Prince's death puts spotlight on opioid epidemic in Minnesota

Suspected links between Prince's death and prescription narcotics come amid an opioid abuse epidemic in Minnesota that worsened last year, according to a Star Tribune review of new state death certificate data.

State records show 336 deaths last year linked to excessive or abusive use of prescription opioids, such as oxycodone, or illicit opioids, such as heroin. That is six times higher than the opioid-related deaths in 2000, and an increase from 313 deaths in 2014.

Two-thirds of the deaths involved legal painkillers or the addiction treatment methadone, which can help wean drug abusers off opioids but is addictive itself.

Ongoing autopsy and toxicology testing will determine whether Prince's April 21 death was related to opioids, but law enforcement sources have told the Star Tribune that they found opioids at Prince's Paisley Park complex and that they are investigating how he received them. Sources also said Prince overdosed on an opioid medication six days earlier, forcing his plane to divert to Moline, Ill., where he received an emergency dose of Narcan to counteract the drug.

"If his death was due to prescriptions alone, then this confirms the message I have been saying for years, which is [that] all these drugs are basically heroin," said Dr. Christopher Johnson, an ER physician directing a state work group to reduce unnecessary opioid prescribing.

Johnson added "that to continue to think of prescribed opiates as 'safe,' or even 'healthy,' and heroin as 'evil' or 'corrupt,' is not only misguided regarding the brain chemistry, but actually dangerous." However, Johnson stressed that the medical examiner's report is needed before drawing conclusions regarding Prince's death and ties to opioids.

The state data showed a continued spread of opioid-related deaths in 2015. The annual numbers remained unchanged at 105 in Hennepin County and at 21 in Anoka County, compared with 2014.

But the total in outstate Minnesota increased, and five deaths occurred in Morrison County, which hadn't reported any in 2014 or 2013.

Among the 2015 deaths, 28 were listed as suicides and 298 as accidents — though advocates say it can be challenging for investigators to differentiate the intentions of people in pain who are addicted or dependent on opioids. Half of the deaths involved victims ages 36 to 55.

The Star Tribune analysis counted death certificates that listed opioids as the official cause, and also a handful that listed opioids in the narrative descriptions of the deaths.

The toll could be higher. There are 783 deaths since 2000 that are attributed to drug overdoses but aren't specific about which drugs.

Another annual increase was disappointing to Carol Falkowski, a former state drug abuse policy leader who formed the watchdog group Drug Abuse Dialogues.

Her April 2016 drug trend report showed the number of addicts in treatment in the metro area had been rising, as had the number of law enforcement seizures of heroin and oxycodone — trends that should reduce fatalities. She was encouraged to see the death figures leveling off in Hennepin County, perhaps because so many of medics, firefighters and other first-responders now carry emergency doses of Narcan.

Expanded access to Narcan occurred in Minnesota in 2014 under Steve's Law, which allowed all first-responders under the authority of doctors to administer the drug to treat overdoses. It also gave members of the public the ability to legally acquire the nasal version of the drug if they were worried that friends or relatives were at risk of overdosing.

Some first-responder agencies have become hesitant to carry Narcan, due in part to the cost, said Tony Spector of the Minnesota Emergency Medical Services Regulatory Board. Anecdotally, he's heard from medical and fire officials who were concerned about the agitated, unpredictable reactions from overdose victims when the antidote kicks in.

"Waking the giant" is how some first-responders referred to it, Spector said. "If ambulance services administer the medicine to patients who are under the influence of opiates and they wake up, depending on how it works out they may be very angry and very out of control."

That concern frustrates Lexi Reed Holtum, who helped establish the Steve Rummler Hope Foundation and successfully lobbied for Steve's Law and for funding so that agencies could acquire the medication. "With the massive amount of deaths we are seeing across the state, it is unacceptable for them to not implement and put into place Steve's Law," Holtum said.

But state officials also are focusing on solutions that prevent overdose situations in the first place, and they are paying particular attention to how physicians prescribe narcotic painkillers that can themselves be addictive and dangerous. Those painkillers can also lead users to heroin; the American Society of Addiction Medicine estimates that 4 out of 5 new heroin users started by misusing prescription opioids.

State officials on the new opioid prescribing work group have discussed when it is appropriate to prescribe opioids to treat acute pain and injuries, and they are taking up the controversial topic of when to prescribe them for chronic pain.

Johnson said there is little, if any, research to support the use of opioids for long-term pain.

The Minnesota Board of Pharmacy also is seeing more prescribers join its monitoring program, by which they can enter their prescribing data and identify patients who are "doctor shopping" to acquire large quantities of opioids. The board's March report showed 14 new accounts created each day by prescribers or pharmacists.

Allegations in the case of Prince's death show the limits of those programs, though. An attorney who previously represented one of Prince's relatives claimed that Prince had "straw buyers" who would get prescriptions for him.

Whether Prince's death ultimately is tied to opioids or to something else altogether, state officials believe it has brought new attention and urgency to addressing the opioid issue.

Officials from the Drug Enforcement Administration, the Minnesota U.S. attorney's office and the Hennepin County Sheriff's Office, in connection with the White House's Office of National Drug Control Policy, will meet Saturday to discuss the dangers of prescription abuse.

"The world," Falkowski said, "is looking at Minnesota to frame this."

Data editor MaryJo Webster and staff writer David Chanen contributed to this story.

Jeremy Olson • 612-673-7744