DEA Presentation on Heroin and Opioids

All that I can say is WOW!  This afternoon at WMHS, we had a continuing medical education session with well over two hundred attendees, most of whom were clinicians.  The presentation was made by Charles “Buck” Hedrick, who works in Intelligence for the U. S. Drug Enforcement Administration and is based in Baltimore.  Buck provided a wealth of information and answered many great questions that followed from the audience.  

Virtually everyone who is involved with the Opioid / Heroin Crisis facing our community was in attendance.  There were law enforcement officers, psychiatrists, trauma surgeons, primary care physicians, hospitalists, nurse practitioners, dentists, ED staff, nurses, crisis counselors and Allegany Health Department staff in attendance.  

Some of the information that he shared included: 

• the USA has 5% of the world’s population, but we use 80% of the opioids and 99% of oxycodone
• there are 24 health departments and over 500 law enforcement agencies in Maryland so teamwork is key as has been the case in Allegany County
• Baltimore is almost exclusively western Maryland’s source for heroin
• the introduction of Fentanyl has set this epidemic apart from the others that began once soldiers started to return from Viet Nam
• Fentanyl is used to enhance poorly produced heroin and it is a killer
• there are over 100,000 clandestine labs in China producing drugs like bath salts and fentanyl
• the DEA has three offices in China
• one kilo of heroin can be bought for around $50K at the Mexican border but it can be cut 3 to 4 times with items like milk sugar and children’s laxative
• you can buy one kilo of fentanyl online for about $3500
• the world’s heroin comes from Southeast and Southwest Asia, South America and Mexico where the poppy crop grows the best
• the DEA has a drug monitoring program where they buy heroin in Baltimore for the sole purpose of testing it to determine where in the world it is coming from

The most interesting piece of information was that 95% of the heroin coming into the US comes from Mexico via three routes: Interstate 5 to San Diego, Route 85 to El Paso and Interstate 35 to Laredo, Texas. (This should be reason enough to better control our southern border.)

Throughout his presentation, Buck repeatedly emphasized teamwork, the sharing of best practices, the need for medical school training of new physicians on prescribing, the success with using peer recovery specialists who can relate very well to those who are addicted, the benefit of mandatory prescription drug monitoring in Maryland, and law enforcement involving the DEA once leads are obtained.  

When an overdose occurs, it is first a medical emergency and then a crime scene. Sharing information and leads among law enforcement with the DEA can be most helpful in addressing the criminal side of this issue.  I, along with the rest of the audience, could have listened to Buck all day.  Like Jimmy Pyles and Sheriff Robertson, who lead many of local efforts on this subject, Buck was a wealth of information and brought a very global perspective to this crisis.