Tuesday 12 December 2017

Dr Ciara Kelly: 'Like Michael Jackson and Elvis, vast wealth, fame and success weren't enough to protect Prince from addiction'

When wealth buys you the worst of healthcare

Ciara Kelly
Ciara Kelly

And so, sadly, the report into the death of Prince by Minnesota officials has concluded that he died from an overdose of fentanyl. It is an opioid medication, in the same family of drugs as morphine or heroin. It's not known currently whether it was prescribed for him by a doctor but it's a prescription-only medication so it's likely either it was - or else it was originally prescribed for someone else but he was able to buy it.

It was hard not to fear that some story like this would emerge surrounding his untimely death. He was a relatively young man, who appeared to be in good health - and with his vast amounts of wealth, he was someone whom you would imagine had access to the best of healthcare, so his death seemed incongruous. But, alas, like Michael Jackson and Elvis before him, vast wealth, fame and success weren't enough to protect him from addiction - perhaps, in fact, they contribute to it.

Fentanyl is a drug I've prescribed many times. I use it in end-of-life situations for palliative-care patients with cancer, for example. Or sometimes in older patients with chronic pain from severe arthritis or with collapsed vertebrae from osteoporosis. That kind of thing. I don't have one healthy, young or middle-aged person on it.

And I'm of the mind that whilst it is always important to control pain, the slew of problems that a drug like fentanyl creates, in terms of addiction and side effects, means there always has to be a very serious reason to justify me prescribing it.

A report into Prince’s death found he died from an overdose of fentanyl.
A report into Prince’s death found he died from an overdose of fentanyl.

Patients do come actively looking for drugs like fentanyl - opioid addiction is a very real problem - but in those circumstances it is the role of the doctor to adhere to proper professional standards and refuse to prescribe. It seems to me that there is a terrible irony in people being so incredibly successful that they can afford to buy the worst of medical care, rather than the best.

But perhaps I'm wrong. Perhaps Prince wasn't prescribed this drug at all and never had a doctor in his pocket, feeding his addiction. Perhaps he was just one of the 20,000 Americans who die from a prescription opioid overdose annually - many of whom get the drugs on the street, not through a physician.

Well, even if that's true, street prescription-drugs come from somewhere, and where they usually come from is from a doctor. One either blatantly selling scripts or one who is prescribing inappropriately - so the patient's threshold for using opioids is simply too low. If you prescribe a drug for a patient, who then goes on to sell it on the street, then clearly they never really needed that drug in the first place.

America, of course, has a massive problem with obesity. And obesity often results in chronic pain. So pain management is a big health problem there. But the risks associated with opioids often outweigh the benefits and just because we can prescribe something, doesn't mean that we should.

Prince would have been 58 last week. It's no exaggeration to say he was one of the greatest musical talents of all time and that he died far too young. There was some question that he'd had hip problems in the past - and that might be why he was on fentanyl. Well, clearly, if that was the case, then the cure was far, far worse than the disease. We as medical professionals need to examine ourselves and see if prescribing in such circumstances can actually ever be warranted. And doctors who prescribe these kinds of drugs without due cause should be struck off.


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