Last year at this time I traveled to my boyhood home in Minneapolis, where I was confronted with a community in mourning over Prince's death. The world-famous performer remained a hometown hero throughout his life, and public remembrances appeared everywhere. Purple lights glowed on bridges, Prince stickers plastered stop signs and telephone poles, and a local theater screened the movie "Purple Rain" nightly.
As a Minnesotan and a music lover, I cried. Now, noting the anniversary of his death, and as a doctor working to reduce overdose deaths, I am outraged. If our medical system had only provided Prince with the opioid reversal medication naloxone and training on overdose prevention, he might still be with us.
I am a resident physician in internal medicine at Montefiore Medical Center in the Bronx, where I see many patients who use opioids. Some have prescriptions for chronic pain; others buy pills or heroin on the street. Many are at risk of dying from unintentional overdose. Because of this, we are working to increase naloxone availability through a pilot program for hospital-based distribution.
Just this year at Montefiore, we began identifying patients at increased risk for opioid overdose and offering them brief, easy-to-understand training about naloxone. They leave the hospital with naloxone in hand. There are various qualifying criteria — very high doses of opioids, mixing opioids with other substances such as Xanax or alcohol — but one of the most obvious is a recent overdose.
Naloxone is a non-narcotic opioid antagonist that functions as a kind of overdose antidote. It bumps opioids like oxycontin or heroin off their target receptors, and can make an unconscious patient breathe again. The FDA approved the medication 40 years ago, and in 2015 made it available as an easy to administer nasal spray.
The Centers for Disease Control estimates that programs distributing naloxone to laypeople have already saved 25,000 lives. It is safe, with no adverse effects if given to someone who has not taken opioids, and almost no side effects when given to somebody who has. It is generic and cheap — a kit costs $20 to $40. In some states like New York and Minnesota, new laws allowing over-the-counter sale of naloxone expand the medication's reach even further. In other states, regulations around prescribing and administration by non-medical professionals prevent naloxone from getting to those in need.
With such a safe and effective medication, any barriers to naloxone distribution must be removed.
But even the most permissive laws do nothing if naloxone is not effectively distributed to the public. Community organizations such as syringe exchanges have been getting naloxone to drug users for years, but health care workers must do their part to identify at-risk patients and distribute naloxone to those in need.
Prince likely began taking opioids due to chronic hip pain and found them difficult to stop. Like many patients, he did not seek help for his opioid use in a clinic, but he did present to an emergency room where doctors could have identified him as at-risk for overdose and connected him to care.
A week before Prince's death, his private jet made an emergency landing because he became unresponsive. He was hospitalized, received naloxone, and recovered, but left shortly after without naloxone to take home.
Although my patients in the Bronx lack the money or privilege of Prince, had they been admitted to Montefiore in a similar situation, they may have fared better. With our new inpatient distribution program, we would likely have discharged a patient like this with a naloxone kit.
Unfortunately, programs such as these are rare. It will take an expansion of projects like Montefiore's and more forward-thinking laws like Minnesota's and New York's to prevent more overdoses.
Prince did not need to die. Health care professionals must take this as a rallying cry to expand the availability of naloxone.
Evan Rausch is a physician in New York City.
