hen a celebrity’s death first becomes public, news outlets usually report “cause of death unknown” or “died suddenly.” Weeks or months later, once the official autopsy and toxicology reports are completed, we discover what we may have already suspected. That was the cycle with Prince, and just happened again with Tom Petty — we recently learned that the legendary musician died of an accidental drug overdose.
Based on the toxicology report, multiple controlled substances were found in Petty’s system, including two types of fentanyl, a potent synthetic opioid. Its deadly effect is staggering. According to the Centers for Disease Control and Prevention, the number of overdose deaths from synthetic opioids including fentanyl (and excluding methadone) surged from 3,105 in 2013 to 20,000 in 2016. Other substances in his system were the opioid oxycodone; alprazolam and temazepam, benzodiazepines that are often used to treat anxiety or muscle spasms; and citalopram, an antidepressant.
As the medical director of a state-run addiction treatment center in New York City, I treat people with various substance use disorders. While the majority experience alcohol use disorder — which kills far more people than all opioids combined — a growing number of individuals struggle with opioids (heroin, Percocet, Vicodin, OxyContin, and the like). Although my patients — mostly low-income, underserved, minority men and women — are far removed from Petty’s rock ’n’ roll lifestyle, they all had pain and suffering in common with the “Heartbreaker.”
According to his wife, Dana Petty, the late singer had been suffering from a painful fractured hip, requiring powerful medications to function. And function he did: Petty continued to endure the physical and emotional grind of a 50-date tour in spite of debilitating pain. “He insisted on keeping his commitment to his fans,” said Mrs. Petty in a statement.
I never met Tom Petty or examined him as a physician. But I can imagine the excruciating pain with which he lived. Although surgical repair or replacement may have provided relief, a major operation would have put him out of commission for a minimum of four to eight weeks — not the ideal option for Petty. Pain, however — particularly undertreated pain — is so much more complicated than physical symptoms.
Depression is commonly associated with pain. Petty was open about his battles with severe depression. Moderate to severe pain can not only impair function, it can also worsen the sequelae of depression, such as lower quality of life. Antidepressants and benzodiazepines can ease that. So can opioids.
To further complicate matters, Petty had a long history of substance use. While that doesn’t rule out the use of opioids to control pain, they must be prescribed and monitored with caution. A complete history and physical must be performed, including a mental exam and a careful review of all medications. Petty was taking various medications with highly sedating and addictive properties. By itself, fentanyl can significantly increase the risk for respiratory arrest. The combination of multiple opioids and benzodiazepines can also be lethal.
What, if anything, could have prevented the tragic death of this beloved musician? Here are a few ideas based on years of research.
After years of heroin use, Petty tried to quit heroin cold turkey. He must have experienced unbearable withdrawal symptoms: nausea, body aches, irritability, severe sweats, anxiety, and more. One of my patients described withdrawal as “getting stabbed all over my body.” Peter Santoro of New York’s Lower Eastside Service Center, himself in long-term recovery, told me that he felt that the “emotional pain of withdrawal was so deep, it touched my soul with no relief in sight.”
Medications like methadone and buprenorphine not only reduce withdrawal symptoms but also reduce the risk of relapse and overdose. Long-acting injectable naltrexone is also FDA approved to treat opioid use disorder. In other words, medication-assisted therapy saves lives. Yet of the 23 million Americans with substance use disorders, only 1 in 10 get access to this treatment. This egregious treatment gap is driven by stigma, as well as lack of patient and clinician knowledge, legislative obstacles, and the like. Medication-assisted therapy, along with psychosocial therapies, could have saved Petty’s life, as they have for a myriad of my patients.
Prescription drug monitoring programs
Petty was receiving multiple medications that potentiated his risk of overdosing. This dangerous concoction probably didn’t come from a single doctor but from multiple providers. A statewide — ideally nationwide — prescription drug monitoring program could have alerted clinicians about Petty’s list of medications. The limitations of this approach include logistical barriers in creating such a system; lack of use by clinicians and pharmacists in regions with existing prescription drug monitoring programs; and the inability to capture street drugs. Many people with substance use disorders are buying and selling through “unofficial channels.”
Addressing the root causes of addiction
Like many of my patients, Tom Petty survived traumatizing events. As a child, his father beat him with a belt until he was covered in welts. Later on, drug use and a mounting music career led to a painful divorce from his wife of 22 years. He became depressed. Substance use and mental illness pair up like magnets to metal. My homeless and incarcerated patients have faced unspeakable pain: sexual assault, the death of a child, burned-down homes, crushing unemployment. Like Petty, they attempt to ease the pain with opioids, benzodiazepines, alcohol, and other substances.
The solution isn’t simple. We must first recognize that drugs don’t really cause addiction; they are simply a tool to temporarily relieve symptoms. We must identify and address the underlying pain and suffering. We must show a lot more compassion and a lot less judgment toward people with addiction. We need more social services for abused children and battered women; job programs for homeless veterans; access to evidence-based treatments like medications and long-term therapy; mindfulness therapies like meditation and yoga; harm-reduction strategies. Perhaps we can also take a step back and not push ourselves beyond our limits. Petty’s dedication to his fans is deeply admirable, but it came at a sad and deadly cost.
Addiction isn’t new. For as long as human beings exist, pain and suffering will exist. And we will continue to find ways to self-medicate to relieve them. Let’s create a culture where brilliant artists like Tom Petty, and regular folks like the rest of us, will no longer feel like “you got me in a corner, you got me against the wall … you’re jammin’ me, you’re jammin’ me.”
Lipi Roy, M.D., is the medical director of the Kingsboro Addiction Treatment Center in Brooklyn, N.Y., and the former chief of addiction medicine at New York’s Rikers Island Correctional Facility.