The opioid epidemic could be described through the life and tragic death of Sarah Fuller.
As a survivor of two car accidents who suffered from fibromyalgia, Fuller experienced debilitating pain that led to an opioid addiction. The drugs eventually caused kidney damage, but she managed to fight her dependency on opioids.
Fuller was clean when she entered the office of Dr. Vivienne Matalon in January 2015. She was still suffering from chronic pain and needed help managing her symptoms. Despite her history of opioid abuse, Dr. Malaton urged Fuller to “let the sales rep start talking about helping her with the pain,” according to Fuller’s father who witnessed the appointment.
The sales rep was from Insys Therapeutics, and the drug for sale was Subsys, a fentanyl equivalent dispensed as an oral spray and typically reserved for the terminally ill. The prescription drug is legal, and was delivered to Fuller’s door.
Fifteen months later, Fuller was dead. She was 32 years old. Her cause of death was recorded as “adverse effect of drugs.” Fuller’s bloodwork showed she had a lethal amount of the prescription drug in her system.
“As far as I’m concerned they killed her,”
said Fuller’s mother, who blames both Dr. Matalon and Insys Therapeutics. Matalon’s license has since been suspended.
The doctor, Insys Therapeutics and their sales reps, the legislation that allows a drug like this to be prescribed, and the politicians who help maintain the status quo can all share the blame for Fuller’s death, as well as their part in the opioid epidemic. Subsys is a Schedule II narcotic, which means the DEA believes it has some therapeutic benefits and is less dangerous than a plant – cannabis. Recently, the FDA awarded Insys with a Schedule II listing for their new pain medication Syndros, a synthetic form of THC, even though marijuana itself is still a Schedule I substance.
Meanwhile, Insys has been actively lobbying to stop marijuana legalization efforts, and is listed among the most dangerous companies fighting legalization to maintain revenue.
Why do pharmaceutical companies care if cannabis is legal?
The reality is pharmaceutical companies see the benefits of cannabis as a non-addictive painkiller that’s inherently safer than opioids. By spending millions of dollars on lobbying to keep marijuana illegal, they can market their own cannabis medication and sell it legally.
The process is made easier by having former DEA officials take jobs at pharmaceutical companies. An investigation by The Washington Post showed that 42 former DEA employees have taken jobs at pharmaceutical companies since 2005, 31 of which have a background in regulation.
“There’s this misconception that illicit markets are run by dangerous criminals, while prescription markets are run by responsible business people, when the truth is that these are not mutually exclusive classifications,”
said Amanda Reiman, former manager of marijuana law and policy at the Drug Policy Alliance.
“Insys has made their money off peddling an extremely dangerous drug, so the idea that they somehow now have this benevolent motivation to provide cannabinoid medication to the public is just a horse and pony show meant to usher in the pharmaceuticalization of cannabis.”
Dr. Lester Grinspoon’s warning
Dr. Lester Grinspoon, a longtime medical marijuana advocate, anticipated the pharmaceutical industry’s attempt to take ownership of cannabis-based medicines.
“The ‘pharmaceuticalization’ of marijuana will only succeed if pharmaceutical products displace marijuana as a medicine,” Grinspoon wrote in 2001. While he seemed to think this was improbable, “due to the plant’s limited toxicity, easy availability, low cost relative to pharmaceuticals, ease with which it can be self-titrated, and remarkable medical versatility,” Syndros is an example of Grinspoon’s “pharmaceuticalization” coming to fruition.
While the Fuller family seeks justice for their daughter, the opioid epidemic continues with some help from the Trump Administration. Tom Marino is suspected to be Trump’s choice for the Drug Czar position. He was a proponent of the Ensuring Patient Access and Effective Drug Enforcement Act, a bill that opponents said would make it more difficult for the DEA to prosecute pharmaceutical companies. He will also have an ally in Attorney General Jeff Sessions, who has vocally opposed medical marijuana as a legitimate medicine. Trump also wants Dr. Scott Gottlieb to run the FDA, who has been paid by opioid manufacturers to speak at events.
This post was originally published on May 11, 2017, it was updated on October 5, 2017.