Coroner's Report: Fentanyl Caused the Death of Prince

This past April, millions of people around the United States and across the globe were shocked to learn that Prince Rogers Nelson, more widely known as Prince, died at the relatively young age of 57. While it was unclear as to the cause of the pop singer's death, many were convinced that the superstar passed away from drug related issues. It probably comes as little surprise that Prince suffered from pain after decades of high energy performances, and it was widely known that he endured a hip injury that required pain medication.

Prince had been known to lead a clean life, refraining from mind altering substances over the years, which made it hard for many to believe that his death could be the result of a drug overdose. Now, two months later, the coroner's report has come out, and the cause of his death was an overdose of the powerful opioid analgesic fentanyl, CNN reports. It is likely that you have heard news reports about the drug in recent years, as fentanyl is commonly mixed with heroin to increase potency—resulting in a wave of overdoses across the united states.

Just to put the drug into perspective, fentanyl is around 80 to 100 times stronger than morphine and roughly 40 to 50 times more potent than pharmaceutical grade (100% pure) heroin. The drug is known to cause severe respiratory depression even in small doses—rife for the potential of overdose. Heroin users, more often than not, have no idea that the “dope” they are about to snort or inject is laced with fentanyl; being unaware of the presence of the powerful analgesic, users will dose themselves out as they normally would—ignorance that can prove deadly.

Authorities are still trying to determine where Prince acquired the fentanyl that led to his death, according to the article. To be sure, it could have come from only one of two places. Either a physician wrote him a prescription for fentanyl to treat his pain, or he acquired the drug through illegal channels. Fentanyl is being produced in clandestine labs, typically overseas in countries such as China where it is easy for chemists to acquire the requisite precursors. The drug is then shipped out of China, finding its way to Mexico where it is then moved north of the border.

Without a doubt it is important authorities find Prince’s source; however, where the drug came from will not bring the beloved artist back—as is the case with the thousands of Americans who lose their life in this country from prescription opioid and heroin overdoses. What’s more, Prince’s death, much like Michael Jackson's and a number of other stars' deaths in recent years, drives home the point that everyone is eligible for addiction—and all who use opioids are at risk of overdose. Every day in the United States alone, over 70 people succumb to opioid overdose deaths.

Is W-18 Too Powerful for Naloxone?

Over the last few years there have been a number of deadly cases of heroin laced with fentanyl overdoses. Fentanyl is a powerful opioid analgesic, typically used in a hospital setting for either surgery or the most severe pain. The drug is roughly 80 to 100 times more powerful than morphine and around 40 to 50 times more potent than pharmaceutical grade heroin, according to the Centers for Disease Control and Prevention (CDC). With potency like this, it is easy to see that mixing fentanyl and heroin together is a sure recipe for disaster.

Fentanyl is now being produced in clandestine labs in China, shipped to Mexico and mixed with inferior grades of heroin to increase potency. Heroin users in the United States are often times unaware of the deadly admixture when they use, so they do not adjust their dosage accordingly—overdose often ensues. You might find yourself wondering if there could be a more deadly amalgamation. The answer to that question, unfortunately, is yes.

A drug that could be as many as 10,000 times more potent than morphine is possibly being mixed with heroin in the Philadelphia area, The Philadelphia Inquirer reports. The drug, known as W-18, may be too powerful for the opioid overdose drug naloxone to reverse. The Drug Enforcement Administration (DEA) has released a bulletin warning of the dangers associated with mixing W-18 with other drugs, such as heroin. The agency pointed out that a microscopic dose of W-18 could be fatal.

Recently, anesthesiologist Anita Gupta, who works as a pharmacist and pain specialist at Drexel University College of Medicine, began seeing cases of overdose where patients didn’t have the typical response when naloxone was administered. Gupta’s suspicion for the atypical response was the presence of W-18.

“The symptoms were worse than we were used to seeing,” said Gupta. “We were getting patients with symptoms of near-death, and often required multiple doses of the antidote naloxone.”

Two Types of Alcoholics

Drugs and alcohol take their toll on the human brain, which can be measured through a number of scanning techniques. When compared to the brains of people who have not had a substance use disorder, clear differences can be seen. That being said, the brain of one alcohol user may look different than another, and new research may have found that there are two types of alcoholics. Researchers from the University of Eastern Finland found that while all alcoholics share similar brain changes, some alterations are exclusive to one type of alcoholic but not another, PsychCentral reports. The findings are published in the journal Alcohol and Alcoholism.

There are two types of alcoholics, anxiety-prone (Type I) and impulsive (Type II) based on Cloninger’s typology, according to the article. The researchers looked at post-mortem brains from both types of alcoholics and a control group.

“From the viewpoint of the study setting, this division was made in order to highlight the wide spectrum of people suffering from alcohol dependence. The reality, of course, is far more diverse, and not every alcoholic fits into one of these categories,” said Olli Kärkkäinen, M.Sc. (Pharm).

Typically, Type I alcoholics are more prone to anxiety and are more likely to become dependent on alcohol later in life, the article reports. On the other hand, Type II alcoholics usually become dependent on alcohol when they are younger and show greater impulsivity and antisocial behavior. In Type I alcoholic brains, the researchers found:

• Changes in the endocannabinoid system, which modulates stress responses.
• Increased Docosahexaenoylethanolamide levels in the amygdala, possibly linked to their anxiety prone nature.

With Type II alcoholic brains, the researchers found elevated levels of AMPA receptors in the anterior cingulate cortex, according to the article. That part of the brain has a hand in learning and the regulation of behavior, which could explain the impulsive nature of Type II alcoholics.

“These findings enhance our understanding of changes in the brain that make people prone to alcoholism and that are caused by long-term use. Such information is useful for developing new drug therapies for alcoholism, and for targeting existing treatments at patients who will benefit the most,” said Kärkkäinen, the study findings were part of his doctoral thesis.

Exercise Creates New Dopamine Receptors

Addiction recovery requires a lot of hard work; years of living in the grips of the disease can be a hard break. It is often said that the easiest part of recovery is putting down the drink or drug, the hard part is not picking them back up. Eternal vigilance is needed if long term recovery is to be achieved. Drugs and alcohol take a heavy toll on the brain; in a sense they change the wiring - one’s neurochemical receptors can diminish over time. The effect that drugs have on the brain from greater and prolonged use can affect one’s ability to abstain from use in recovery.

Fortunately, the human brain has an extraordinary ability to repair the damage done by substance use, and there are things that can be done to speed up the process. Researchers at the University of California Los Angeles (UCLA) found that exercise can help those in recovery from methamphetamine addiction, UPI reports. The UCLA team’s research indicates that exercise aids the brain in adding new dopamine receptors, diminishing one’s cravings for meth. The findings were published in the journal Neuropsychopharmacology.

"We know that deficits in the striatal dopamine system are hallmark features of substance-use disorders and are caused by molecular adaptations to repeated drug exposure and, likely, also reflect a genetic predisposition," said Dr. Edythe London, professor of psychiatry and molecular and medical pharmacology at UCLA, in a press release. 

The study involved 19 people; the researchers asked 10 of the participants to exercise three times a week for an hour and to do resistance training for eight weeks, according to the article. The other nine members of the study were asked to not exercise, but were given health education training. PET scans were performed to find how many dopamine receptors were present in the reward system part of the brain - known as the striatum. After eight weeks, the exercising group had a 15 percent increase in dopamine receptors, compared to just 4 percent in the non-exercising group.

"Although this is a small study, it's a very encouraging finding," said London. "The results demonstrate that methamphetamine-associated damages to the dopamine system of the brain are reversible in human subjects, and that recovery of the dopamine system after chronic drug use can be facilitated with exercise training." 

At Celebrate Hope clients are encouraged to exercise and/or do yoga, as we believe that recovery requires healing both mind and body. Please contact us to begin the journey of recovery.

Being Charlie: Addiction and Homelessness

Hollywood often paints inaccurate pictures of addiction, usually the result of writers who themselves have never struggled with the disease. While it is good that such movies spark conversations about addiction, helping break the stigma of the insidious illness, it is always nice to see films that were written by those who walked the lonely road.

Every adult in America has probably seen a Rob Reiner film, such as WHEN HARRY MET SALLY… You may even know something about the acclaimed director's life. You may not know that Reiner’s son Nick began his battle with addiction in his early teens, according to People. Nick Reiner was sent to his first addiction treatment center when he was about 15 years of age. The center would be the first of 17 such facilities that he would check into, and he is only 22 years old.

Nick’s story is like so many others who began using drugs and alcohol at a young age. He bounced in and out of treatment centers, found recovery and relapse - eventually winding up homeless living on the streets. Now sober, he decided to write a film that resembles his own experiences, according to the article.

Being Charlie, directed by Rob Reiner, is the story of the son of a famous former actor who is running for governor. Along the way, Charlie who is trying to find recovery, refuses to go back to rehab and finds himself homeless. "It's not my life," says Nick Reiner but he adds "I went to a lot of these places, so I had a lot of these stories."

"I was homeless in Maine. I was homeless in New Jersey. I was homeless in Texas," says Nick. "I spent nights on the street. I spent weeks on the street. It was not fun." 

Please take a moment to watch the trailer below:




If you are having trouble viewing the trailer, please click here.

Heavy Cannabis Use Compromises Brain's Dopamine System

Marijuana, despite what many will claim, is not a benign substance and carries the risk of addiction. All over the country, more and more people are in favor of doing away with marijuana prohibition, in favor of both medical and recreational marijuana legislation. This fall, a number of states are expected to vote on legalizing the controversial drug. Whether legalization is a good or bad thing is up for debate; however, the change in stance on marijuana has allowed for research that was previously impossible to conduct.

In recent years, a number of studies have been conducted dealing with cannabis use and the drug's effect on the brain. If we are going to vote on the legality of a drug, it is crucial we have all the facts. It turns out, that marijuana’s impact on the brain may not be too dissimilar to other, more dangerous drugs. New research suggests that heavy cannabis use compromises the brain's dopamine system, Science Daily reports. Heavy cannabis use can impact the striatum - the region of the brain responsible for working memory, impulsive behavior, and attention. The findings were published in the journal Molecular Psychiatry.

"In light of the more widespread acceptance and use of marijuana, especially by young people, we believe it is important to look more closely at the potentially addictive effects of cannabis on key regions of the brain," said lead author Anissa Abi-Dargham, MD, professor of psychiatry (in radiology) at Columbia University Medical Center (CUMC). 

The researchers used positron emission tomography (PET) on 11 adults severely dependent on cannabis and 12 matched healthy controls, according to the article. The heavy cannabis users had significantly lower dopamine release in the striatum, compared to the controls. Lower dopamine release was associated with worse performance on learning and working memory tasks.

"We don't know whether decreased dopamine was a preexisting condition or the result of heavy cannabis use," said Dr. Abi-Dargham. "But the bottom line is that long-term, heavy cannabis use may impair the dopaminergic system, which could have a variety of negative effects on learning and behavior."

Social Media and Depression

Addiction to technology is a real disorder, one that can be especially difficult to treat because technology is an aspect pervasive of everyday life. Practically everyone has a computer with access to the internet, and it is probably fair to say that even more people have a smartphone of some kind. Having a device in your pocket that can be reached for at anytime can be a slippery slope, especially for people who actively use social media platforms, such as Facebook or Twitter.

Past research has shown that people who use social media may be at risk of depression, but a new study has found the link may be rooted in addiction, Reuters reports. The findings were published in the journal Depression and Anxiety, and come from 1,763 people ages 19-32, who were asked questions about their:

• Symptoms of Depression
• Social Media Use
• Addictive Behaviors

“We believe that at least having clinicians be aware of these associations may be valuable to them as they treat patients with depressive disorders. For example, they may wish to inquire about social media use patterns and determine if those patterns are maladaptive,” said study coauthor Ariel Shensa of the University of Pittsburgh School of Medicine.

The researchers looked at how often the participants used 11 of the most commonly accessed social media platforms, according to the article. The sites included:

• Facebook
• Twitter
• Google+
• YouTube
• LinkedIn
• Instagram
• Pinterest
• Tumblr
• Vine
• Snapchat
• Reddit

Addiction to social media explained for most of the cases where social media use was linked to depression, the article reports. However, how social media is used and depression was noticeably linked together.

“Ultimately, it appears that the way social media is used, rather than the amount social media is used, leads to maladaptive outcomes,” said Lindsay Howard of the Virginia Consortium Program in Clinical Psychology.