Multiple waves of drug addiction have swept the United States in the last 40 years: the post-Vietnam War heroin epidemic, the rise of crack cocaine in the 1980s and ‘90s, and the current crisis around heroin and narcotic painkillers.
“This epidemic dwarfs the other two epidemics because it has something that the other two epidemics didn’t have, and that’s a feeder system called the misuse and abuse of prescription opioids,” says Gary Tuggle, special agent in charge of the U.S. Drug Enforcement Administration’s Philadelphia Division. “This current epidemic is the worst in this country’s history.”
The DEA recently launched a new effort to tackle heroin trafficking and abuse that combines criminal investigations with outreach to health care providers, community groups, and citizens. Tuggle appeared on KET’s Connections to discuss that strategy and his perspectives on the current drug scourge. The conversation is part of KET’s Inside Opioid Addiction initiative.
White Coat Drug Dealers
“This country has an insatiable appetite for drugs, both licit and illicit,” Tuggle says.
To illustrate his point, Tuggle says enough opioid prescriptions were written in 2012 that every adult in the United States could have their own bottle of painkillers. Furthermore, he says Americans consume 99 percent of all the hydrocodone produced in the world.
But what can start as a legitimate need for relief from pain can have dangerous and far-reaching consequences.
Federal officials estimate about 75 percent of heroin users today started down the path to addiction by abusing opioid-based painkillers they received from family members or friends, or by personal prescription.
Tuggle says some 1.6 million pharmaceutical companies, pharmacists, physicians, hospitals, and other medical practitioners are registered with the DEA to produce and distribute controlled substances. Of that number, Tuggle says less than 1 percent are so-called “rogue” doctors who are improperly prescribing prescription painkillers like Vicodin, Dilaudid, or OxyContin. He blames them for creating a new subculture of heroin addiction in the U.S.
“These are folks that hide behind degrees and stethoscopes,” Tuggle says. “That in my opinion makes them no better than the guy or the girl standing on the corner selling heroin. I call them white coat drug dealers.”
Recent reports indicate that doctors are finally writing fewer prescriptions for opioids, yet the overdose death rate continues to increase. Tuggle attributes that trend to the fact that more people are moving from abuse of medicinal opioids to heroin, which he says is cheaper and more potent.
The Push for Purity
Tuggle says today’s crisis differs from the earlier drug epidemics in two other significant ways. On the trafficking side, Tuggle says drug kingpins used to maintain tight control over the entire supply chain from production in Colombia to street-level sales in the United States. Now, he says Mexican drug cartels will deal with multiple brokers who handle distribution within the U.S.
That’s made the DEA’s work that much harder because there’s more competition among dealers. Tuggle says his agents can clear a neighborhood of drug runners, only to have other sellers move into that territory once his officers leave. He says if there’s enough demand for drugs, somebody will move in to fill the void.
Another key difference is the purity of illicit drugs on the market.
“Twenty years ago when I was a young agent, we saw street purity levels at an all-time low and prices at an all-time high,” Tuggle says.
In those days, Tuggle says a kilo of heroin could sell for more than $150,000 but have a purity level of less than 40 percent. Today, heroin costs about $60,000 a kilo and is 90 percent pure. The competition to deliver a purer product, and therefore stronger highs, has resulted in some dealers cutting their heroin with other drugs such as Fentanyl, which Tuggle says is 80 to 100 times more powerful than morphine.
It’s also more deadly.
Addicts who think they’re injecting heroin but may unknowingly take a mixture of heroin and Fentanyl can suffer respiratory failure and death. The Kentucky Office of Drug Policy’s 2015 Overdose Fatality Report cites 420 deaths related to Fentanyl. That’s slightly more than a third of all overdose deaths in the commonwealth last year.
Tuggle says clandestine Fentanyl is produced in Mexico, China, and other Asian countries, and is readily available for purchase on the internet. But for some dealers and addicts, Fentanyl may not be strong enough. Tuggle says he’s seeing evidence of new synthetic narcotics normally used to anesthetize elephants and rhinos hitting the illicit market. He says these drugs, with names like Carfentanil, W18, and U-47700, are 10,000 times more powerful than heroin.
The DEA Response
Tuggle says his agency’s mission is to catch the “biggest and baddest” drug traffickers. But law enforcement officials recognize that strategy may not be enough to combat the current epidemic.
Last winter, the DEA launched “360 Strategy,” a pilot program that’s designed to take a more holistic approach to drug trafficking and abuse. The initiative focuses on three areas: beefing up enforcement efforts on all levels of trafficking as well as gang-related drug activities; encouraging responsible production and prescribing of opioid drugs by the health care and pharmaceutical industries; and education and outreach efforts to engage citizens and community partners in the fight against illicit narcotics. Tuggle says involving more people in prevention and treatment will impact the demand side of the drug equation.
“We’re in the game of denying revenue to drug traffickers,” says Tuggle. “If we can do that by preventing people from using in the beginning or treating those who do use and stop them from using, then that denies revenue to the upstream drug trafficking groups.”
Tuggle admits the heroin and opioid crisis isn’t going away any time soon, but he says the 360 Strategy is an important step in breaking the long-term cycle of substance abuse.
“If we can impact it in this generation so that we can protect the next generation, I think we’ll start to see some real outcomes,” says Tuggle.