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When 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.

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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.

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.

  • As a retired psychotherapist and drug counselor myself, I mostly agree with your article. As someone who has/had known Tom since 1979, there are a couple of misconceptions you wrote I feel compelled to correct. First, yes, back in the 90’s (nearly 20 years clean), Tom did have a heroin addiction. And yes, he did try on his own to quit, including waiting longer between fixes and trying cold turkey on his own. However, he did eventually go to a rehab and kicked the habit and was on Suboxone, or as you would call medical assistance, for a time. Secondly, and possibly most importantly, Tom Petty was not a prescription addict!! Now, I have my own ideas about how his meds should have been managed, including what you said about somebody informing the various physicians of ALL medications and herbal items Tom was taking. I also personally feel that with Tom’s opioid history, if at all possible, he should never have been on any opioids, let alone two kinds of fentanyl plus oxycodone. If it was not possible, I firmly believe that SOMEBODY, a family member, a friend, a physician, someone, should have both kept the meds away from Tom as much as humanly possible AND should have been watching him in case something did indeed go wrong, as it obviously did in the end. Yes, I am the first to admit that Tom was a very stubborn man with a mind all of his own, and this might not have been possible. And yes, I probably don’t literally know if this was even ever attempted. But I can tell you, unequivocally, without a doubt, I would have never, at the very least, left him alone with these medications for this disastrous end to have happened. And he knew me well enough to know that I was at least just as stubborn as him, that I didn’t take any crap from anyone, including him, and that I would not have cared how many times he called me a nagging bitch. I could survive that; I’ve survived worse. But knowing that my friend, my love died this tragic way, that I find almost impossible to survive.

    • Thanks for this, Layla. And he was so smart…he knew the dangers. I just wish he would have fixed the hip first and foregone the drug ‘bandaid’ – he’d probably still be here with us. I recently lost a loved one to cancer. We doled out those pain meds, literally counting the minutes on the clock until it was ‘safe’ (until hospice inpatient took over). I wish someone could have controlled Tom’s supply as you indicated. Dammit.

    • Dear Layla, thank you for your comments. I appreciate the clarifications. As I mentioned in the piece, I never knew Mr. Petty personally nor was I his physician (thus, did not have access to his medical records). Glad to hear he was prescribed MAT (Suboxone); many people benefit from MAT (“saved my life”), while others don’t. I don’t force MAT on my patients; I offer it to them (which, sadly, does not happen to most people w/ OUD). We both def’ly agree that being on all of those medications/substances simultaneously was dangerous. Thanks again for sharing your story.

    • If Tom Petty did not have a team of healthcare professionals who could/should have educated and protected him how do you expect the rest of the population to handle chronic pain, mental health issues and life in general. #sad

  • Very clinical but shows you know nothing about the real world these musicians live in. I’ve been in this world as a band manager for five years. If you really want to learn something about these people and their special struggles in and out of music and addiction I recommend a primer starting with Greg Allman’s best selling book “My Cross to Bear”, than come back to us with something we don’t already know about addictions.

    • You are absolutely right — I have never lived the life of a musician. Never observed them in their world, never been on tour, never talked to them or their band/crew/managers, etc. But I would LOVE to learn more. Thanks for recommending Allman’s book. I will add, however, that I do know something about having stress, a demanding career, pain, trauma. These are universal. The approach/treatment remains the same — irrespective of career.

  • You may feel it’s a crime, but in doing so you leave many chronic pain sufferers in unmanageable pain.
    One of the causes of my own pain is nicknamed “the suicide syndrome” because of the unrelenting heightened pain which drives people to the end of their tether, the other causes my joints to dislocate daily.
    Neither are end of life conditions, but that doesn’t mean they don’t deserve adequate pain relief.

  • This is great to read , while Tom Petty was prescribed so many options for excruciating pain & surely given a warning label -you’d think on Fentanyl . I feel it’s a crime to prescribe Fentanyl, lest a d pull the plug type agreement in writing.

  • This is great to read , while Tom Petty was prescribed so many options for excruciating pain & surely given a warning label -you’d think on Fentanyl . I feel it’s a crime to prescribe Fentanyl to anyone not in an ER DYING bed.

    • Thank you for your comment. Fentanyl can be prescribed as a transdermal patch or via IV for patients with severe pain; closely monitored. The “street” version is being synthetically made and mixed with other drugs; clearly far more dangerous.

  • Yes, pain does remind you that your alive. Seems like you are addicted to pain. It is not the doctors fault just because they gave him a script for a legitimate reason.

  • Very good article. “… more compassion…and less judgment”- on the money! As is mental illness and addiction pairing up “like a magnet to metal”.
    Still clean, I went through treatment in late 1990 for hydrocodone addiction. It was the most difficult and grueling period of my life. Yet, relative to so many, I got off easy. Like many, certainly far from all, I did not suffer the sort of abuse described in the article. And many who carry those scars never become addicts. There is no doubt a significant predisposition but far from a one-to-one correlation.
    To say drugs don’t cause addiction is akin to asserting that the chicken came before the egg. It downplays the necessary role of drugs. Like a very substantial number of addicts, I began with recreational use in adolescence. The pressures of career and family led me as an adult to the entitled idea, “l deserve to feel better” and I sought out narcotics. Was there pain? Absolutely. Was there a moral failing on my part. Yes, permitted by self-deception. But it didn’t take long that being high was my new normal and I needed to stay out of withdrawal. I became trapped in the vicious cycle that is the disease of addiction and which requires a drug and several terrible decisions.
    Lastly yes more compassion and less judgment are warranted. But what matters most is he addict’s perception of herself in that regard. There will always be people that judge addicts harshly. But we addicts ultimately must accept responsibility for our actions, be it getting help or the life of deception and desperation that is addiction. MAT wasn’t around when I got clean, but I’d like to see it available to all opioid addicts. Those with the best will in the world usually find it virtually impossible to face life and themselves while still caught up in that vicious cycle.

    • Thanks for your comment and for sharing your story, Charles. I was always taught “drugs cause addiction.” In all of my formal addiction medicine training, I was taught that drugs hijack the brain and impair key cognitive functions like decision-making, craving. And that part is true. But I later learned – after yrs of caring for the most vulnerable patients – that psychosocial circumstances are the TRUE causes of addiction. I could decide to experiment with heroin right now. Highly unlikely I’ll become addicted. Why? I am lucky enough to have a fulfilling life (job, family, education, health). Drugs fill gaps. That said, some people are initially curious, experiment, becomes an addiction over time. Former cases (psychosocial) far outweighs latter.

  • My heart goes out to his family. Addiction is so terrible & at time’s people wish they were dead! Wish he could of gotten help for his pain instead of doing it himself. I understand though!

  • Excellent article, this is the fist one in over 30 years that actually speaks volume about what addiction really stems from. How refreshing.

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