W

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.”

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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.

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Medication-assisted treatment

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.

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  • I love the compassion and empathy you share about your clients and others who are suffering with this disease. I have experienced many of the same things Tom Petty was going through. It is very difficult to find the right doctor to help people with all that Tom Petty was going through.

    • Thank you for your comment, Gail, and for sharing your story. Sorry about your experiences but certainly hope you’re doing better now 🙂

  • I have some terrific memories of listening to Petty’s music and heard an interview not long ago which I appreciated for his modesty.
    What precisely led to the overdose of any given individual is most often a matter of speculation, as many posts here illustrate.
    Yet, Petty, in regards to his addiction and death is one out of 10’s of thousands in 2017.
    As to why the crisis, this article makes a strong case- https://www.bloomberg.com/view/articles/2018-01-10/supply-not-despair-caused-the-opioid-epidemic , though I’ve argued about economic ills in the past.

  • Thanks for the article. I would like to add that acetyl fentanyl was one of the fentanyl’s found in Petty’s system. This “version” of fentanyl has never been approved for medical use, and it is about 15x more potent than morphine. So, although most of the drugs in his system were legal prescriptions, the acetyl fentanyl is not. Whoever gave that to Petty got it from an illicit source. So, this case isn’t really simply about overdosing on legally prescribed medications.

    In any event, Petty has stated in many interviews that he was a big user of marijuana. Regardless of what you think about marijuana, you cannot argue that it affects the mind. I can easily imagine a situation in which Petty was stoned and in severe pain and could not attend to proper dosing and timing of opioids and other all his other meds. (Not that you can correctly time acetyl fentanyl – it’s illegal.) He was probably so tired from that tour and so zonked on all his meds and in so much pain…how could anyone be expected to manage that many meds in that kind of condition? It makes me think opioids need to be prescribed differently. Something like a lock box that only opens at certain times with exact doses available. I know it sounds crazy, but 20 or more of these pills in one big, open bottle is a disaster waiting to happen to anyone.

    If anyone reading this is battling with an addiction to opioids, I want to tell them that they need help from a doctor to beat it. And, the sooner they get started, the better. Waiting “until tomorrow” to deal with a creeping pain killer addiction is not the answer – call your doctor now and just tell them what’s going on. They can help get you started on the road to good health. Addiction to opioids can be beat, but it requires medical assistance.

    • sure ,but most addict’s cant afford health insurance to be able to get help. and most treatment ctrs. are too expensive for most people with no insurance.It’s sad and wish i knew a answer for anyone with a addiction problem.i have seen to many people die from addiction i could go on and on. its a problem that needs to be addresed ASAP!

    • Kathy,

      Thank you so much for your statements! The acetyl fentanyl “story” has been missed by every major news agency. Dr. Roy didn’t even appear to catch this in this news article. I happened to notice this illegal designer drug in the autopsy report, but your comments are the first I have seen on the internet anywhere. I would wager that the Petty family didn’t catch this fact either.

      I find two take home messages from these events. First, exactly what you mentioned that anyone dealing with this sort of crisis should get professional help as this mixture of drugs is just too dangerous to self medicate and can often be deadly.

      Secondly, there has been a crime here. Some person committed murder just as if they had shot Tom Petty. Acetyl fentanyl is an extremely potent and dangerous drug. Whoever gave Tom Petty this illegal drug should be held to at least manslaughter charges. There is an epidemic of these “murders” across America. More people are dying from this than those lost per annum in Vietnam. Most of Dr. Roy’s statistic of 20,000 deaths in 2016 can probably be tied to someone selling illegal and deadly drugs to the victim. The purchaser is of course culpable as well, but the average lay person is duped by the the seller. I feel that law enforcement should pursue murder charges for all of these “accidental overdose” cases! I think that this may be the only way to show how serious this illegal drug trafficking affects the end user.

  • I put a comment in earlier about the use of stem cells to relieve pain by reducing the cause of pain. The sad truth is, right now stem cells are expensive because the FDA says there aren’t enough studies showing its safe. The big, investigational studies the FDA wants cost millions, sometimes billions. The pharmaceutical industry will fund studies for their drugs because in the end, they can recover the cost by selling these drugs. Stem Cells can’t be synthesized, or mass produced for sale. In addition, they appear to be curing many medical conditions as stated in the small, but promising studies that have been released. My hope is that the insurance industry might realize it would be more cost effective to pay a few thousand dollars to attempt to cure an arthritic knee joint by simple injection, than to spend tens of thousands for a replacement knee joint. The studies suggest even if the stem cells don’t work, the have very few, if any side effects because in most cases, they are using the person’s own stem cells. Fix the root cause of pain, and there won’t be any need for medications. Think of it another way, if Tom Petty, Prince, Michael Jackson, or countless others had the information about stem cells, maybe they would have tried them first, maybe they would still be with us. Information is power, spread the word.

  • Drugs that destroy entire families and are killing people at epidemic rates, shouldn’t be offerred as pain relievers. All those Nazi era patented drugs are owned by Pharma manufacturers who have admitted to fraudulent marketing. My elderly mother in law wouldn’t touch wine. She became addicted to Benzos for obediently taking the dosage her doctor prescribed. Without the Xanax, her stomach would swell, and her heart would pound through her chest. For that she was given a Pacemaker and more Benzos. She was bedridden years before her time. She went to the hospital with the flu, and never came out. She was given Seroquel to sleep, instead her organs shut down. We still don’t know if it was the pill contraindicated for elderly and heart conditions, or the hospital acquired infections. Seroquel has thousands of Class Action Law Suits against them and doctors are oblivious. Hospitals are no place for sick people. We were much too devastated to seek legal action. It was just too painful. May God’s justice be swift.

  • thank you for this article, it shows the complexity of the problem. Unfortunately, our country does not recognize mental health as a disease that can be treated. Until we accept mental illness as a chronic disease like diabetes and cancer and provide comprehensive care to those impacted, we will continue to read these stories and shake our heads. Tom Petty had money and should have gotten help, instead, he was prescribed dangerous drugs and died. #SAD

  • I was prescribed fentanyl patch not sure how many milligrams or whatever 10 mg oxycodone and Xanax it was for severe pain the anxiety PTSD when I moved and went to a different rheumatologist he refused to give me anything because he said I was drinking cuz he found alcohol in my system I don’t drink alcohol I haven’t drank alcohol in 30 years the alcohol came from the fentanyl patch

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