It's official: Prince died of an overdose from opioid painkillers, becoming the latest high-profile victim of America's opioid epidemic.
Prince had been reportedly trying to check in to drug abuse treatment but couldn't get an appointment before he died. As my colleague Julia Belluz reported, that even a rich celebrity couldn't access care in time demonstrates how difficult it can be to get into treatment. According to 2014 federal data, at least 89 percent of people who met the definition for a drug abuse disorder didn't get treatment. Patients with drug abuse disorders also often complain of weeks- or months-long waiting periods for care.
The news of Prince's overdose is absolutely tragic, but it's also an issue that Americans are becoming more and more aware of. According to a Kaiser Family Foundation survey, one in five Americans has a family member who's addicted to prescription painkillers, and more than four in 10 Americans personally know someone who's addicted. And in 2014, overdose deaths reached a record high, because of the increase in opioid deaths.
The opioid painkiller epidemic goes back to the 1990s
Back in the 1990s, doctors believed — and many still do — in the need to treat pain as a serious medical issue. There's a good reason for that: About 100 million US adults suffer from chronic pain, according to a 2011 report from the Institute of Medicine.
Pharmaceutical companies took advantage of this concern. Through a big marketing campaign for doctors and by backing advocacy groups, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is fairly weak, although the drugs are effective for acute, short-term pain. The drugs proliferated, landing in the hands not just of patients but also teens rummaging through their parents' medicine cabinets, other family members and friends of patients, and the black market.
As a result, opioid painkiller deaths skyrocketed. In 2014, nearly 19,000 Americans died from overdoses linked to opioid painkillers — sometimes opioids alone, other times involving other drugs like alcohol and benzodiazepines, which are typically prescribed to relieve anxiety.
Seeing the rise in opioid abuse and deaths, doctors, clinics, and governments began to crack down on prescriptions for painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.
Ideally, doctors should still be able to get painkillers to the many patients who truly need them — after, for example, evaluating whether the patient has a history of drug abuse. But doctors who weren't conducting even such basic checks are being told — not just through the crackdown but by health care organizations and public education campaigns — to give more thought to their prescriptions.
But many people who lost access to painkillers were still addicted, so they looked for other ways to satisfy their habit. So some who could no longer access prescribed painkillers — or perhaps could no longer afford them — turned to a cheaper, more potent opioid, heroin. Not all painkiller users went this way, and not all heroin users started with painkillers, but statistics suggest many did: A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 CDC analysis found people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.
So heroin abuse increased, and so did overdoses: In 2014, more than 10,000 deaths in the US were linked to heroin.
That doesn't mean cracking down on painkillers was a mistake. It appeared to slow the rising number of painkiller deaths, and may have prevented doctors from prescribing the drugs to new generations of potential addicts. So the crackdown did lead to more heroin deaths, but it will hopefully prevent future populations of drug abusers, which could have suffered even more overdose deaths.
But ultimately, the likely solution is to get opioid addicts into treatment to ensure they don't resort to even more dangerous drugs if painkillers are restricted. So the Obama administration, for one, is asking for more funding for treatment programs, including medication-assisted treatment like methadone and Suboxone. Some states have also talked up treatment programs, although others, like Louisiana and Indiana, have taken a "tough-on-crime" approach that focuses on incarcerating drug traffickers.
Whatever the approach, based on Kaiser's polling, most Americans don't believe that the government is doing enough — and many of them are being personally affected.