The pop superstar Prince may have lived an outsize life, but emerging details about his long struggle with pain and reliance on opioids will resonate with thousands of patients who have stumbled down that well-trod path. It is a remarkably common narrative in the unfolding story of the nation’s opioid epidemic.
Many details have yet to be confirmed about Prince’s case, but a typical trajectory can go something like this. A patient undergoes a procedure to address a medical issue – extracted wisdom teeth for example, or, as Prince did, orthopedic surgery. To help the patient get through recovery, a dentist or surgeon writes a prescription for opioid painkillers, like Percocet or Vicodin.
Procedure over; problem addressed.
But that prescription may not be written judiciously.
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“Opioids may be required after a procedure for a few days, but sometimes physicians practice sloppy prescribing habits and they give patients much more than they need,” said Dr. Patrick G. O’Connor, a professor of medicine at Yale School of Medicine and a past president of the American Board of Addiction Medicine. “And the more patients take, the more likely they are to become dependent.”
After a follow-up visit or two, the specialist who did the procedure has no reason to continue seeing the patient. (That doctor could also be an emergency room physician who treated kidney stones, sciatica or any number of other conditions involving stabbing pain.)
Yet the patient’s pain may persist, demanding to be tamed. The patient, who now knows just how effective these drugs are, wants to refill the prescription.
“The default approach is you go to your primary care provider, and they’ll take care of it,” said Dr. Jonathan H. Chen, an instructor at the Stanford University School of Medicine, who has researched the distribution of opioid prescriptions.
As he spoke during a break in his shift in a same-day urgent care clinic, he had just attended to a patient who had recently had shoulder surgery but said she was still in pain.
“I have to figure out how to manage that pain,” he said. “It would be easier to continue the pain medication she is on.”
Has the acute pain now become chronic? And have the opioids created a pleasant, dulling sensation that itself has become desirable?
Though their introduction to opioids had a legitimate foundation, certain vulnerable patients may now be set on a path that could end in dependence, or addiction.
According to one study of older patients, those who received an opioid prescription within a week after low-risk surgery were 44 percent more likely to become long-term users of opioids within a year than patients who were not given such prescriptions.
Evidence has been mounting that suggests that Prince started taking medications for hip pain and became dependent on them. About 10 years ago he had hip surgery to ease the toll that decades of physically strenuous performances, including spectacular splits, had exacted on his small frame.
At first glance, Prince did not appear to have the risk factors that addiction specialists have identified in many patients susceptible to opioid dependence, which can include abuse of alcohol or other drugs, mental health challenges or a family history of substance abuse. Indeed, much has been made of Prince’s abstinence from drugs and alcohol.
But some experts say the potency of these painkillers, and the very real effect of pain on a patient’s life, can send someone with no history of substance issues down a path toward addiction.
“These are still powerful drugs that can affect many people’s lives,” Chen said.
According to the Centers for Disease Control and Prevention, opioids, which include prescription pain relievers and heroin, killed more than 28,000 people in 2014. The National Survey on Drug Use and Health said 4.3 million people were using pain relievers for nonmedical purposes that year.
O’Connor said that if patients continued to have pain after a procedure, they should be reassessed.
“Throwing more pain medication at it isn’t necessarily the answer,” he said.