An article in Forbes responds to the coverage of Matthew Perry’s death. Specifically, the references to buprenorphine (Suboxone) in his system.
Several articles about Matthew Perry’s death have focused on ketamine, and justifiably so, as it was the ultimate cause of the actor’s death (drowning also contributed). But what I think is just as important to point out is what was not found in Perry’s system: opioids such as heroin, oxycodone and the highly potent, synthetic fentanyl.
…Buprenorphine was detected at therapeutic levels.
Roy, L. (2024, January 2). Matthew Perry’s Death Underscores The Significance Of Buprenorphine. Forbes. Retrieved from https://www.forbes.com/sites/lipiroy/2023/12/31/matthew-perrys-death-underscores-the-significance-of-buprenorphine/?sh=4ad666c850af
We don’t know all the details of Matthew Perry’s death, but we do know that he had a history of severe addiction and that his death was attributed to nonmedical use of ketamine.
This highlights a couple of problems with the current emphasis on Substance Use Disorders (SUDs).
First, the use of SUD to describe AOD problems results in the conflation of low-severity and acute problems with high-severity and chronic problems. These problems are often apples and oranges rather than different severities or stages of the same problem. This leads to overtreating lower severity problems and undertreating higher severity problems.
The other problem this highlights is the emphasis on specific substances (Opioid Use Disorder, Alcohol Use Disorder, Cannabis Use Disorder, Amphetamine Use Disorder, etc.) often obscures the patient’s addiction and, therefore, their need for addiction recovery rather than opioid recovery.
If a patient has high severity and high chronicity problems with heroin, alcohol, and methamphetamines, do they have three disorders (Opioid Use Disorder, Alcohol Use Disorder, and Amphetamine Use Disorder)? Or, would it be more helpful and appropriate (for the patient and the clinician) to think of them as having one diagnosis — addiction?
Again, we don’t know all of the details of Matthew Perry’s death. Still, it highlights the reality that the focus on Opioid Use Disorder can result in a system that measures success with opioid use while the patient dies of addiction.
Update: A couple of readers have noted that the substance used may have important implications for things like withdrawal and detox. My point was more about how we think about success or endpoints. (It’s also worth noting that the author’s pointing to the absence of opioid use isn’t unimportant at all. It could be thought of as an important intermediate endpoint.)
Different substances bring different risks, withdrawal, and post-acute withdrawal sx.
I haven’t totally thought this through, but my instinct is that the substance matters a lot for mild and/or acute AOD problems. For severe and chronic problems, they probably matter a lot initially and matter less over time.
Recovery Review 