It Wasn't Addiction That Killed Prince; It Was America's Stigmas About Addiction
Opioid addiction and overdose are preventable and treatable. The missed opportunities that could have prevented Prince’s death are astounding, and sadly, not surprising. In all the talk about the overdose crisis in this country, there has been scant attention to one of the biggest killers – stigma. Stigma about addiction led to Prince’s death, just like stigma leads to others’ deaths every single day.
Why didn’t Prince, or the people around him, acknowledge his addiction and seek care earlier? In countless stories of fatal overdoses, we have learned that individuals and families affected by addiction have refused to acknowledge addiction. Whether they are trying to avoid tarnishing their reputations, protect their privacy, or never knew their loved one had an addiction, stigma is to blame. Imagine if we accepted addiction as we do other medical conditions. Do individuals with diabetes or their family members hide the disease? Would those with diabetes avoid treatment, putting themselves at risk for fatally high or low blood sugar?
Why, after a non-fatal overdose, do people leave the hospital without treatment for addiction? The risk of dying from overdose is high after a non-fatal overdose event. However, it is typical for those who are hospitalized with addiction-related illnesses to leave hospitals without addiction treatment. In fact, it is very rare for people leaving the hospital to even be prescribed naloxone, the antidote that reverses opioid overdoses. Making the situation even worse, over 90% of people who have non-fatal opioid overdoses continue to be prescribed opioid analgesics after overdosing. Many hospitals in the US are not equipped to start addiction treatment or connect individuals to addiction treatment in a timely way. In addition, there are simply not enough addiction treatment providers or programs to address the need. Because of stigma, insurance coverage has been inadequate even after the Affordable Care Act, reimbursement to providers is poor, and many providers themselves do not want to treat addiction, considering it a second-class disease or one which is outside their charge.
Why do people with addiction overdose alone? Prince was alone the night that he died. Using alone puts people at risk for fatal overdose, because there is no opportunity for someone else to notice, seek help, or administer naloxone. Too often, people use drugs alone because of shame (wanting to hide their use), or because they are fearful of law enforcement.
Why do we accept stigma about addiction? It is time to shed our Puritan roots. We need to reject the faulty premise that addiction is a shameful moral failing that should be hidden. Our collective brushing of addiction under the carpet kills real people every day, and no one is immune. In reality, addiction is a medical condition that is treatable! Addiction treatment saves lives. However, due in large part to stigma, not enough people who need treatment seek it. And not enough clinicians who could treat addiction treat it. Every primary care doctor should have a buprenorphine waiver so that they can treat opioid addiction as just another medical condition. In our experience, it is the most rewarding thing that we do as primary care providers because it allows our patients to regain their lives. As the war on drugs fades, we now need to combat stigma about addiction. Until we do that, stigma will continue to kill.