Circumstances Surrounding Prince’s Death Remain Speculative

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Prince Died of Fentanyl Overdose (posted on PPM, June 2, 2016)

Right after news of Prince’s autopsy report became public last week, I spoke to Practical Pain Managagement about fentanyl risks and benefits. Since then I’ve had several queries from blog followers to post comments of the PainDr.com Blog.  Below is a small portion of the entire article which PPM graciously allowed me to include below.  To read the whole story, click here.

Since his death, news coverage has speculated about what caused Prince to collapse in his home. The speculation ended today when the Midwest Medical Examiner’s Office in Ramsey, Minnesota, confirmed that his death was caused by an overdose of self-administered fentanyl.

The performer and musician was found on April 21, 2016, unresponsive in an elevator in Paisley Park, his home and recording studio. According to the New York Times, Prince, 57, was preparing to enroll in an opioid treatment program presumably to treat an opioid use disorder.

What We Do Know

According to Dr. Fudin, fentanyl is notorious for redistributing from body tissues into the blood stream making the post-mortem levels appear significantly higher than they actually were at the time of death. Also, patients metabolize drugs differently and without an antemortem level for comparison, victims of opioid overdose are frequently mislabeled.

This one is especially for those that asked to comment, so please read the entire article on PPM and chime in here!

And for more on Prince, see Dr. Webster’s guest re-post here from April 24th, Prince and Why We Need More Compassion About Addiction.

6 thoughts on “Circumstances Surrounding Prince’s Death Remain Speculative

  1. It is notable that it was stated he was preparing to enroll in an opioid treatment program. Some of the highest risk times for opioid overdose are the night before rehab and following release from treatment after a period of abstinence, among others.

  2. It’s important to withhold conclusions about the “fentanyl toxicity” listed as the cause of death in the autopsy report for Prince released by the Midwest Medical Examiner’s Office in Ramsey, MN. Between April 2005 and December 2006, almost 1,000 overdose deaths in PA, IL, MI, MO, NJ, and DE were blamed on fentanyl toxicity. The fatal fentanyl had been clandestinely made in a lab in Mexico and mixed with heroin.

    At about the same time, police in NE, NM, and CA were seizing thousands of counterfeit OxyContin 80 mg tablets, commercially punched with the color and logos of authentic OxyContin. These fake OxyContin tablets were found to contain fentanyl HCL, a form of fentanyl not present at the time in FDA-approved medicines. Clearly, anyone crushing and solubilizing these tablets for injecting risked an immediate overdose.

    In 2007, I was asked to author a comprehensive report on street fentanyl for SAMHSA’s Center for Substance Abuse Treatment. It can still be found on the Internet here: http://towardtheheart.com/assets/fentanyl/fentanyl-analogs-in-street-drugs-pdrc-2007_17.pdf.

    This is from my 2007 report:

    “According to the DEA, there are two known routes of synthesis used to produce illicit fentanyl. The first of these is the original 1965 patented process used by the Janssen Pharmaceutica lab in Belgium. The Janssen route begins with a precursor substance called N-benzyl-4-piperidone and requires a complex process considered to be beyond the rudimentary skills of most clandestine laboratory operators. (Federal Register, 2007)

    The second method was published in the scientific literature in the early 1980s and is referred to as the Siegfried route. This process begins with a different precursor, N-phenethyl-4- piperidone, known as NPP. Variations and modifications to the Siegfried route have been noted by the DEA in four of the five clandestine fentanyl labs seized in the U.S. since 2000.b (Federal Register, 2007)

    By analyzing the finished product, forensic chemists can tell which method was used to make it and, as a result, know whether the fentanyl has a clandestine or legitimate origin. The Janssen route produces a substance called benzylfentanyl, an impurity that is present in detectable traces when the precursor starting material is N-benzyl-4-piperidone. The Siegfried route, however, produces a different impurity, called 4-anilino-N-phenethyl-4-piperidine, known as ANPP, and is detectable by the lab in the finished product. (Federal Register, 2007)

    b. Detailed recipes for making a fentanyl analog, “beta-hydroxy-alpha-methylfentanyl,” have appeared on the Internet as far back as 1998. (See Appendix A for a sample)”

    To be sure, a number of important changes in the street fentanyl trade have occurred since the above report was written almost ten years ago. Additional formulations and analogs have been discovered in street drugs, particularly heroin. In addition to Mexico, Canada has emerged as a major source where underground chemists use banned chemicals smuggled from China to produce a variety of fentanyl analogs for Canadian and U.S. customers. The popularity of street fentanyl stemming from the media coverage of its potency no doubt has increased additional interest in medicinal supplies of the drug. The DEA’s special testing and research lab has been working with the Carver County Sheriff’s Office in the investigation of Prince’s death. It’s likely we will be learning more about the actual form of fentanyl that caused his death, whether it was from medicinal or nonmedicinal supplies, and perhaps how and from whom he obtained it.

    1. Thank you John, and as always an amazing and informative reply! Your knowledge of the chemistry is quite impressive and should be helpful for some of our readers. I’m hoping this particular post will serve to help people understand the complexity of the situation and also why it’s important not to jump to any conclusions. It’s also important to understand thyat while none of us condone the use of illicit drugs, probably the majority of those that abuse them (or gamble out of control for that matter) would prefer not to be caught in such a quagmires. There obviously are a whole host of risks with illicit drugs, but laced street drugs with very potent fentanyl and derivatives obviously elevates the risks to an even higher unpredictable level and risk for opioid-induced respiratory depression and death, particularly in persons that have the disease of addition and are unable to control their craving despite potential outcomes.

    2. Excellent reply, John. The problem is that the media and the anti-opioid camp will pay no attention to it whatsoever, as they’re invested in dissemination of half-truths and incomplete information in order to continue to sell “sexy” print and further their frankly perverse agenda. Sigh…..

      1. Excellent article! Thank you Jeffery, John, and Michael.

        I concur Michael… this sort of info doesn’t meet the current popular agenda.

        Apparently anyone who doesn’t comply with sympathy & action for the “epidemic” are shut down by outlets. Walking chairs, cups, and pencils etc. by the fire …. etc. is plenty evidence to be compelling enough to convince folks of an epidemic out of control.

        My dose has been decreased from a stable and effective dose. During the years on this dose I taught myself how to draw so I could be a graphic artist/designer (I can no longer do construction), how to use almost all of the Adobe Creative Cloud Apps, many audio and video programs and started a journey to build an online advertising and marketing company.

        Now? I can barely shower. Never mind Tai Chi, yoga, walks around the back 40 or much of anything.

        I pray all of you keep pushing forward. Thank you so MUCH for your incredible efforts to educate all of us.

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