A Lesson from Prince?

It is a little early to speak and the official report of the cause of death for Prince has not been released. However, at this juncture, there are strong indications that prescription narcotics may have been part of the problem.

There are two doorways into narcotic addiction, recreational abuse and pain. The recreational user never had pain but used a variety of drugs for a euphoria and prescription narcotics became part of story.

I have not seen the statistics, but it is my feeling that the second door, pain, is taken more commonly. This appears to be Prince’s door . . . it has been reported that he was suffering from chronic pain. This is the inherent danger for the headache sufferer as well. There are two courses for narcotic addiction for the headache sufferer.

The first one is poor care to start with. Narcotics are a poor way to treat headaches because they only cover up the pain and do nothing about the underlying physiology that is causing the pain.  Also, we know that when narcotics are used too often, they often make the headaches get worse and more difficult to treat.

The tendency for the over use of narcotics is a product of discrimination towards the diseases of headache. No one can imagine giving a diabetic just pain killers to cover up their suffering but never treating their underlying diabetes, but this is what often happens with headache sufferers. It happens because of;

  1. Medical providers are poorly trained in how to treat headaches. The average medical school has 2 hours of instruction over eight years regarding headaches and that instruction is usually decades behind the research. Even board certified neurologists often have about double that, which is pathetic. So, with this poor training, you know of only a few options. Give them propranolol, nortriptyline topiramate and sumatriptan. What if that doesn’t work?  Then give them narcotics or send them off to the shrink.
  2. The insurance companies now control every aspect of health care with the goal of making money. Because of this, they prefer that headache patients . . .  well, go away . . . but if they won’t go away, then give them the cheapest treatments you can. The cheapest treatments are the old narcotics.  So if the first couple of triptans don’t work, they won’t pay for the next one that might. They won’t pay for expensive things like PT, that might help, but they love to pay for narcotics. They also put incredible pressure on medical providers to spend as little time with the patient as possible (after-all it is just a headache, as I heard one health insurance executive say). So the time needed for thoughtful and compassionate treatment is denied. If we spend “too much time” with the patient, the insurance company will deny payment and send us nasty letters telling us we are committing fraud because headache should not take more than 10 minutes. So it makes it more tempting to give someone a narcotic that will keep them happy (for a very short time) than to take the time to fix the real problem.

The second place where headache patients can be given a lot of narcotics is after they have had excellent care and are still not better. This is a real dilemma. Out of compassion, we can’t see these people suffer, however, we must be very careful not to over prescribe.

The biggest concern, as with the case of Prince, narcotics can be deadly. We are in the midst of an epidemic in drug over-doses. Headache patients deserve better. Yes, there is a compassionate place them, but as a last resort and limited qualities, not the first.  It makes me sick to see a teenager with a horrible migraine problem and the only treatment they have ever received are pain-killers. We can and should do better. The patient also must take responsibility and not push the envelop for narcotics, but to focus on working to get better and not just covering up the pain.