PRINCE DIED FROM AN ACCIDENTAL OVERDOSE OF OPIOID PAINKILL

Jun 2, 2016 by

NYTIMES

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Prince in 2007. Credit Kevin Winter/Getty Images for NCLR

Prince, the music icon who struggled with debilitating hip pain during his career, died from an accidental overdose of self-administered fentanyl, a type of synthetic opiate, officials in Minnesota said Thursday.

The news ended weeks of speculation about the sudden death of the musician, who had a reputation for clean living but who appears to have developed a dependency on medications to treat his pain.

Authorities have yet to discuss how he came to be in possession of the fentanyl and whether it had been prescribed by a doctor.

Officials had waited several weeks for the results of a toxicology test undertaken as part of an autopsy performed after he was found dead April 21 in an elevator at his estate. He was preparing to enroll in an opioid treatment program when he died at 57, according to the lawyer for a doctor who was planning to treat him.

The Midwest Medical Examiner’s Office, which conducted the autopsy, declined to comment beyond releasing a copy of its findings. The Carver County Sheriff’s Office is continuing to investigate the death with help from the federal Drug Enforcement Administration. The sheriff’s office had said it was looking into whether opioid abuse was a factor, and a law enforcement official had said that painkillers were found on Prince when investigators arrived.

“The M.E. report is one piece of the whole thing “ said Jason Kamerud, the county’s chief deputy sheriff.

Fentanyl is a potent but dangerous painkiller, estimated to be more than 50 times more powerful than heroin, according to the Centers for Disease Control and Prevention. The report did not list how much fentanyl was found in Prince’s blood. Last year, federal officials issued an alert that said incidents and overdoses with fentanyl were “occurring at an alarming rate throughout the United States.”

Weeks before his death, Prince postponed a concert in Atlanta, saying that he had the flu. A week later, he made up the show, but on the flight home to Minneapolis, he fell unconscious and his private jet made an emergency landing in Moline, Ill. There, emergency medical personnel treated him with Narcan, a drug typically used to counteract the effects of an opioid overdose, according to a law enforcement official briefed on the matter.

Prince told his friends and associates after that emergency that he was O.K. His publicist said he had the flu and that this was what had led to the emergency landing.
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But a concerned friend later reached out to a California-based doctor who specializes in treating opioid addictions, in hopes of getting him into treatment, according to William Mauzy, a lawyer for the doctor, Howard Kornfeld.

On April 20, Dr. Kornfeld sent his son, Andrew Kornfeld, who is not a doctor but works at his father’s clinic, on a red-eye flight to Prince’s Paisley Park estate in Chanhassen, Minn., Mr. Mauzy said. But when Andrew Kornfeld arrived on the morning of April 21, he and two members of Prince’s staff found the singer lifeless. He then called 911.

Andrew Kornfeld was carrying a drug used to treat opioid addiction, but Mr. Mauzy said he hoped his client, who was not authorized to dispense medications, would not be charged with any crime, in part because of a good Samaritan law that allows people to call 911 to get someone help without worrying about criminal consequences.

The medical examiner’s report listed Prince, who was 5-foot-3, as weighing 112 pounds and said he had been dressed all in black that morning, including a black cap.

Prince’s death came at a time when an opioid addiction epidemic has been sweeping the United States. Studies showed that more than 28,000 people died from opioids, which includes heroin and painkillers, in 2014, and 4.3 million people were taking pain medication for nonmedical purposes that year.

Pain management can be a fine line for doctors, medical experts said. When patients have procedures or ailments that leave them in pain, doctors might end up prescribing more pain relievers than they need. That, and persistent pain, can lead to long-term dependency or addiction.

Prince’s body was worn down from decades of taxing performances, in which he often did splits or jumped from heights in platform shoes, several people close to him said. One person who knew him said that Prince had hip surgery in the mid-2000s, but it did not completely alleviate his pain. The medical examiner’s report noted a scar on Prince’s left hip as well as one on his lower right leg.

To some of Prince’s closest friends and colleagues, his struggle with pain medication came as a surprise because the musician had become a Jehovah’s Witness and strove, friends said, to live such a clean life. He was averse to drinking alcohol and frowned on the use of recreational drugs. He typically ate a vegan diet, and would not allow meat in his house.

“It doesn’t matter what people say after you are gone,” Cassandra O’Neal, Prince’s keyboardist for the last seven years, said after being told of the overdose report. “What matters is what they meant to you when they were here. Prince is still a genius and one of the most gifted artists I ever worked with.”

Investigators have used search warrants as they look for evidence in the case and collected records from medical personnel who treated him in the final months of his life, including one Minnesota doctor, Michael Schulenberg who had seen him the day before he died.

It was unclear what Dr. Schulenberg saw Prince for, but he had also seen him weeks earlier, the same day that Prince had postponed the Atlanta show. Dr. Schulenberg also prescribed medications for Prince, according to an affidavit filed by an investigator in support of a search warrant, though it did not specify the drugs.

Lori Rotenberk contributed reporting from Chicago, Sheila M. Eldred from Minnesota and Joe Coscarelli from New York.
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