05 Jan 2018
Meet Roger Crystal MBA2009, an LBS alumnus whose company developed a nasal spray that revives people overdosing on heroin
‘Tell patients to eat more ice cream’: that was Roger Crystal’s advice to the US government on America’s opioid epidemic. He wasn’t being facetious
– the former surgeon and now CEO of California-based, NASDAQ-listed company Opiant Pharmaceuticals was deadly serious.
While testifying to President Donald Trump’s Commission on Combating Drug Addiction and Opioid Crisis at The White House in September 2017, Crystal – a former ENT (ear, nose and throat) surgeon – explained how British and US medics differ when treating patients who need pain relief after having their tonsils removed.
In the UK, patients are advised to take paracetamol or ibuprofen and eat soft foods such as ice cream. American doctors routinely prescribe addictive opioid painkillers, such as OxyContin or Vicodin, for 30 days, which is long enough for someone to become dependent on them.
The US government has encouraged American doctors to prescribe less opioid medication in recent years. But people who are already addicted to them will often take other opioids that are cheaper and easier to source, such as heroin and fentanyl – which is 50 times more potent than heroin. In 2016, there were 53,000 opioid-related deaths, 40% from fentanyl, across the US.
“It’s worse than the AIDS crisis of the 1980s,” says Crystal, an MBA graduate from London Business School (LBS). His company Opiant Pharmaceuticals has developed NARCAN Nasal Spray, an emergency lifesaving treatment that re-establishes a regular breathing pattern in someone overdosing on opioids.
“More Americans die from opioid overdoses than from gunshots and road traffic accidents – it’s the biggest killer of men aged below 50,” Crystal says. “US life expectancy is 2.5 months lower as a result of the opioid crisis.”
Despite the dangers, doctors still commonly prescribe opioids to patients, often for several weeks. Why? One reason is that hospitals receive incentive payments from Medicare and Medicaid – federal government programmes providing health care insurance for millions of Americans – based on positive patient satisfaction surveys. These questionnaires ask people how they feel their pain was controlled and whether providers did everything to ease their discomfort.
No quick fix to opioid epidemic
Crystal and the US government agree that curbing prescriptions will help. But tackling an epidemic in a country with more than 2.5 million opioid addicts won’t happen overnight. “In the US, only one in nine addicts gets the right treatment,” he says. “Imagine if you said that about people with cardiovascular disease or cancer – you wouldn’t believe it. Most people who become addicted to opioid painkillers don’t take them to get high, they take them because their doctor told them to. They don’t realise they’re addicted until it’s too late.”
In the short-term, Opiant Pharmaceuticals’ NARCAN Nasal Spray can help reduce the number of fatalities caused by overdosing. The company’s nasal spray delivers naloxone quicker and easier than a syringe, making it simpler for someone to administer.
“Every second counts; the longer it takes to receive naloxone, the greater the chance of someone dying from an overdose or suffering brain damage from a lack of oxygen,” Crystal says. “In the past, you’d call an ambulance and wait for the paramedics to arrive to either give a naloxone injection on the scene or take the person overdosing to A&E. That all takes time, which could prove costly or even fatal. But now naloxone can be administered much quicker through the NARCAN Nasal Spray.”
Opiant Pharmaceuticals is developing other medications to treat disorders, such as alcohol addiction and bulimia, by targeting the brain’s reward centre (see How opioids affect the body). With clinical trials underway, these products could be submitted to the US Food and Drug Administration within three to four years. Crystal and his team are also working on a heroin vaccine, which makes people who inject the drug immune to the high.
From the surgery table to the boardroom
Crystal has travelled far, both geographically and professionally, since practising as a surgeon in the UK. While on duty at University College London during the London Bombings in 2005, Crystal recalls treating a heroin addict who had contracted a flesh-eating infection from a dirty needle. The addict, who was lying on a bed with his liver and intestines exposed, could only think about his next fix.
The incident inspired Crystal to help addicts on a population scale rather than treating then individually in hospital. “You can only do so much at a doctor-patient level, so I wanted to make a bigger impact,” he says. “Academic research is one way to do that, but I’d always been interested in business and thought the best route in was to do an MBA.”
He quit his job in 2007 to study at LBS. After graduating at the peak of the financial crisis, he did an M&A internship at Goldman Sachs, before working in management consulting at A.T. Kearney and business development at GE Healthcare. Crystal was also “moonlighting” as the CEO of Opiant Pharmaceuticals (then called Lightlake Therapeutics), when the company was in its infancy and only needed a part-time chief executive. He was still based in the UK, which made things challenging.
“You just don’t sleep,” he says. “I worked evenings and weekends and took annual leave to make it happen. The advantage of being in the UK was I could come home from work and then crack on with Opiant for a few hours because of the time difference in the US. I have a very understanding wife.”
When Crystal joined Opiant Pharmaceuticals, the business was developing a treatment for a binge eating disorder and doing trials in Finland. By 2012, the company had begun working on its NARCAN Nasal Spray, just as Americans were waking up to the national opioid crisis. In 2014, Crystal moved from GE Healthcare to California to work for ImaginAb – a Los Angeles-based biotech company – before becoming Opiant Pharmaceuticals’ full-time CEO.
Helping opioid addicts in the US is immensely rewarding, but Crystal doesn’t see himself as special or unique. “It’s a privileged position to be in, but you can’t have any expectations or a sense of entitlement when starting out,” he says.
“Presenting at the White House and being thanked publicly by a member of the President’s Opioid Commission for saving so many American lives was certainly a ‘pinch myself moment’. However, our work isn’t done – we need to develop new treatments.
“Opioid overdose is the unfortunate downstream consequence of opioid addiction, but now we need to go upstream and tackle the addiction itself.”
How opioids affect the body
The body has many receptors that switch on our brain’s natural reward system, which is why we feel happy after eating a good meal or having sex. Opioids mimic the body’s natural receptors, giving someone an overwhelming sense of euphoria when the drug takes effect. They also make people feel sleepy and can slow or stop their breathing, causing brain damage, coma or even death.
More than 100,000 Americans have died from opioids since the late 1990s, according to a 2014 report by the American Academy of Neurology. People aged 35 to 54 are at highest risk of abusing opioids.
Another study, from the US Centers for Disease Control and Prevention, finds that people who abuse opioid painkillers are 40 times as likely to take heroin. Nearly half of the young people who admit to injecting heroin when surveyed by the National Institute of Drug Abuse say they abused prescription painkillers before taking heroin.