The Details of Prince’s Death Are Dizzying

By Zachary Siegel 05/08/16

Despite media's liberal use of unverifiable, anonymous sources, what is known now, less than two weeks since Prince’s untimely passing, is still little. But stigma around opioid dependence may be partly to blame.

The Details of Prince’s Death Are Dizzying
Photo via Princestagram

After kicking heroin, I worked at a small Jewish deli in the overly-Lutheran city of St. Paul, Minnesota. The first job I held down sans opiates. Perfect for a stunted 23-year-old. My morning duty at the deli was to display the freshly baked bread on the tall rack. Pumpernickel, Russian rye and, of course, challah on Fridays. Big, steaming loaves, so soft that if you put one through the bread slicer before it cooled, it’d come out the other end a pile of hot mush. The best breads always sold out. And the hardest part of working at Cecil’s was breaking the news to an adorable old regular that the bread she so desired was gone. I’d shrug, and meekly suggest a lesser bread, “Onion rye?”

One of my co-workers, a Minnesota native, told me even Prince dug the bread at Cecil’s. Yeah, right. No, no, we have proof, he said. He took out his phone and showed me a Minneapolis-based food blog called Heavy Table. The blog had an ongoing series where they asked famous Minnesotans if they could inspect their fridge to find out what’s inside. Of course they asked Prince, the pride of Minnesota. Only, before agreeing to be featured, Prince and his people laid out conditions: 

“No descriptions of the house or its location; Prince would not actually be present during the fridge inspection; No photographer.” So they had to bring in an illustrator. 

Just as you’d expect, Prince’s fridge was childlike (Dunkaroos), obscure (yak milk), and only posed more questions than answers (18 varieties of mustard). But, the proof was indeed in the fridge: “Half a loaf of challah bread from Cecil’s Delicatessen.” Though, Prince did specify that someone named Manny eats the bread, because Prince, as you know, is a vegan. No one knows who Manny is. 

(Andy Sturdevant / Heavy Table)

That’s my only vaguely apophenic connection to Prince. I was born in 1989, mostly missing his era on the charts. Of course, I knew Mouth from The Goonies wore a Purple Rain T-shirt throughout the whole film. And I had watched Charlie Murphy’s brilliant narration of an absurd basketball game between his crew and Prince’s "Revolution" (or, “shirts against blouses”), where after getting smoked by the blouses, Murphy's crew was served pancakes by Prince. Then, on April 21, the news came. Prince, at 57, was found dead in an elevator. Opiates are the suspected culprit. 

Despite the media's liberal use of unverifiable, anonymous sources, what is known as of now, less than two weeks since Prince’s untimely passing, is still little. Autopsy results, which will include toxicology tests, are still pending. Unnamed sources say the prescription painkiller Percocet—or oxycodone—was found in Prince’s system. But it remains unclear whether it was the cause of or contributed to the musician's death. The medical examiner has yet to issue an official cause of death, which could take another couple of weeks. 

Since it’s been reported that prescription painkillers were found at Prince’s house as well as in his body, investigators are trying to determine where Prince got the pills and who provided them. But knowing so little, it’s troubling that so many have made immediate assumptions, saying he battled an addiction the way Amy Winehouse or Phillip Seymour Hoffman did. When a celebrity dies and drugs are involved, the portrait of the tortured genius is swiftly painted, cementing the stigmatized identity of an “addict.” We simply don’t know Prince’s interior life, which for his own reasons he kept mostly private. 

But slowly, a timeline of Prince’s last days is being pieced together, along with details of his history on opioids to treat chronic pain. It begins on April 15, six days before Prince was found dead, when his private plane made an emergency landing in Moline, Illinois. Unnamed sources have said Prince’s bodyguard carried him from the plane to waiting paramedics who administered naloxone, an opiate antagonist, to reverse an apparent opioid overdose. He was then taken to a nearby hospital but left shortly after, against medical advice. 

In the days following his death, friends close to Prince revealed he had suffered from pain related to years of high-energy performances. It’s rumored that after Prince had hip surgery many years ago, he had used painkillers as means to manage chronic pain. 

But a more recent addition to Prince’s timeline involves one Bay Area opioid specialist, Dr. Howard Kornfeld, who operates Recovery Without Walls in Mill Valley, California. Prince representatives called Dr. Kornfeld the night of April 20, the day before he died, said William Mauzy, a Minneapolis-based criminal law attorney working with Kornfeld, at a news conference outside his Minneapolis office on Wednesday afternoon.

Prince “was dealing with a grave medical emergency,” Mauzy said. He added that Dr. Kornfeld, unable to clear his schedule, sent his son, Andrew, on a redeye to Minneapolis to initiate Prince’s treatment. “The plan was to quickly evaluate his health and devise a treatment plan,” Mauzy said. “The doctor was planning on a lifesaving mission.” Though Andrew Kornfeld is not a doctor, Mauzy said he is pre-med.

The doctor’s son arrived at Paisley Park, home to Prince and his record label, at 9:30 a.m. on Thursday, the day Prince died. Mauzy, on behalf of the younger Kornfeld, said that those present “screamed” when they found Prince in the elevator and “were in too much shock” to call 911. It was Andrew Kornfeld who eventually made the call. “We’re at Prince’s house,” he told the 911 dispatcher. When asked again to specify a location, Kornfeld said, “The people are just distraught … We’re in Minneapolis, Minnesota, and we are at the home of Prince,” unaware Prince lived 20 miles outside of Minneapolis in the suburb of Chanhassen.  

The StarTribune reported that Andrew Kornfeld was in possession of buprenorphine, given to him by his father, to try and give to Prince. Buprenorphine, which is the main ingredient in Suboxone, is a semi-synthetic opiate, typically given to people with addiction to curb the use of illicit drugs such as heroin. Mauzy noted that Andrew Kornfeld eventually turned over the buprenorphine to Carver County investigators, as it was never given to Prince. There are laws in Minnesota granting immunity to people who call in drug overdoses, making it unlikely Kornfeld would be charged for carrying the buprenorphine.

“If [Andrew] is not a physician then he shouldn’t be giving drugs to anybody,” Dr. Jerrold Winter, a pharmacologist at the Jacobs School of Medicine and Biomedical Sciences of the University at Buffalo, told The Fix. “Even if he were a physician, it’d still be a bad idea because you don’t want to give a partial agonist to somebody who may be dependent on a full agonist.” Since oxycodone was found in Prince’s system, had someone given him buprenorphine, he would have been thrown into an immediate and uncomfortable withdrawal. 

Dr. Winter recently wrote a takedown of the Prince media coverage. “A rational discussion of the death of Prince—and of so many others—should not be guided by notions of ‘doctor-shopping,’ an opioid ‘epidemic,’ or vague images of those in pain enslaved by drugs,” he wrote. Rather, he wishes we acknowledge the difference between the concepts of physical dependence and addiction, citing multiple instances of Prince being called an addict or addicted. “We should also avoid the notion that treating chronic pain creates ‘addicts,’” he wrote.  

If Prince was being treated for chronic pain, then it’s likely he was physically dependent on opioids, but that does not mean he was addicted, according to Dr. Winter, who sees a problem with headlines saying Prince battled an opioid addiction. 

When asked about the ethics of Dr. Kornfeld giving buprenorphine to his son to then give to Prince, Dr. Sam Snodgrass, who currently works at a buprenorphine clinic in Little Rock, Arkansas, said, “A physician is not supposed to prescribe medication to a patient they have not seen or evaluated. And you can't do that over the phone.” On the other hand, he acknowledged they were trying to save a life, that of Prince no less, and in such cases the ethics become murky. 

Dr. Kornfeld is known to utilize buprenorphine to treat opiate-dependent patients at his Bay Area clinic. There is voluminous research suggesting buprenorphine is one of the most effective treatments for people dependent on opiates, often referred to as medication-assisted treatment (MAT). According to his clinic’s website, Dr. Kornfeld specializes in “innovative, evidence-based medical treatment for chronic pain and drug and alcohol addiction.” He may have been called to address issues regarding Prince’s supposed chronic pain, but when his son made it to Paisley Park, buprenorphine in hand, Prince was already dead. 

“But you have to wonder, if they had gotten there sooner, if Prince had started buprenorphine treatment sooner, he may very well still be alive,” said Dr. Snodgrass. 

Despite organizations such as the National Institute on Drug Abuse (NIDA) and the World Health Organization (WHO) that say medications like methadone and buprenorphine are “essential” and the “gold standard” in treating opioid dependence, there are significant barriers to expanding their usage. Mainly, there is a stigma attached to treating opioid dependency with drugs like methadone or buprenorphine, despite the evidence that it could be a lifesaving treatment. 

Whether or not this stigma contributed to the death of Prince, what’s far too common in stories about opiates, is that the users feel the need to keep their use a secret. It’s been speculated by those close to Prince that his being devoutly religious, along with his dedication to clean living (not letting anyone on tour with him smoke or drink), may have a produced a sense of shame about becoming dependent on painkillers. 

While everyone is starving for answers—a simple one being he was addicted to opioids—what has been ignored is the artist’s pain. “He was that kind of old school, the-show-must-go-on guy,” Alan Leeds, Prince’s tour manager during the ‘80s, told the New York Times. Imagine the difficulties of aging, on top of experiencing pain, and wanting to please your fans. “The idea of him medicating himself in order to perform isn’t strange to me,” said Leeds.

Editor's Note: A lot of energy has been put into distinguishing "addiction" from "dependence." And while we criticize the media for immediately labeling Prince an "addict," we must also examine why that label carries so much stigma and why our criticism is so extreme. If Prince did not have chronic pain and was dependent on opioid medication, would our grief be different? Would the conversation about treatment be different? Maybe. But it shouldn't be treated with any less urgency or care. In this story, a doctor wrote that “We should also avoid the notion that treating chronic pain creates ‘addicts.'" It does appear that the majority of chronic pain patients do not become dependent on their pain medication. But what about for those, like Prince, who do? Are we avoiding that notion because the idea of an addict is distasteful? In circumstances where people do become dependent on pain medication, when and under what circumstances does this dependence turn into "addiction"?

As Katie MacBride explains in today's companion story, addiction is always accidental. No one starts out with the goal of getting hooked on heroin, for example, just like no pain patient hopes to become addicted to the medication that is providing relief. In order to ensure that stigma does not contribute to people receiving a different quality of care based on fluid definitions and public perception, we need to keep examining how our semantic choices reflect and inform our conscious or unconscious biases. To continue this conversation, please read Addiction Is Accidental.

Zachary Siegel has been a regular contributor to The Fix since 2013. He last wrote about civil rights being threatened by rehab legislation in California.

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.