You’ve probably heard by now that a medical examiner has determined Prince, the musical superstar, died of a fentanyl overdose.

While other opioids get more attention, fentanyl is the stealth bomb for abusers.

Fact About Fentanyl

Fentanyl is 100 times more dangerous than morphine. The dose at which fentanyl produces the pain relief that users require, and the euphoria that drug abusers seek, occurs quickly and at low doses.

However, the dose required to stop a person’s breathing is only a little bit more than the amount users need to get relief from their pain or to get high.

We call the difference between the onset of analgesia or high and the toxicity (potentially leading to death) that follows it the “therapeutic window.”

Fentanyl has a very narrow therapeutic window, which is why it is often lethal when taken other than the way in which it is prescribed. It is far more lethal than heroin, and — as we all should know by now — heroin is extremely dangerous and life threatening.

All drugs should only be used as prescribed, but some drugs are more dangerous than others. Fentanyl may be the most dangerous of all the opioids that are available in our communities.

Fentanyl can be pharmaceutical grade, or it can be manufactured under dubious circumstances inside or outside of the U.S., and then illegally trafficked to potential abusers.

Fentanyl Reporting Issues

There’s no easy way to know the source, but fentanyl is considered a prescription painkiller when it is found in a deceased person’s body. CDC then reports these overdose deaths as due to prescription painkillers, even if the painkiller in question was manufactured outside of FDA controls.

Of course, the implication of this type of reporting is that too many opioids are being prescribed and, therefore, we need to do something about the amount of opioids prescribed.

As a result, regulators will react, which means people in pain who seem to benefit from opioids will find it increasingly more difficult. This will partly be because of the inaccurate reporting of overdose deaths (again, if the medical examiner finds painkillers such as fentanyl, there will be no distinction made between a drug that was produced by Pharma and one that was made illegally).

This is only one way the data from the CDC can be misleading. To prevent further misinterpretation of reports that describe the cause of overdose deaths, we need more information about each overdose death.

Important Questions About Fentanyl and Prince’s Tragic Death

Prince’s tragic death should lead to important questions that need to be answered to avoid misinterpretation about his cause of death. These questions would include:

• Was Prince’s death due to prescription fentanyl, cartel manufactured fentanyl, or a combination of both?
• If his death was due to prescription fentanyl, was it prescribed, or did Prince (or someone who works for him) obtain the drug illegally?
• How did Prince obtain the fentanyl, anyway? If it wasn’t prescribed, what led him to that drug and why?
• If fentanyl was prescribed, was it taken as directed or not?
• Since fentanyl is so dangerous that taking it requires medical supervision, who was the doctor who was in charge of ensuring that the patient was using the medication appropriately? Or was there a doctor involved at all?
• Were other drugs on board that could have contributed to his death? Was fentanyl actually the cause of death (as the media is reporting), a contributing factor to the death, or just present at time of death?
• It’s been reported that Prince suffered from hip pain, and that may be why he was using fentanyl. But, if that’s the case — why fentanyl? Why not a less dangerous opioid or another painkiller that could be used somewhat more safely?
• Was Prince offered alternative therapies for pain?

It is unlikely anyone will ask all these questions. The fact that we don’t know the answers to these questions is why we don’t understand the problem with opioids in the U.S.

We must ask these critical questions with every overdose. It is necessary to know why each overdose occurs so we can develop appropriate interventions and public health solutions without causing unintended harm to those who are in pain and who seem to need opioids because there are no effective alternatives.

Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD