By Ashley Hayes
WebMD Health News
Reviewed by Brunilda Nazario, MD
June 2, 2016 -- Pop superstar Prince, found dead more than a month ago at his estate outside Minneapolis, died from an overdose of the powerful opioid fentanyl, authorities said Thursday.
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Prince, whose full name was Prince Rogers Nelson, was 57. In its report, the Midwest Medical Examiner's Office lists his cause of death as "fentanyl toxicity," saying the overdose was accidental.
"The decedent self-administered fentanyl," the report says. The office said in a statement that the Carver County Sheriff's Office continues its investigation, and said the medical examiner's office would have no further statement.
Prince was fully clothed in black socks, hat, pants, shirt, and a grey undershirt when he was found dead April 21 in an elevator at his Chanhassen, MN, home, the report says.
How he got fentanyl isn't known. It's the most potent opioid available for medical treatment. But in recent years, it has become a favorite of opioid addicts, because it's extremely potent and packs a near-instantaneous high.
That's also what makes it so deadly. It can kill in seconds, and fentanyl overdoses are a growing problem in the U.S.
The drug was introduced into medical practices as an IV anesthetic in the 1960s. Today it's legally available by prescription as a treatment for cancer pain that returns while you're on other opioids. But it's also made in clandestine labs and imported into the U.S. as a street drug.
People who become addicted to prescription opioids often turn to street drugs when it becomes too hard or expensive to get refills of the prescriptions they're abusing.
Fentanyl is cheaper than heroin, so drug dealers lace their products with it to increase their profit margins. People who buy heroin often don't know that it has been cut with fentanyl.
"It's 80 to 100 times stronger than morphine and 20 to 40 times stronger than heroin," says Melvin Patterson, a spokesman for the Drug Enforcement Administration. Mixing fentanyl with heroin or cocaine makes them more potent, and boosts the potential danger, according to the National Institute on Drug Abuse.
The DEA issued a nationwide alert last year to warn law enforcement officials that the drug could be fatal even in small doses.
"It's very, very dangerous," Patterson says. "It's the cause of a lot of unintentional overdoses. It is something that has caused us great concern."
Just like other opioids, fentanyl kills by suppressing the breathing centers in the brain, says Mike Cohen, RPH, president of the Institute for Safe Medication Practices. By prescription, it's available as a shot and also as a patch that releases the drug slowly over 72 hours, he says. A prescription lozenge is also available.
Standard practice says that fentanyl wouldn't be prescribed for someone who hasn't taken opioids before, he says.
Prince postponed two concerts in Atlanta in early April, with his publicist saying he had the flu. He traveled to Atlanta the following week and performed the two shows. His return flight to Minneapolis made an emergency landing in Moline, IL. His publicist again cited the flu, but media reports said the pilot radioed that an unresponsive passenger was on board.
Several media outlets reported Prince was treated in Illinois with Narcan, a drug typically used to reverse opioid overdoses. It would also be used for fentanyl overdoses, Cohen says.
Controversy over the cause of the star's death swirled in recent weeks, with numerous media outlets reporting he was seeking treatment for a painkiller addiction.
Those who attended the Atlanta concerts said Prince had a cane -- he'd had a bad hip for years, reports say -- but did not use it.
Last month, authorities issued a search warrant for his medical records, and in court documents identified a doctor who was treating him for an undisclosed illness. Michael Schulenberg, MD, a suburban Minneapolis family-practice doctor, saw Prince twice in April, with the last visit the day before the musician died, according to the warrant. He apparently arrived at Prince's Paisley Park estate to deliver test results the morning Prince was found dead.
Authorities sought the late star's medical records at North Memorial Medical Center in Robbinsdale, MN, where Schulenberg used to work. A spokeswoman for the health system told the Minneapolis Star-Tribune in May the doctor was no longer with the system.
WebMD's Brenda Goodman and Kathleen Doheny contributed to this report.
SOURCES: Press Release, Midwest Medical Examiner's Office. Drug Enforcement Administration website. Melvin Patterson, spokesman, DEA. Mike Cohen, RPH, president, Institute for Safe Medication Practices. Hennepin County District Court documents (posted on Minneapolis Star-Tribune website).
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