugs, would he still be alive? According to medical evidence, yes. He could have sought more intensive treatment, or help for a drug problem. He was in the Twin Cities, which is Ground Central for that sort of thing.

But fentanyl took away the choice– apparently while help was on the way.

It could be that, like so many patients, he’d used it in the past with apparent success. Overdose can be unpredictable. Also, we’re assuming he knew it was fentanyl, because sometimes users don’t– it comes disguised as something else– Vicodin for instance.

By the way, I was surprised to discover that Americans consume 99% of the world’s hydrocodone.  Somehow that seems unfair. Don’t other countries need some? Don’t they have pain to alleviate?

We don’t want to fall into the trap of focusing on the underlying problems and neglecting the obvious. That’s what  defense attorneys do when they argue for their clients on the basis of an unhappy childhood (or in that one notable case, “affluenza”).  It’s tempting to blame Prince’s pain on dancing in high heels, or on being only 5’2″ tall, which is probably what motivated him to wear them in the first place. All contributors, and yet…

Without that dose of fentanyl, he’s still breathing.