Don't Be So Quick to Judge Prince

Photo credit: youneedit-music.blogspot

It is easy to snicker when someone who is far richer, better looking, and more famous than you'll ever be gets into trouble because of a self-indulgent lifestyle, too much money, or perhaps just stupidity.

"Trouble" can take many forms, but more often than not, it appears as substance abuse.

But, there is a huge difference between the kind of trouble that arises from recreational drug or alcohol use, and addiction to drugs that were originally prescribed for a legitimate medical reason. Here we are in 2016, and there remains a huge, unmet medical need — pain.

Although final results on Prince's death have not yet been revealed, it is likely that narcotics were involved. The singer/dancer/musician had been suffering for years from chronic pain from performing, and it was reported that after the emergency landing of his plane in Illinois days before his death, that Narcan — an antidote for opioid overdoses —was administered.

Don't be so quick to trivialize or judge Prince's presumed opioid addiction as a character flaw. Here's why.

To illustrate how little pharmacological progress has been made in the area of pain management, one needs to go back to the late 19th century.

The photograph above and the story behind it is very telling, and somewhat ironic. Heroin, which got its name from the German word "heroisch" meaning heroic, was intended to be a less-addictive alternative to morphine, whose addictive power had taken an enormous toll on society since it was first isolated in the early 1800s. Surely, this 1871 description of morphine addiction, which was written by a physician in Victorian England must rank among the most poetic:

[Opiate] addiction “among women in high places is incredibly large” [and the typical addict is] “the lady of haut-ton, idly lolling upon her velvety fauteuil and vainly trying to cheat the lagging hours that intervene ere the ‘clockwork tintinnabulum’ shall sound the hour for opera or whist, the quasi-lady of the demi-monde as well.”

The heroin idea didn't work out too well, but in fairness to scientists 117 years ago, not much else has since. Instead of the opioid heroin, other opioids like hydrocodone (Vicodin), and oxycodone (Percocet) are the "go to" medicines for moderate to severe pain. For less severe pain, non-steroidal antiinflammatory drugs (NSAIDs) are widely used. Advil (ibuprofen) and Aleve (naproxen), formerly prescription drugs are now available over the counter, where they are consumed in massive quantities.

Since the beginning of the 20th century, medical breakthroughs (e.g., antibiotics, insulin, vaccines, chemotherapy, organ transplantation, AIDS drugs, etc.) have completely transformed human health, but the same two classes of drugs that were used in 1899 remain the primary therapies for treating pain(1).

But both of these classes have a significant downside: addiction and overdose potential with opioids, and gastrointestinal and bleeding problems with NSAIDs. This is truly a case of "pick your poison." There are simply no good medicines available to treat chronic pain.

It is unfair to find fault with people who have needed these very imperfect drugs only to fall victim to them later on.

NOTE:

(1) Other classes of drugs have been used with varying success for treatment of chronic pain. The properties and utility of some of these are given in the table below.