Prince

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Dr. Ice

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Any takers as to whether or not prince's death was related to opiate od or poly pharmacy? And who is the poor schlep doctor who will be destroyed because of it. How many vote primary care doc? After all it couldn't have possibly been the demanding vegan icon himself who was to blame at all.
 
If it's related to Percocet it's likely polypharmacy or drug-drug interaction from whatever he may have been given for the acute illness. It was well known he had end stage hips, but refused surgery because the likely need for intraop transfusion and his religious beliefs. So I wouldn't be surprised if he was on COT under those circumstances. The other possibility is some underlying health issue being exacerbated by the illness or medication; like with Danny Gans having an underlying heart disease and polycythemia and then being given dilaudid post-op.
 
I'm sure polypharm is one of the suspects. I wonder if his prescriber will get in trouble? I def vote PCP
 
Thinking about this... What would be "best" is if he had been getting scripts from his orthopedic surgeon...

Too many scripts are coming from them, and having everyone's eyes on their practices would be good for a change.

I am scheduled to see a comp patient on Monday that the ortho "pcp" has had on OxyContin 80 mg daily for 10 years. He "retired", moved to Florida, and the patients pcp has felt forced to prescribe, but not through comp... That pcp (a personal friend) called me and said "she's doing fine all you have to go is write for the oxy"...

It's going to be interesting...


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Ducttape said:
Thinking about this... What would be "best" is if he had been getting scripts from his orthopedic surgeon...

Too many scripts are coming from them, and having everyone's eyes on their practices would be good for a change.

I am scheduled to see a comp patient on Monday that the ortho "pcp" has had on OxyContin 80 mg daily for 10 years. He "retired", moved to Florida, and the patients pcp has felt forced to prescribe, but not through comp... That pcp (a personal friend) called me and said "she's doing fine all you have to go is write for the oxy"...

It's going to be interesting...


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there is a spine surgeon here who fuses everyone and everyone gets standard oxycontin 40mg bid before and after fusion and he continues them on it for about 3-4 months and then sends them eslewhere to cont meds- usually the pain mgt doctor in his group
 
jsaul said:
there is a spine surgeon here who fuses everyone and everyone gets standard oxycontin 40mg bid before and after fusion and he continues them on it for about 3-4 months and then sends them eslewhere to cont meds- usually the pain mgt doctor in his group
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and hopefully that is not you... 😉
 
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Weird I've seen this guy's name thrown around before as I had a friend who was applying for a PM&R pain job at Highland General in Oakland (rough job) and I saw there was this Dr. Kornfeld associated with the hospital. It seems that he has done a lot of local presentations on suboxone. His office is up in Mill Valley north of the golden gate bridge around the Sausalito area (Marin county) where there are some affluent areas.
 
He's got patients in many states - including Oregon - who travel great distances for refills.
 
drusso said:
I wonder how much Medicaid he takes? Or, has he separated himself from third-party reimbursement?

http://recoverywithoutwalls.com/dr-howard-kornfeld/
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Sounds like what other private practice docs do.

Some contract work (medical director of county hospital program), academic affiliation, boutique practice on the side.

His rates don't look unreasonable. $1,000 for 1.5-2 hour initial eval, + record review and advocacy work.
 
Who was his prescriber and should they Face charges?
 
Hmmm your prescribing leads to addiction which in turn kills a star. I wonder if that's a violation of the MN state medical practice act.
 
drusso said:
I suppose first there would need to be proof of violation of the MN state medical practice act:

https://mn.gov/boards/medical-practice/licensees/practice/pain-mgmt-guidelines.jsp
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those guidelines from FSMB are what we have been using all along.

Objective evidence of improved or diminished function should be monitored and information from family members or other caregivers should be considered in determining the patient’s response to treatment. If the patient’s progress is unsatisfactory, the physician should assess the appropriateness of continued use of the current treatment plan and consider the use of other therapeutic modalities.
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101N said:
Hmmm your prescribing leads to addiction which in turn kills a star. I wonder if that's a violation of the MN state medical practice act.
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I think that the proper argument for causality is, "but for the fact..." But for the fact X happened, Y could never have occurred.
 
The chickens have really come home to roost on the opiate problem. It feels like we're on the cusp of the "massive deleveraging" in the 2007-8 markets.
 
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Truly sad part about friends is that he lives down the road from Hazleton. He could have gotten treatment there, without having without having to bother importing Dr Kornfeld's non-physician son.
 
101N said:
Hmmm your prescribing leads to addiction which in turn kills a star. I wonder if that's a violation of the MN state medical practice act.
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1) Addiction is not caused by prescribing

2) When the patient you write for Norco 5mg BID (#60) decides to take them all at once, are you responsible for their overdose?
 
ampaphb said:
1) Addiction is not caused by prescribing

2) When the patient you write for Norco 5mg BID (#60) decides to take them all at once, are you responsible for their overdose?
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Lol I assume your joking?
 
ampaphb said:
Nope.

http://www.addictionsandrecovery.org/is-addiction-a-disease.htm

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I think we might have to get a few things straight. Genetic predisposition is obviously there (and the key word is predisposition), but the current opioid epidemic is hugely iatrogenic. Addiction is a disease, but no way can you not correlate prescribing with addiction. Thats absurd to think that addiction is not caused by prescribing. Just because a book/website?? (with 3 references from 2001, 1998, and 1999) says otherwise is complete bullcrap. Do you not know how Purdue pushed its pain drugs in early 2000s? Why are there articles on opioid prescribing? Why are there new regulatory standards for opioid prescribing? Many, many, many people have become addicted to opioids not of their own will but because a physician didn't know better and prescribed increased about of opioids. Addiction is a serious matter, but to blow it off and say its not due to prescribing is a statement from the old era. I truly hope that you don't just hand your patients anything they want and think to yourself that addiction has nothing to do with your prescribing.

Second part to this, is that if you prescribe your patient Norco 5/325, you better be looking for signs that could lead them to OD. Obviously thats hard and requires certain experience, but dude, if a patient is very depressed/has obvious signs and you hand them 60 tabs of Norco, and they attempt an OD, I bet you will be in some legal stuff. We have a pain clinic around our parts that advertises heavily. Their model is like this: If the patient doesn't want to get injections or doesn't respond, then they see the PA for opioid prescriptions, thats it. Several of them ended up in the ED because of their addiction and unintentional ODs. Lets just say that clinic is on the local investigatory body's radar, not only because of ED visits, but because of the highly dangerous model.
 
Heroin, cocaine, marijuana, methamphetamine.

No rx.

Addiction.

Blaming doctors is convenient. But wrong. 9 to 10% of US population has addiction or substance abuse problems. This is a genetic and social phenomenon, not an rx phenomenon. Doctors are to blame for failure to identify substance abuse, ignoring it, or failure to discuss and get treatment started via referral.
 
lobelsteve said:
Heroin, cocaine, marijuana, methamphetamine.

No rx.

Addiction.

Blaming doctors is convenient. But wrong. 9 to 10% of US population has addiction or substance abuse problems. This is a genetic and social phenomenon, not an rx phenomenon. Doctors are to blame for failure to identify substance abuse, ignoring it, or failure to discuss and get treatment started via referral.
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Of course. But many patients that never encountered Heroin, Cociane, Marijuana, alcohol, and Meth were subject to heavy opioid doses from prescribers that and then those pts became addicted to opioids. It's not convenient to blame physicians, but it's the truth. I'm not saying to go on a witch hunt, as many physicians had good intent behind their prescribing, but addiction to opioids was pushed by pharama(bad intent) and prescribers with/without knowledge of addiction. That's why there is an opioid epidemic. That's why it's a new epidemic that did not exist before the mass prescription of opioids, that's why there are now regulatory bodies specifically for prescriptions. Furthermore, certain patients will be on opioids no matter what the circumstance, and a good middle ground between procedures and prescription should be practiced.
 
The "employed" part is really essential, not for the facts, but for the continued proselytizing of your worn out narrative.
 
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You need to review the difference between dependence and addiction, extra.

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Hmm.

Loss of control : overdose x 2, the second fatal check
Continued use despite harmful consequences - addiction and narcan rescue check
Compulsive use - to the point of overdose x 2 - check
Craving - yep, check

Ok reviewed the addiction criteria. He meets all four.
 
101N said:
Hmm.

Loss of control : overdose x 2, the second fatal check
Continued use despite harmful consequences - addiction and narcan rescue check
Compulsive use - to the point of overdose x 2 - check
Craving - yep, check

Ok reviewed the addiction criteria. He meets all four.
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Addict for sure. But how do you know if he had cravings and how do you know it was compulsive use? I don't really know the answers how to best decine tbese when loss of control and contd use despite harm are so flagrant
 
if you read the internet and read the comments made 10-15 years ago from his stepbrother and stepsister.... moderate use disorder, opioid. DSM-V.


He's no longer employed by the way
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so now he is safer to prescribe whatever he wants, on a cash basis....
 
Pretty sure he's not working at all right now


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ampaphb said:
You need to review the difference between dependence and addiction, extra.

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I wont waste much more time on this: dependence is criteria for addiction, FYI. There is a spectrum(DSM 5). Google it.


Back to Prince,

lobelsteve said:
Addict for sure. But how do you know if he had cravings and how do you know it was compulsive use? I don't really know the answers how to best decine tbese when loss of control and contd use despite harm are so flagrant
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Yea, I'm hoping more information will surface answering some of these questions.
 
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"So the addiction doctor from California sends his son to Minnesota carrying buprenorphine in his pocket"

Is this legit? Does Kornfield have a medical license in MN? Does his son have medical training? Why would they even admit to this.
 
pmrrmp said:
"So the addiction doctor from California sends his son to Minnesota carrying buprenorphine in his pocket"

Is this legit? Does Kornfield have a medical license in MN? Does his son have medical training? Why would they even admit to this.
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I think that his son is a RN. But, you can see how painfully low the standards are to practice "addiction medicine." It's not a field that attracts the best and brightest.
 
drusso said:
An employed-FP working at a urgent care clinic was the prescriber.
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no media outlet has stated that Schulenberg wrote for opioids, but "medications". i would have suspected the search warrant would have revealed something by now.
 
NYT article:

On April 20, Dr. Kornfeld sent his son, Andrew Kornfeld, who is not a doctor but works at his father’s clinic, on a red-eye flight to Prince’s Paisley Park estate in Chanhassen, Minn., Mr. Mauzy said. But when Andrew Kornfeld arrived on the morning of April 21, he and two members of Prince’s staff found the singer lifeless. He then called 911.

Andrew Kornfeld was carrying a drug used to treat opioid addiction, but Mr. Mauzy said he hoped his client, who was not authorized to dispense medications, would not be charged with any crime, in part because of a good Samaritan law that allows people to call 911 to get someone help without worrying about criminal consequences.

Amazing. Most likely suboxone a CIII drug carried across state lines by someone that was not prescribed the drug. Hope Mr. Mauzy is a good attorney....
 
pastafan said:
NYT article:
Andrew Kornfeld was carrying a drug used to treat opioid addiction, but Mr. Mauzy said he hoped his client, who was not authorized to dispense medications, would not be charged with any crime, in part because of a good Samaritan law that allows people to call 911 to get someone help without worrying about criminal consequences..
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Seems like an awfully big coincidence that Andrew Kornfeld arrived and found him overdosed and was the one to call 911. I wonder if he gave Prince something and then went "oh **** he was like that when I found him." Would giving someone a high dose of suboxone while on oxycodone be enough to cause overdose and would you not find suboxone on forensics?
 
He died of a fentanyl overdose.
 
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