This guy is launching the “Silk Road” as a legal cannabis brand … to fight the opioid epidemic with weed.
What is the #1 killer of people under the age of 50 in the United States?
Social media toxicity?
The answer is, by far:
I learned this at a cannabis industry event when I met David Kram, founder of a new legal cannabis company called “Silk Road,” which is, he says, the only cannabis company founded with the political intent of encouraging people to replace opioids with cannabis as a tool for chronic pain management.
I’ll get to Kram, his company, and its undoubtedly controversial name — he chose it to pay homage to the famed libertarian Internet drug bazaar created by Ross Ulbricht and closed by federal authorities in 2013 — in a moment.
But first, I want to share a few facts about the opioid crisis — which I started looking into after first talking with David. For some very specific personal reasons I’ll share in a moment, he’s fiery and passionate about this issue. In contrast, I had heard about the issue before, but thought it was just the typical news media’s sensationalism about the latest drug scare, and hadn’t paid much attention to it before meeting David and reading further. What I learned when I started reading was shocking — and I’m hard to shock.
It turns out, no, this is not sensationalism. This is what the New York Times has called “the deadliest drug crisis in American history.” As the newspaper of record, you don’t get to make a claim like that very often — but the numbers back it up. And in the last few years, the numbers are getting out of control.
According to the Times, 64,000 people died of drug overdoses in the US in 2016 alone, the vast majority of those from opioid overdoses. This total death toll is up 22% over one year. A Vox article states (with links in the original:)
In comparison, more than 58,000 US soldiers died in the entire Vietnam War, nearly 55,000 Americans died of car crashes at the peak of such deaths in 1972, more than 43,000 died due to HIV/AIDS during that epidemic’s peak in 1995, and nearly 40,000 died of guns during the peak of those deaths in 1993.
The crisis has gotten so bad that life expectancy in the US has gone down two years in a row — the first time in decades — because of this new epidemic. And this decline is on track for three years in a row, which, the head of the National Center for Health Statistic says, would be the first time in 100 years, since the Spanish Flu.
About 15,400 of those 64,000 deaths were from heroin, and 14,400 from prescription opioids like OxyContin, Vicodin or Percocet. These compare to 10,600 cocaine overdoses, and 7,600 meth overdoses.
But the biggest contributor to the overdose epidemic by far — and growing in its impact dramatically over the last few years — is fentanyl, a synthetic opioid that is mostly made and sold illegally. Fentanyl and its analogues accounted for 20,100 overdose deaths in 2016. That’s up 540% in just 3 years, according to the Times analysis. This is a rocket-ship of death that’s just taking off.
I’d never heard of fentanyl before. It turns out, chemists can mimic the narcotic effects of plant-based opioids, which have been around for hundreds of years, to make synthetic versions that are over 100X stronger than methadone, and over 10X stronger than heroin.
Here’s a photo comparing a lethal dose of heroin (around 30mg for an adult male,) to a lethal dose of fentanyl (about 3mg.) The article in which this photo appears is entitled “Why fentanyl is deadlier than heroin,” which pretty much sums it up.
Fentanyl, which can be made in a lab (rather than having to grow poppies in Afghanistan to make it,) is often mixed in heroin to increase strength and cut costs to the dealer. Look at those few sugar-grains of fentanyl — imagine those being mixed into a bag of heroin, and that’s the amount that can kill. With that stuff hitting the streets in the last few years, no wonder we are in the midst of an unprecedented national emergency of drug overdoses.
According to a new book on the opioid crisis, “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America,” by journalist Beth Macy, the current opioid crisis has a clear start date: 1996. As the positive New York Times review of the book recounts, that year is when:
Purdue Pharma released OxyContin with the claim (preposterous in hindsight) that its new pills would be less addictive than other opioids on the market. Yes, OxyContin contained more medication than the others, but its time-release formula (the “contin” was pharma-speak for “continuous”) would frustrate an impatient addict looking for a quick high.
It turned out, that was a bald-faced lie promulgated by Purdue in the name of pure profit. According to an earlier New York Times report:
[Purdue’s false claim of safety] became the linchpin of the most aggressive marketing campaign ever undertaken by a pharmaceutical company for a narcotic painkiller. Just a few years after the drug’s introduction in 1996, annual sales reached $1 billion. Purdue Pharma heavily promoted OxyContin to doctors like general practitioners, who had often had little training in the treatment of serious pain or in recognizing signs of drug abuse in patients.”
However, the Times report continues, in 2007:
[Purdue] and three current and former executives pleaded guilty today in federal court here to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.
To resolve criminal and civil charges related to the drug’s ‘misbranding,’ the parent of Purdue Pharma, the company that markets OxyContin, agreed to pay some $600 million in fines and other payments, one of the largest amounts ever paid by a drug company in such a case.
Also, in a rare move, three executives of Purdue Pharma, including its president and its top lawyer, pleaded guilty today as individuals to misbranding, a criminal violation. They agreed to pay a total of $34.5 million in fines.”
In part of the proceedings of this settlement, it came out that Purdue knew — and hid evidence from prosecutors — that many of its sales were coming from “pill mills.” These are so-called “pain management clinics” that have been popping up out of nowhere, staffed with doctors whose practice consists primarily of prescribing opioidst to pretty much whoever walks in, often selling the pills in the same location as the prescription is written. It’s legalized smack dealing.
The epicenter of these pill mills is West Virgina, which now suffers the highest opioid overdose death rate in America, according to Vox, at 48 deaths per 100,000 residents. (By contrast, the murder rate in West Virgina is 6 per 100,000, and the car-crash death rate is 15.) According to the Vox report:
From 2007 to 2012, drug firms poured a total of 780 million painkillers into the state — which has a total population of about 1.8 million. The small town of Kermit had a population of 392, but a single pharmacy there received 9 million hydrocodone pills over two years from out-of-state drug companies.” In 2016, there were 230 million opioid prescriptions in the US, about one prescription for every adult.
In Missouri, “[o]ver the last six years, enough opioids were shipped to the state of Missouri to give every resident 260 pills,” NPR reports. That’s 1.6 billion pills, for a population of about 6.1 million.
In 2016, 11.5 million people misused prescription opioids, 2.1 million people had an opioid use disorder, and 170,000 people tried heroin for the first time (part of the 948,000 who tried heroin in total that year,) according to the US Department of Health and Human Services,
And much of this smack-use starts with misused prescription medication. According to the National Institute on Drug Abuse, “21 to 29 percent of patients prescribed opioids [such as OcyContin] for chronic pain misuse them,” and “about 80 percent of people who use heroin first misused prescription opioids.” When the get hooked on OxyConting or other opioid painkillers, and their prescription runs out, and they can no longer get their fix “legally” from their doctor, they turn to questionable pill mills. Or, they go the streets, where blackmarket opiod painkillers, or heroin, or cheap and frighteningly-powerful fentanyl, are always available.
This recent escalator of addiction was started by Purdue. With the 2007 judgment against the company, the originators of the modern opioid crisis all got a fine (and no jail time.) But by 2007, the opioid crisis was already in full force, and millions of people were hooked on these incredibly lucrative (for the pharmaceutical companies) drugs. Street-corner dealers were replaced by fully-legal smack-dealers in white coats, called doctors, with the full approval of the FDA and DEA.
Since 1999, 630,000 people have died of drug overdoses in America — most of these from opioids. About 115 people die of an opioid overdose every day in America.
Why David Kram Decided to Do Something About It
David Kram’s younger brother Adam’s day, unfortunately, came in April 2016.
“I got a series of calls from my sister one day, very early in the morning, around 5AM,” David told me. “I was obviously sleeping, but finally on like the 14th or 15th missed call, I finally heard the ringer and I answer it. She said, “Adam is dead. Our brother is dead.” I was half asleep, my brain wasn’t really on. I was not processing things. She had to say it over and over again to me. She was crying, hysterically. ‘He’s dead. He overdosed. He’s gone.’ Nothing can prepare you for that moment.”
Adam, who was 26 when he died, had been addicted to prescription opioid painkillers for many years. “I can tell you, there were times when I didn’t even recognize him. In terms of external appearance, he was the same person. But the way he spoke, the way he acted, was completely different. You could tell when he was high. You could just tell. I remember one time we were on the couch watching TV and he starts nodding off… in the middle of the day.”
After Adam’s death, David started seeing some of the stories coming out about how states with legalized cannabis were seeing lower rates of opioid prescription. Obviously, these studies took on even more salience for David now that the crisis had hit home for him.
A widely-cited study in the Journal of the American Medical Association found that, between 1999–2014, states with legalized medical marijuana had a 24.8% lower opioid overdose rate compared with states without legalized medical marijuana. Of course, correlation does not equal cause — it could be that some other factor about those states (such as overall patterns of drug use or attitudes towards various drugs) led to both relaxed marijuana laws and lower opioid deaths. However, the effect grew over time in most states, suggesting a causal link.
As more states legalize marijuana medically or recreationally, more data is coming out showing a causal impact of marijuana legalization on lowering opioid use and overdose. One recent study in the Journal of the American Medical Association found that, between 2010–2015 in states with legalized medical marijuana, Medicaid patients filled 14% fewer prescriptions for opioid painkillers after marijuana legalization was introduced. Another study found that number closer to 30%. Another study, from the National Bureau of Economic Research, found that admissions to substance abuse programs reduced 15%-35% in states that legalized marijuana dispensaries. And another study, in the American Journal of Public Health, found that opioid overdose deaths in Colorado reduced by 6.5% after recreational marijuana legalization, a “reversal” in a 14-year climb.
Given the staggering climb in opioid overdoses, anything that can potentially lead to a “reversal” is a welcome blessing — and David Kram has become a true believer.
“Everyone who smokes pot knows that you get pain relief. And more and more studies are coming out backing this up. I’m not going to say it’s a cure-all replacement for all painkillers. There are some individuals that suffer from extreme chronic pain — particularly cancer patients — who need insane dosages of opioids. Cannabis could help substitute a small portion of their pain regiment, but they still need opioids for pain management. But I would guess — throwing out numbers — that two-thirds or greater of the population that has prescriptions for opioid painkillers today, don’t need them. They don’t need the strength of an opioid to manage their pain.
“I want to be reaching these people, and saying, ‘Cannabis is an amazing alternative, that is healthy, non-lethal, and non-addictive, with essentially no side-effects, except perhaps munchies [laughing.] Most of you who are currently taking opioid painkillers for pain management, probably don’t need them, and could switch and substitute for a healthy alternative, like cannabis. It has powerful painkilling potential, and there’s never been a documented death from cannabis overdose. You actually cannot take a dose of cannabis that will kill you. Whereas 115 people every single day in the U.S. die from an opioid overdose, and 60% of those overdoses are from people with a legitimate prescription. Imagine that — “legitimate” prescriptions that are killing over 60 people a day! And there’s a perfectly viable alternative out there, that has never killed a single person, and that’s not as widely known about, or available, as it could be, because of irrational prohibition and stigmatization.”
David decided he was going to do something about it. He saw hundreds of cannabis companies popping up around him all over California. “Not one of them was talking about cannabis as an alternative to opioids, and as a solution to the opioid crisis. I decided to change that. So I created Silk Road.”
The Decision to Create “Silk Road” Cannabis Brand
Now, a skeptic might raise hackles here. After all, people were in fact selling and buying prescription opioids on the infamous free-wheeling, anarchistic, anonymous Internet marketplace to which David’s company pays homage. Why name a company that’s aimed at battling the opioid crisis, after a site where people were able to buy opioids?
Well, it turns out, opioids were a side-current of the drugs being sold there. The main current was drugs that are increasingly seen as having therapeutic and medical benefits, despite prohibition. One major study of users of the site found in the US found that 53% had used the site to buy MDMA, 45% had used it to buy LSD, 34% had used it to buy marijuana, and 27% had used it to buy psychedelic mushrooms — compared to 20% who had used the site to buy any prescription medications (with no breakdown in the study of what percentage of thse medications were opioid painkillers. No major amount of heroin or fentanyl purchase was found in the study.)
In other words, most of the major illicit drugs being bought and sold on the site were psychedelics now being studied extensively for potential medical and therapeutic benefits, in what is now being called the “psychedelic renaissance.” (The flourishing of this renaissance, and its impact on medicine, is detailed in Michael Pollan’s recent #1 New York Times-bestseller How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.)
The Silk Road (the site) was largely devoted allowing people to buy substances that are fully prohibited, but probably shouldn’t be, because they have potential therapeutic benefits. That doesn’t mean everyone was using the drugs bought and sold there for therapeutic purposes— of course not. But it does suggest that the site was largely a stand against the prohibition of substances — like cannabis — that have potential social and medical benefits, and are being outright banned unjustly.
David Kram believes in a free market for cannabis — but not one for opioids. “I’m not advocating for the same free market approach for all drugs. We have to make a clear distinction between cannabis and opioids. In states without cannabis legalization, it’s way easier to walk into a doctor’s office and get a prescription for opioids, than it is to get cannabis. That’s insane. It should be the opposite. The Silk Road site bucked cannabis prohibition and made cannabis available to pain patients who wouldn’t have had access to it otherwise. I want to continue that mission — but within a legal framework.”
Consistent with its mission to provide medical alternatives to prescription opioids, David Kram’s Silk Road is creating vape pens that, he says, are designed in every aspect, from the cannabis sourcing, to the delivery hardware, to the dosing precision, to be friendly to medical patients.
“This is a market that, because of its origins, is largely dominated by companies that choose to cut their products with synthetic additives in order to increase their margins. Those who chose to not focus on whether they’re selling a quality and clean, pesticide-free product because it’s more expensive to do it in a good way. And those who chose to use these vape pens from yesteryear that come from the e-cigarette industry, that are cheap and from China, using things like cotton wicks. They’re made with so much plastic inside that when you heat it up using cannabis oil, the cannabis oil burns because the temperature is too hot in the vape pen and you basically inhale chemicals and parabens and BPA because you’re using an e-cig with a cannabis extract.
“What differentiates us on the product level is that we focus on best-in-class vaporization technology, that is literally built for cannabis extracts, and not e-cigarette pens. It uses a ceramic heating element that doesn’t burn, doesn’t leak, doesn’t erode any plastic. We found a hardware provider that we partnered with that had the highest-end vaporization technology available on the market today, which is what we wanted to go with. It is probably the most expensive hardware out there, but we did not want to sacrifice for quality. We truly wanted to have the best experience for our customers even if it meant that our margins would be cut in half because we’re paying double for our hardware. I think experience really matters, and if we can introduce really high quality oil, it should be paired with a really high quality vaporization technology.
“I’ve been lucky enough to be in California for eight years now and I’ve tried pretty much every cannabis product on the market in the last eight years. I really haven’t been satisfied with all the other cartridges and vape pens out there. Most of them make your throat itch or it makes you cough incessantly or it tastes like plastic or tastes like shit. So what we saw was an opportunity to level up and increase the quality of what was being put out there in front of consumers, especially consumers that are new to cannabis and haven’t yet experienced any cannabis product. They need to come into this market and really have a quality, safe, healthy option.”
Riding the Anti-Opioid Cannabis Wave
If what Kram says is true — that his is the only cannabis company focused specifically on counteracting the opioid crisis — then he’s caught onto a big wave, first.
States across the country, desperate to find solutions for the overdose crisis facing their clinics and their morgues — are looking at marijuana as a potential route to solving the problem.
And David Kram has someone else on his side of this issue: Dr. Sanjay Gupta. The famed CNN doctor has become a passionate believer in the potential of marijuana to stem the opioid crisis. In an open letter to Attorney General Jeff Sessions, he writes:
These are desperate times, and while some may consider making medical marijuana widely available to be a desperate measure, the evidence has become increasingly clear of the important role cannabis can have.
We have seen real-world clues of medical marijuana’s benefits. Researchers from the Rand Corp., supported by the National Institute on Drug Abuse, conducted “the most detailed examination of medical marijuana and opioid deaths to date” and found something few initially expected. The analysis showed an approximately 20% decline in opioid overdose deaths between 1999 and 2010 in states with legalized medical marijuana and functioning dispensaries. . . . Though it is too early to draw a cause-effect relationship, these data suggest that medicinal marijuana could save up to 10,000 lives every year.
Cannabis and its compounds show potential to save lives in three important ways. Cannabis can help treat pain, reducing the initial need for opioids. Cannabis is also effective at easing opioid withdrawal symptoms, much like it does for cancer patients, ill from chemotherapy side effects. Finally, and perhaps most important, the compounds found in cannabis can heal the diseased addict’s brain, helping them break the cycle of addiction.
Mr. Sessions, there is no other known substance that can accomplish all this. If we had to start from scratch and design a medicine to help lead us out of the opioid epidemic, it would likely look very much like cannabis.
The reason Dr. Gupta is addressing Attorney General Jeff Sessions is that Sessions, to put it politely, has his head up his ass about the relationship between opioids and cannabis. At a conference in which he stated his goal of reducing opioid prescriptions in 2018 (which is almost cetainly not going to be achieved,) he said, in relation to the opioid crisis, that “a lot of this is starting with marijuana.”
That is an absolutely outrageous statement. As we’ve seen, the source of opioid prescriptions are — surprise, surprise — the doctors prescribing them, all supported by the pharmaceutical marketing budgets and sales forces encouraging them to push painkillers onto patients who don’t need them, and completely condoned by the law enforcement agencies that Sessions oversees.
When the boss of the DEA, failing to stop this massive legal trade in pharmaceutical smack, blames marijuana for the problem, you might want to look at your calendar and see if you’re living in the year 1984.
As Richard Friedman, a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College, commented in the New York Times about this absurd statement by Sessions:
There is a relationship between cannabis and opioids, but Mr. Sessions has it backward. Marijuana isn’t a gateway drug to opioid addiction; it’s a safer alternative to pain medicines. Mr. Sessions’s vow to crack down on marijuana will only make the opioid epidemic worse.
We know that 40 percent of all opiate overdose deaths involve a prescription opiate. So having legal access to cannabis as another option for pain relief may actually reduce consumption of opiates.
It isn’t just CNN’s doctor, Sanjay Gupta, or Dr. Friedman on the op-ed page of the New York Times who are enraged at Session’s retrograde anti-pot stance in relation to the opioid crisis.
Here’s a rant in national media that got me hopeful. Not because of the content (which I agree with,) but because of its source (wait for it…. wait for it… I’ll reveal in a moment… ) The rant went like this:
It’s very straight forward and Attorney General Jeff Sessions and his anti-pot crusade are on the losing side of the argument.. . . As plain as the green on your reefer, two studies show a direct correlation between marijuana and opioid use. One shows states with legal cannabis have 2.2 million fewer daily opioids prescribed and the other a 25% drop in opioid overdose deaths in places with medical pot laws.
What does Jefferson Beauregard Sessions say about that? He kind of shrugs and says he doesn’t think that will be sustained in the long run. Jeff Sessions won’t be sustained in the long run because his ass-backward anti-liberty thinking is the very thing that’s getting people killed!
The more we study cannabis, the more it can be refined and used to treat medical conditions. And boredom. The longer we protract the immoral drug war, the more decimation we’ll see in inner cities and rural communities that are hit hardest by supply-side drug combat that has been proven fruitless.
Jeff Sessions needs to do the right thing and admit he is wrong, but he won’t, so instead he has to go. Hopefully the next AG will be a force for good and not a cesspool of backward-thinking, bad drug policy.
Where did this rant appear? On the pages of High Times magazine? In a newsletter from the National Organization for the Reform of Marijuana Laws (NORML)?
No, it was from Lisa Kennedy Montomgery, on Fox Business.
When CNN and Fox hold up the same politician as an enemy on a major issue, and agree passionately on a solution to that issue — the power of pot as an antidote to the opioid epidemic — there just might be something there.
And David Kram is well positioned to be the cannabis industry’s voice on the matter.