The opioid crisis reached emblematic apogees this week. First, the New York Times devoted its lead Sunday editorial to the topic—a 1650-word magnum opus that chased other urgent issues off the page. Then, on Wednesday, Google trumped even that gesture, dedicating the space just below its search box—the most valuable hortatory real estate mankind has ever known—to urging readers to “help curb opioid abuse.” (As an aside, the week ended with a Cabinet nomination collapsing when it was alleged that, among other things, the nominee, a chief White House doctor nicknamed “the Candyman,” had handed out prescription drugs with abandon, including, on at least one occasion, an alarmingly large supply of Percocet.)
We’ll discuss the Times and Google stories in a moment, but the week also featured fascinating new research on attempts to repurpose obesity drugs to fight opioid craving; a discussion of lethal fraud in the for-profit drug treatment industry; an apparent breakthrough in FDA recognition of the safety and effectiveness of the cannabidiol (CBD), a compound found in marijuana, for treating certain epilepsies; and more wrenching, anecdotal reminders of the unimaginably grim human toll the epidemic is exacting.
While the Times editorial provided a familiar overview of the origins of the epidemic, including the role of opioid overprescribing in the late 1990s and 2000s, it placed these recent events in the historic context of the nation’s two earlier opioid epidemics, dating back to the nineteenth century. (It appeared to rely largely on David Courtwright’s book, Dark Paradise: A History of Opiate Addiction in America.) It concluded that Congress and the Administration were not doing enough, and endorsed the view of Andrew Kolodny, who co-heads the Opioid Policy Research Collaborative at Brandeis’s Heller School, that we need a commitment of at least $6 billion a year for 10 years to combat the crisis. (In an interview with Opioid Watch published earlier this month, Kolodny gave both his view on the origins of epidemic—an indictment that amounts to a precis of the litigation now proceeding against the manufacturers in more than 600 lawsuits throughout the nation—and, in part 2, his view of why he regards opioids as “lousy” pain drugs and his controversial position that chronic pain patients on very high doses must be tapered down, even against their will.)
The Google public service announcement was related to the DEA’s National Prescription Drug Take Back Day, and it mainly directed readers to an online locator system it created to help people find nearby facilities where they can dispose of leftover opioid medications. (The company also said it was giving $750,000 to the Parent Helpline of The Partnership for Drug-Free Kids to get families of addicts the support they need.) The National Safety Council is also addressing the safe disposal issue, offering free, DEA-approved Stericycle Seal&Send envelopes for those purposes. Meanwhile, at least two frequent defendants in the opioids litigation, drug distributor AmerisourceBergen and retailer Wal-Mart, are making free DisposeRx pouches available, yet another way of safely disposing of unused opioid pills. Finally, there is apparently yet another way of getting rid of opioids that requires neither a GPS device or a pouch. The FDA says it’s safe to just flush them down your toilet.
Google did something else significant last week relating to opioids, though it made no show of it. It began taking applications once again for the purchase of AdWords relating to the addiction treatment market, but this time under the close supervision of an outside group called LegitScript, which will try to ensure that the ads are not deceptive. Google halted AdWords auctions for detox industry participants after a Verge story last September exposed the way bad actors were using those ads to lure recovery patients to unsavory detox treatment centers.
One of the nation’s authorities on this kind of fraud is Dave Aronberg, the State Attorney for Palm Beach County—one of the nation’s premier destinations for those seeking drug treatment. We have an interview with Aronberg this week in which he explains the dense thicket of often lethal frauds in that industry, now known collectively as the Florida Shuffle. Using illegal gifts and kickbacks, dirty operators engage in “patient brokering,” milking patients of their insurance benefits and then, Aronberg says, actually encouraging relapse, so patients’ benefits can be milked again. “When people get caught up in the Florida shuffle,” he says, “the only way they leave is in an ambulance or a body bag.”
An FDA panel voted unanimously to approve pharmaceutical-grade cannabidiol, or CBD, for treatment of two rare forms of epilepsy. STAT has that story. CBD is a non-psychotropic compound found in marijuana, which has long been believed, anecdotally, to possess positive medical benefits. The drug, Epidiolex, is made by GW Pharmaceuticals, a UK company. While the DEA will likely maintain marijuana’s Schedule I status—unprescribable because the DEA deems it to have no legitimate medical purpose—cannabidiol will have to be rescheduled, according to STAT. The FDA has previously approved synthetic THC (Marinol), the main active ingredient in marijuana, and Cesamet, another synthetic cannabinoid. Another GW Pharma drug, Sativex—a synthetic combination of THC and cannabidiol—has been approved in the UK.
In related news, on May 5, San Diego State University will hold a public forum on marijuana as an alternative to opioids, with CBD being one of the topics. Meanwhile, CNN’s Sanjay Gupta, who will air a special report on Sunday, April 29, called Weed 4: Pot vs. Pills,” published an open letter to AG Jeff Sessions on Tuesday. In it he asks for “safe and regulated medical marijuana” to be made available nationwide. He argues that marijuana can treat pain (in lieu of opioids), ease opioid withdrawal symptoms, and hope “heal the diseased addict’s brain, helping them break the cycle of addiction.” (This week, Pennsylvania became the second state to approve the use of medical marijuana to treat opioid withdrawal.) Finally, here at Opioid Watch we have discussed some of the literature on medical marijuana versus opioids in writing about a recent Columbia study showing that marijuana can boost the painkilling power of very low-dose oxycodone.)
In other key regulatory and legislative developments: