Dramatic details emerging about how a California doctor reacted to a desperate call for help from Prince's staff a day before the musician was found dead have drawn criticism from experts in addiction medicine.
Prince's representatives contacted Dr. Howard Kornfeld of California on April 20, with the musician's knowledge, seeking help for Prince's addiction to painkillers, Kornfeld's attorney, William Mauzy, said Wednesday. Kornfeld wasn't able to travel immediately to Minnesota, so he arranged for his son Andrew to travel instead via an overnight flight, Mauzy said.
Andrew Kornfeld was carrying a small amount of the prescription drug buprenorphine. Mauzy said Andrew Kornfeld planned to give that drug to a Minnesota doctor who was scheduled to see Prince. Andrew Kornfeld - described as a pre-med student - was among the first to discover Prince unresponsive on April 21 and he called 911.
Asked by reporters about the legality of his carrying buprenorphine, Mauzy declined to answer. But he said he believes Minnesota law would protect Andrew Kornfeld from any potential charges related to Prince's death. Under the law, a person who seeks medical assistance for someone who is overdosing on drugs may not be prosecuted for possessing or sharing controlled substances, under certain circumstances.
The Kornfelds did not respond to multiple requests for comment from The Associated Press.
Here are some questions and answers about buprenorphine and addiction:
WHAT IS BUPRENORPHINE?
Buprenorphine is a long-acting opioid similar to methadone that is among "the most commonly prescribed medications for the treatment of opioid use disorders in the U.S.," said Dr. Joshua Lee of New York University School of Medicine.
It is more readily available than methadone treatment. Any doctor who has completed a brief training can offer it, including primary care doctors.
"As a Schedule 3 controlled substance, buprenorphine is taken by the patient at home, obtained from retail pharmacies, and managed like other prescription controlled substances," Lee said. "Beginning treatment is typically done through a typical outpatient medical visit and does not require admission to a residential treatment facility."
Suboxone is a brand name form of the drug that also contains naloxone, added to prevent abuse. Suboxone comes as a film that dissolves under the tongue.
WAS IT LEGAL TO SEND THE DRUG WITH A NON-PHYSICIAN?
Howard Kornfeld is not listed as a licensed physician in Minnesota and his son is not a physician at all. That raises serious legal questions in the mind of Dr. Mark Willenbring, a former director of treatment research at the National Institute for Alcohol Abuse and Alcoholism.
"First of all, it's unethical to prescribe a medication for someone you haven't seen. It's also unethical to prescribe across state lines if the patient is residing in another state. And if you're not licensed here, you're practicing medicine in Minnesota without a license and that's illegal," Willenbring said.
Willenbring is founder and CEO of Alltyr Clinic in St. Paul, which offers addiction treatment including buprenorphine. The drug is available in Minnesota, so there was no reason to bring it from California, he said.
"I assume this was done because of the wish for anonymity, but that doesn't excuse it," Willenbring said. "It could well have been illegal for his son to be transporting medication that was not prescribed for him. ... I think there's a clear legal infraction there, no matter what."
Two Minneapolis attorneys also questioned Kornfeld carrying the drug across state lines. Fabian Hoffner, who represents doctors in licensing matters, called it "highly unusual that a physician would send drugs with his son, or anyone" to Minnesota for them then to be given through a doctor.
Dozens of doctors are authorized to prescribe buprenorphine in Minnesota, including Willenbring and his colleagues. Federal law limits doctors to 100 patients, but Willenbring said he isn't at the limit.
"I could have driven to Paisley Park from my office in 20 minutes. I would have been happy to do so," he said.
Mauzy said Prince's representatives told Howard Kornfeld that the singer was "dealing with a grave medical emergency." He declined Wednesday to detail the emergency.
Asked what Kornfeld should have done if told Prince's condition was an emergency, Willenbring said: "If it's an emergency, call 911 for God's sake. Don't send your pre-med son on a redeye."
DOES PAIN TREATMENT LEAD TO ADDICTION?
With good management and no history of addiction, opioids can help people find relief from pain with only a small risk of causing addiction, according to a 2010 systematic review of the available studies.
"If you do not have a past history of addiction and are in your 40s and getting pain treatment with opioids, your odds of becoming newly addicted are low," said Maia Szalavitz, author of "Unbroken Brain," a newly published book about addiction. "One study of thousands of ER visits for overdose found that only 13 percent of victims had a chronic pain diagnosis."
If Prince had become addicted, Szalavitz said, he may have shunned seeking help.
"The stigma that is associated with addiction could well have been what killed him," she said. "Maybe he was afraid to seek help. Maybe he sought help before and was treated in a disrespectful and unproductive way."
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