Some people think fatal ODs have nothing to do with pain management—they think virtually all people who OD either bought street drugs or stole from other people’s prescriptions (“Medical use surely increased access to the drugs—but the people who got hooked tended to do so while using medication that was either prescribed for someone else or otherwise distributed illegally”). But damn, we keep hearing stories that show this is not true.

For every prominent person whose opioid abuse started with real pain, you can bet there are hundreds or thousands of people whose names have not been on marquees who started abusing drugs while seeking relief from what has increasingly become known, in coverage of the opioid problem, as “legitimate pain.”

The Los Angeles medical examiner today announced autopsy results for Tom Petty, who was found dead last fall:

it was found that he died of a heart attack caused by an accidental drug overdose. His body had traces of three different kinds of fentanyl—which seems to be ubiquitous in ODs involving opioids, particularly heroin, these days, and which was prescribed to Petty for pain—and also oxycodone (the drug in OxyContin) as well as two different benzodiazepines (Xanax and Restoril).

As they used to say when I was a kid: Enough drugs to kill a horse. 

And a doctor (or doctors) prescribed them all.

He also smoked (see “emphysema” below). If he also drank, that would further have taxed his body’s ability to detoxify itself.

Petty’s wife and daughter issued a statement saying that Petty

suffered from many serious ailments including emphysema, knee problems, and most significantly a fractured hip. . . . Many people who overdose begin with a legitimate injury or simply do not understand the potency and deadly nature of these medications.

Which means it’s entirely appropriate that doctors’ prescribing practices should be more closely monitored. And doctors themselves—even pain specialists—need to get better education, especially in communicating with patients about real-life limitations.

Petty’s wife and daughter further said:

Despite this painful injury he insisted on keeping his commitment to his fans and he toured for 53 dates with a fractured hip and, as he did, it worsened to a more serious injury.

Sounds to me like a commitment not to his fans but to his ego. If he had been committed to his fans, he would have put his health first, so he could be alive today.

And maybe the doctors were a bit starstruck, too. Prince and Michael Jackson had the same problems: chronic pain that led to addiction, and doctors who fed their weaknesses.

“First doing no harm” in such cases would be to tell the patient that he has to quit smoking, and he Has To Stop Fucking Touring. Period.