Opinion by Terry Gotham
This article goes out directly to the party people & Burners who think they can party like rockstar gods. While the measure of any varsity party person is the ability to handle multiple types of substances concurrently, that game has become intensely more dangerous in the last 5 years. In case you missed it, the coroner’s reports on Tom Petty & Dolores O’Riordan’s deaths came back. The lead singer of The Cranberries & one of the most distinctive voices of a generation is suspected of killing herself via fentanyl poisoning. And Tom Petty’s toxicology is so startling, I’ll just quote TMZ (yes, it’s been corroborated elsewhere put the pitchforks down) directly:
Tom’s autopsy report shows the singer was on several pain meds, including Fentanyl patches, oxycodone (Oxycontin), temazepam (Restoril), alprazolam (Xanax), citalopram (Celexa), acetyl fentanyl and despropionyl fentanyl. The reason doctors prescribed the meds was because of a number of medical problems, including emphysema, knee problems and a fractured hip.
~Tom Petty Died From Massive Accidental Drug OD. TMZ.com 1.19.18
In the immortal words of Alex Shulgin, that is a “heroic” cocktail. For all my psychonauts and chem nerds out there, Kevin Shanks has an exceptional review of the chemicals here. For people out there that might not be too familiar with pharmacology, I’d like to explain why this combination of drugs is terrifying and a perfect example of the crisis currently afflicting all 50 states. While many have seen that pile of substances and flagged it as an “opiate overdose,” in a lot of toxicology reports, autopsies revealing multiple drugs are categorized in similarly incorrect ways. Some counties would flag it as a synthetic opiate overdose, while others only bucket many different types of opiates under the umbrella term “drug overdose.” Still others might even classify it as a benzo or Xanax overdose. While New York City differentiates between fentanyl and heroin in its reporting, this is not the norm. And that is a huge problem. Especially now that it’s easier than ever to be on half a dozen different drugs.
Every time someone important dies with substance-related circumstances, we watch the totality of the drug naive populace misunderstand what actually happened. The fight rages on about whether it’s a drug problem, a heroin problem, an opiate problem, an overdose problem, a public health problem, and your eyes have already glazed over, haven’t they? All of these explanations are oversimplifications. The problem is that certain drug combinations are exponentially more dangerous than others, and many dependent or recreational users are inadvertently consuming much more complex cocktails of substances than they had anticipated taking. While we don’t have the exact levels of both the substances and their metabolites, I think we’d all wager that Tom would still be alive if he didn’t take all of that stuff in a 24hr period.
In the case of Tom Petty, Prince, Lil Peep, even Michael Jackson, Fredo or Heath Ledger, this is how they ended up dead. Not by taking drugs, but by taking oxy, fentanyl, benzos, cardiotoxic SSRIs, alcohol, painkillers and/or propofol (in MJ’s case. Also Jesus fucking Christ don’t take propofol and drink). The idea of acute multi-drug driven poisoning is something that a lot of the best toxicologists have been yelling into the internet about for years now. This type of multi-substance consumption is not well understood, so it’s important that I measure my words and not run around like Chicken Little on this. But synthetic opiates like the dozens of fentanyl analogs currently in circulation are not approved for use in a prescription setting and are mostly illegal. Precursors for some of these substances have even been outlawed in China. We may not know exactly which ones are lethal, but with the news that broke Friday evening with Tom Petty’s report, and what we found out about Prince months ago, it’s getting harder and harder to ignore the tens of thousands of deaths in non-famous people that adulterated benzos, cocaine, and heroin/morphine are contributing to. Interestingly, the presence of 4-ANPP strongly implies that the fentanyl was illicitly manufactured and it may imply that he had consumed other synthetic fentanyls like furanylfentanyl beforehand, but at this time we don’t have enough data to make that call confidently.
We need to get away from this idea that certain drugs are bad in all cases and will ruin your life and kidnap your children. We need to arrive in the universe of the real where everyone takes more than one drug, in varying quantities, at differing times, for different reasons. When examining the effect of a single drug under an MRI against a control, you can at least generate some baseline data about how the drug affects blood flow or potentially neurological activity. Once that person has a cup of coffee that morning? Gotta throw the whole thing out. A lot of research hinges on modifying one variable at a time, which is at odds with the way that most people consume drugs. And as America ages, it will naturally be prescribed an increasingly complex regimen of pharmaceuticals. This requires doctors to be up on their shit, and in the case of Prince, Tom Petty, and many others, ensure their patients aren’t accidentally being given illicit fentanyl analogs with their daily routine.
One of the most important parts of this conversation is, how the hell did Tom Petty get a Schedule I fentanyl analog? In the same way that Prince’s doctor was providing him with what turned out to be illegal synthetic opiates, Tom Petty’s bloodstream had substances in it that no business being in his or anyone’s bloodstream. And I’m not even talking about the Xanax, the SSRI, the fentanyl or the Oxy. I’m talking about aceytlfentanyl. We don’t know how it interacts with citalopram, nor how much of the SSRI Tom Petty had in his bloodstream. The fentanyl could’ve been the thing that did it, but it’s also possible that the citalopram or even the Xanax was what did it. The waters in this case are so muddied I doubt we’ll ever know what really pushed Tom over the edge. There are a ton of terrible drug combinations out there, and it seems we’re inventing new ones every month.
Am I saying all, most, or even some doctors do this? Of course not. Am I saying that there’s an illuminati lizard conspiracy to kill celebrities/Americans by overprescribing them? Also of course not. What I am saying is that more and more Americans, even ones of modest means, are getting access to an increasingly complex mixture of central nervous system depressants, while tens of thousands of Americans are being found dead after consuming multiple types of synthetic opiates, benzos and other substances that make it hard . There are so many things we can do to keep these adulterated substances out of the peoples hands. We can stop this. Stigmatizing Karen, who is in her 50s and has been using fentanyl patches as directed by her doctor, for help dealing with a slipped disk since 1999, will not solve the problem. The Beatles complained about Doctor Robert, a mysterious figure who was injecting celebrities (potentially even Jackie Kennedy) with amphetamines to provide relief from the pains of life. Every time one of these doctors overprescribes for a celebrity, there is inevitably a blowback that affects Chronic Pain patients. Let’s try hard to make sure it doesn’t happen this time. They still need help, no matter how many celebrities are served up a lethal cocktail by a doctor who is out of his depth. Take care of yourselves, and for God’s sake, don’t combine fentanyls with benzos.