An early November 2018 report from the Los Angeles coroner’s office confirmed earlier speculation that rapper Mac Miller died in September after accidentally overdosing on a mix of fentanyl, alcohol and cocaine. The 26-year-old’s death in September followed the fentanyl-related deaths of Tom Petty by one year and of Prince by two years.

Such high-profile preventable personal and artistic tragedies are among the few reasons that my Virginia wrongful death attorney colleagues and I have asked on more than one occasion whether the prescription painkiller that is more than 10 times as powerful as morphine is too dangerous to be commonly available. More than 29.000 Americans died during 2017 from overdosing on medications like fentanyl. Another nearly 16,000 deaths resulted from overdoses of heroin, which is chemically quite similar to fentanyl.


Fentanyl is an opioid whose FDA-approved labeling states that it should be used almost exclusively to control breakthrough pain in patients with terminal cancer. Its relatively low cost, wide range of availability and heavy marketing to health care providers, however, have led doctors and pharmacist to use it much like oxycodone (e.g., OxyContin) and hydrocodone (e.g., Vicodin) — which present their own dangers. Illegal drug dealers also cut more-difficult-to-source heroin with easy-to-find fentanyl, making the deadly street drug even more deadly.

How deadly? Each patient who receives a legitimate prescription for fentanyl receives a government-mandated Medication Guide that starts with a 1,134-word warning. That statement of risks begins


Fentanyl may be habit forming, especially with prolonged use. Use fentanyl exactly as directed. Do not use a larger dose of fentanyl, use the medication more often, or use it for a longer period of time than prescribed by your doctor. While using fentanyl, discuss with your health care provider your pain treatment goals, length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse fentanyl if you have or have ever had any of these conditions. Talk to your health care provider immediately and ask for guidance if you think that you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.


Patients are strongly advised to avoid alcohol while using fentanyl tablets, taking dissolvable oral films or caplets, or applying patches. The official warning statement also specifies the following drugs to avoid or take special care with while explaining what can happen if the medications are mixed:


Taking certain medications with fentanyl may increase the risk that you will develop serious or life-threatening breathing problems, sedation, or coma. Tell your doctor if you are taking any of the following medications: amiodarone (Nexterone, Pacerone); certain antibiotics such as clarithromycin (Biaxin, in PrevPac), erythromycin (Erythocin), telithromycin (Ketek), and troleandomycin (TAO) (not available in the US); certain antifungals such as fluconazole (Diflucan), itraconazole (Onmel, Sporanox), and ketoconazole (Nizoral); aprepitant (Emend); benzodiazepines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), oxazepam, temazepam (Restoril), and triazolam (Halcion); cimetidine (Tagamet); diltiazem (Cardizem, Taztia, Tiazac, others); certain medications for human immunodeficiency virus (HIV) such as amprenavir (Agenerase), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Invirase); medications for mental illness and nausea; muscle relaxants; nefazodone; sedatives; sleeping pills; tranquilizers; or verapamil (Calan, Covera, Verelan). Your doctor may need to change the dosages of your medications and will monitor you carefully. If you use fentanyl with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.


Now, untreated pain, especially at the end of life, is often a serious problem. Fentanyl may be the solution, but the medication’s potential for doing more harm than good for most people argues strongly against its use in all but the most-limited situations. Fentanyl should certainly not be so easy to access and abuse.

Rather than doing all it can to constrain the production, prescribing and administration of fentanyl and other opioids, however, federal regulators just compounded the problems by approving a tablet called Dsuvia that contains sufentanil. Somehow, FDA officials believe they can limit overdose deaths from sufentanil even though the new drug is even more powerful that fentanyl.

As Virginia wrongful death and medical malpractice attorneys, my colleagues and I can call attention to the deadly dangers from fentanyl and other opioids, but we cannot directly prevent harm. We can also seek compensation and other types of monetary dangers when defective dosage forms, prescribing errors or dispensing and administration mistakes result in overdoses deaths.