Wisdom Shared with Carole Blueweiss

Retired FBI Agent Reflects On Opioid Crisis

Episode Notes

Episode Summary

Our last episode explored addiction from the perspective of loved ones. In this episode, we are looking at the opioid crisis from the point of view of a retired FBI agent, Aaron Weeter, who spent 25 years specializing in drug-related crimes. From his frontline perspective, we learn how the opioid epidemic of the 90s spread to become the fentanyl epidemic we have today. 

For the visually-minded who prefer to listen and read or for those who need closed captioning, watch the transcript video here: https://youtu.be/oXq6XJ_z-HI

About Aaron Weeter

Beginning in 1998, Aaron served for over 23 years as a Special Agent in the Federal Bureau of Investigation's Washington, D.C. Field Office.  He served for twenty years as a case agent and three years as a supervisor investigating matters primarily involving white-collar/financial crimes in the areas of healthcare fraud and prescription drug diversion and distribution.  During this time, Aaron also worked on a variety of national/office-wide cases including the 9-11, D.C. Sniper and January 6th investigations among others.  Aaron is a licensed Certified Public Accountant (CPA) and a Certified Fraud Examiner.  He retired from the FBI in late 2021 and recently started a fraud consulting business.  Much of Aaron's FBI investigative work focused on the illegal distribution of pharmaceutical narcotics and other controlled substances by physicians, pharmacists and street-level dealers.  He opened his first "pill case" in early 1999 in the early stages of what would become the pill epidemic and through dozens of cases thereafter, had a window into the evolution of the pill epidemic and its influence on the current fentanyl epidemic gripping the U.S.  

More to Watch and Read

Chasing the Dragon: The Life of an Opiate Addict - a documentary made by the FBI & DEA

Dr. Feelgood: Dealer or Healer? - a documentary about Dr. William Hurwitz, a Virginia physician who served nearly five years in prison for drug trafficking

Anonymous Sister - a documentary where director Jamie Boyle explores her family's collision with the opioid epidemic

All the Beauty and the Bloodshed - a documentary about artist and activist Nan Goldin and her personal fight to hold the Sackler family accountable for the opioid overdose crisis

Demon Copperhead by Barbara Kingsolver - a novel that shows the devastating impact of the opioid epidemic on a young boy in Appalachia

Dopesick: Dealers, Doctors, and the Drug Company that Addicted America by Beth Macy - the definitive account of America's opioid epidemic

Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis by Beth Macy - a sequel to Dopesick

Dopesick - Hulu limited series remake of Beth Macy's book 

Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe - a book that describes the Sackler family and their role in the opioid epidemic

The Family That Built an Empire of Pain - article by Patrick Radden Keefe that led to the book

What Can Be Done?

Words Matter - Terms to Use and Avoid When Talking About Addiction



Fentanyl Test Strips

Find Narcan Near You

If you or someone you know is struggling with substance use disorder, SAMHSA's (Substance Abuse and Mental Health Services Administration) National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information. You can also visit https://www.samhsa.gov

How opioid addiction occurs - Mayo Clinic

List of Treatment Facilities and Support Groups

Drug Takeback Programs

Safe Drug Disposal

Related Episodes

Addiction to Sobriety: A Mother's Journey

Anonymous Sister

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The Wisdom Shared Team

Episode Transcription

[00:00:00] Aaron Weeter: The majority of what I learned wasn't learned in a book. You know, it was learned by talking to the people that actually used initially these medications and later fentanyl on the street, and that taught me more about drugs than I ever learned at the FBI Academy.

[00:00:23] Carole Blueweiss: Welcome to Wisdom Shared, where parents, children, and others on the front lines are the experts and where connection inspires change. I am your host, Carole Blueweiss. 

What do I do when I'm sitting in a van for five hours while on a family trip and next to me sits a former FBI agent? You guessed it. I ask a lot of questions. His name is Aaron Weeter, and the answers resonated with me. So I invited him to be my guest and share his frontline perspective.

I see it this way. In this day and age of AI and social media, misinformation is all over our computers. Eyewitness stories told by the people on the front lines are needed now more than ever. 

[00:01:06] Aaron Weeter: This pill epidemic is, they say, I think it's sometimes referred to drug abuse, you know, victimless crime. It's not a victimless crime. There are so many victims that you can hardly count all of them. 

[00:01:20] Carole Blueweiss: Aaron Weeter spent 23 years as an FBI agent at the Washington DC field office, working as a case agent for 20 years, and then three years as a supervisor overseeing investigations. Aaron focused on healthcare fraud and prescription drug diversion and distribution.

Most of his FBI work revolved around the illegal distribution of pharmaceutical narcotics and other controlled substances. He investigated the parties that were involved in the illegal activity, including physicians, pharmacists, and street level dealers. Retired FBI Special Agent Weeter is this episode's frontline expert. Can you explain what was this pill case? 

[00:02:06] Aaron Weeter: I worked healthcare fraud and prescription drugs fall under that healthcare net. And your prescription benefit plan through your insurance company covers the cost of those medications, and some of those medications are very expensive, both narcotic and non-narcotic.

What led us to become interested in it was the spike in distribution on the street of drugs like OxyContin and Dilaudid, particularly OxyContin. In the late 1990s, it was a very expensive drug from the standpoint of the pharmacy benefits that were being paid by the insurance companies, and we were seeing larger and larger quantities of this drug being prescribed, and then also larger quantities of this drug being distributed on the street.

In my assessment at the time, I hadn't had that much exposure in the late 1990s, which is when I also started as an agent. But it was different than what I had always thought drug investigations were all about. I always thought that drugs were in the city. It was just kind of stereotypes and things you grew up watching, maybe on tv.

The crime shows were always in the city, and what we were seeing was these drug cases were taking place all over the countryside now, into the counties and the suburbs, et cetera, and that the difference seemed to be that where people used to have to go to the city to buy drugs, they didn't have to go to the city anymore. They went to their doctor, they got a prescription. They went to their pharmacy, which is a mile or two away, picked up that prescription, and then the drug deal happened right there in the suburban parking lot.

[00:03:47] Carole Blueweiss: How does it come to you go to your doctor, you go to the pharmacy, get your medication. And then you go to the parking lot and make a drug deal. What's the link there? 

[00:03:54] Aaron Weeter: There were a couple types of patients. There were folks that were going there just purely to get the pills because they were addicted to other drugs. They were addicted to heroin. They were using heroin. They were using other people's pills, and they were routed to these physicians as places that they could go get their own supply, that they wouldn't have to buy off the street. Then there were also patients who had a legitimate injury who went there and needed help with their pain. And they were prescribed quantities of these medications and types of medications and combinations that quickly led to them becoming physically dependent. 

[00:04:31] Carole Blueweiss: Physical dependence on opioids happens when the body gets so used to the presence of these medications that the body needs them to feel normal. If someone is physically dependent, they might need more and more of the medication to get the same effect. And that is related to building tolerance.

[00:04:49] Aaron Weeter: As things went on, and obviously I'm not medically trained, but you know, I'll give you my nuts and bolts definition on physical dependence and addiction. To me, physical dependence is if you don't have the medications, you go through withdrawals, you feel terrible.

[00:05:05] Carole Blueweiss: They'll likely experience restlessness, trouble sleeping, depression, irritability, very significant anxiety, sweating, or even physical discomforts like muscle pain. I mention these, it gives a sense of how horrible withdrawal is and how important it is for someone going through it to have as much support as possible.

[00:05:26] Aaron Weeter: Where that crosses over for me to what I felt like somebody was addicted, those withdrawals and those urges were so strong that they did things that otherwise they would not have done, i.e. committed other crimes. Bought and sold other drugs. Those drugs or other drugs stole from friends and family or complete strangers and crossed the line that the drug had taken control of their lives.

Patients who went there initially with legitimate pain issues and became physically dependent and then crossed over kind of into an addictive state where they really just couldn't live without it and would do anything to get it. And those folks went from having pain to having another medical diagnosis, addiction, because of the quantities and combinations of drugs.

Then you had folks, like I said, that were just there to get the pills because they were addicted to, you know, pills and other drugs before they got there, and they were just there to get more supply. 

[00:06:26] Carole Blueweiss: You had recommended the movie Dopesick. Do you believe that that's realistic? Is that a good way for people to understand how something like this could happen and become an epidemic?

[00:06:36] Aaron Weeter: Oh, absolutely. Yeah. Dopesick is based on a real case. That was the case down in Southwest Virginia. The prosecutors who were featured in that case, and their real names, those are real people that worked those cases, Rick Mountcastle and Randy Ramseyer. And we interacted with them on our case on a limited basis because we were working in Northern Virginia on some of the doctors that were prescribing large quantities.

And a lot of those pills in Northern Virginia would sell for, an OxyContin 80 might sell for $40 a pill, but if you took it down to Southwest Virginia, you could sell it for $80. So a lot of our drugs that were originating in Northern Virginia were ending up in that area of Southwest Virginia. 

And in my assessment is they began to address the doctors down there that were responsible for the distribution in their area, the problem was still there because there was still flood of pills coming from other areas into their area 'cause the demand was there. They had developed a consumer base in Southwest Virginia that had a demand for the pills and was willing to pay more money than people would in other places. I did have doctors that I investigated and prosecuted in Northern Virginia that did have their own drug addictions to medications. So yeah, that definitely does happen. 

[00:07:52] Carole Blueweiss: Yeah, I thought that really elucidated to me the connection, how one thing led to the other. That brings me to the role of pharmaceutical companies. I wonder from that movie, let's just start there and then you can give us your inside scoop on that. What they depicted was a marketing campaign to doctors and that, not all doctors were doing this maliciously, because they believed that these medications would help people who had pain. 

Yet we see in Dopesick the behind-the-scenes marketing campaign. And what struck me was that they created these marketing papers and they actually called it research. They presented to the doctors and they just made a case for how this is a great drug. Tell us how something like that could happen. Doctors who are super intelligent, go through medical school, just didn't understand marketing, or maybe they did. So could you tell us your side, how you interpret all that? 

[00:08:49] Aaron Weeter: I feel like it was almost like a tidal movement, like a swell in the ocean that builds. In this case, Purdue Pharma, this drug, OxyContin, which otherwise had not been available. That opened up a whole new world.

And because these pills were supposed to be time release, in other words, you took an 80-milligram tablet, but you didn't get 80 milligrams of oxycodone all at once. But you could give one or two pills a day and you could take 'em every, you know, 12 hours instead of every four hours. 

[00:09:22] Carole Blueweiss: Theoretically, a time releasing pill for pain sounds great. And for many people, it was, especially in a controlled hospital setting. But the problem was that when the doctors were now handing out prescriptions with no assurance that the patient would adhere to the recommendations, and since these were highly addictive opioids, people were at risk for overdosing.

You get a time release over 24 hours of a heavy duty pain-relieving medication. But what if you take the 80 or 160-milligram pill and crush it and snort it or chew it? You are getting a super high amount of opioid into your system dangerously quickly. Because people who were addicted needed that drug.

[00:10:10] Aaron Weeter: There was a very different dynamic between a controlled environment and an uncontrolled environment, and as these drugs continued to be marketed to physicians and pharmacists as safe alternatives to treat pain in larger dosages, it just basically, you know, became a tidal wave of opioids into a market that had not been available to that market before, wasn't familiar with it. It created this massive population of people who became physically dependent and some crossed over to becoming addicted to these drugs. Then thereafter had a continuing need to have that medication or that chemical in their system. Which then logically, as things began to clamp down and physicians began to realize we can't just keep doing this.

[00:11:05] Carole Blueweiss: And at the same time, these pill mills were being investigated.

[00:11:09] Aaron Weeter: And the FDA took measures and the FBI and the DEA and Health and Human Services agents began addressing criminally the physicians, the pharmacists, and the pharmaceutical companies responsible for this, all of a sudden that supply starts to dwindle of prescription opioids, which just, I think then opens the gates to what's the alternative? 

The patients at that point who have become addicted, they still need that drug. And they're gonna get it, and that's where fentanyl starts to come in and there's no better way to tie that back to the pill epidemic than to look at where fentanyl is now.

Fentanyl is being distributed, in large part, in pill form. The fentanyl that people are taking is made to look exactly like prescription medications. In my mind, there's a direct tie between this pill epidemic that started in late 1990s and built through the early 2000s and mid 2000s.

And then pills became more difficult to get, and physicians stopped prescribing in the quantities and in perhaps in the manners that they were doing before. Fentanyl comes on in powder form, initially mixed into heroin, and then later with pill presses made to look exactly like that OxyContin that you used to use, or oxycodone.

[00:12:36] Carole Blueweiss: Am I right to say that there's no difference between taking it in pill form versus shooting it into your arm except for the maybe speed in which you get high? 

[00:12:45] Aaron Weeter: Well, it's interesting because the people that, and I've interviewed hundreds of people addicted to prescription drugs and fentanyl through my career, primarily prescription drugs, because fentanyl came on towards the latter part of my career.

But most of those folks draw a very strong line between taking the pills by mouth or crushing and snorting them or crushing, dissolving and injecting them. And they will be quick to tell you, oh, I don't shoot. I don't shoot my dope, I only snort. Or I only take 'em by mouth. Yeah, as far as mechanism to get it into your system, the direct injection is the quickest way, and then snorting and then perhaps chewing them and then just taking them by mouth orally, just swallowing them whole. That's kind of the hierarchy of things, the reverse hierarchy. Basically shooting is the quickest way to get it into your system. 

[00:13:39] Carole Blueweiss: So I still can't wrap my head around how the doctors, according to the Dopesick story, were being led by the marketing techniques of the pharmaceutical companies, that they didn't do their own research in their own medical journals to really understand what they were doing. They made it sound like they just believed this very sophisticated marketing campaign from people that weren't necessarily thinking of the patients in their best interests. They were more thinking about profits. Is that true or was it not that simple? 

[00:14:11] Aaron Weeter: Being a physician, not unlike being a police officer in today's world, has become a lot harder. But I feel like they're always very booked. At least when I make an appointment with a physician, they're always very booked. They have a 15-minute increment to see a patient, assess what's going on and make some medical decision-making to help that patient. 

They're required to assess pain as one of the things that they go through in that appointment, and as folks come in and the physicians are exposed to patients who have experience with narcotics, perhaps have experience going to a variety of different doctors to get narcotics. Patients become very adept to dupe the doctors, to tell them what they want to hear or need to hear in order to prescribe.

And the physician has a limited amount of time to make that assessment and make a determination. And so I think it is very hard for doctors to do that effectively. But I think in the case, what I've seen in a lot of internal medicine doctors, they just won't prescribe those types of medications and certainly not on a chronic basis.

What they have now added a prescription monitoring program. They can log in and if they were seeing me that day, they can actually put my information in there and see what prescriptions I have received for controlled substances within the last year, certainly, easily and quickly. It's real-time, and they can have that in front of them before they make a decision on what to do. But it's put just yet another thing on a physician within that 15-minute timeframe that they need to do to make sure that they're prescribing appropriately. 

I know some of them saw this as an opportunity to, you know, either transform their mediocre practice as far as from a financial performance standpoint into something that could boom almost overnight. There are also doctors who, as I was saying, are just so busy and they have such a heavy practice that they just didn't have time to independently research that, or didn't take the time to independently research that. 

In the days when there were yellow pages, I went through the pain management physicians and let's say there were 40 that were listed in the yellow pages, there were only three or four that I had ever heard of. There were practices and there were physicians always, even during that time of that heavy marketing by the pharmaceutical companies that did things the right way, because I never heard of them. And I did it for 20 years, and when I would hear about them, I would hear about them in a positive context. Oh yeah, we went to that guy. He wouldn't prescribe what we wanted. 

[00:16:51] Carole Blueweiss: So when you say you hadn't heard about them, meaning in the criminal justice system or?

[00:16:55] Aaron Weeter: Correct. I hadn't heard about them from state and local police officers who were interacting with their patients who, you know, on DUIs or distribution cases, I hadn't heard about them from insurance companies who said, hey, this doctor's all of a sudden prescribing huge quantities of medications and his practice has, you know, kind of blown up. I didn't hear about them in a criminal context. 

[00:17:17] Carole Blueweiss: You're saying like the majority of doctors were not falling into this trap of over-prescribing. However, just agree with me or disagree with me, goes to show how just a few bad apples can create a tsunami. 

[00:17:33] Aaron Weeter: Absolutely. When a single physician can prescribe millions of dosages of opioids per year with his or her pen, there's nothing that keeps them from adding another zero or adding a few more digits to the left of that comma.

And when they do that, they can absolutely flood the market. It was definitely a minority of the physicians who were responsible for the epidemic in my assessment, for sure. When we would take off some of these physicians and do search warrants of their offices, which would typically shut their practice down as far as the prescribing, all of a sudden, what you would hear within, you know, days and weeks from the streets was that pill prices had gone up because the bottom had dropped out of the supply market. 

There was a physician that saw over a hundred patients Monday after July 4th weekend. The average patient there was walking out with probably 200 pills of opioids, and all of a sudden, if you take those pills off the street for that day, imagine what the demand is still there.

The people that are consuming those pills and need those pills to avoid withdrawals are still going to want them. And if you take that quantity of pills off the streets, it has a real impact on price. 

[00:18:51] Carole Blueweiss: Could this have been handled differently? You talked about all of a sudden it was hard to get these medications. The price went up, and now you still had a problem of people that were addicted.

[00:19:01] Aaron Weeter: That's a huge question. That could be multiple podcasts, I'm sure. In hindsight, of course. It could have been done, what should have been done and when. This movement to treat pain was a legitimate movement, right? People should not have to suffer needlessly with pain. But the way the pharmaceutical companies, some of them looked at it, I think was this is an opportunity now for us to put medications out there that will purportedly address this movement or this need to treat pain, but not in a way that was necessarily sustainable or helpful or valid. 

And so was there a way that they should have caught this beforehand? I think you look at institutions and agencies like the FDA, DEA, who have some purview. And primarily I think that's at the FDA level as far as approving medications. DEA has within its purview, they have basically drug enforcement for illicit drugs and they also have DEA diversion, which handles pharmaceutical type medications and the control of those and the licensing, like I said, of physicians with DEA numbers. God, that's a tough question for me to answer. In hindsight, everybody should have seen this coming, but it built so quickly. 

[00:20:19] Carole Blueweiss: We didn't talk much about the pharmaceutical company. When you do look at the story of the opioid epidemic, there's one family that comes up and one company that comes up predominantly. Are there others that were involved, or was it truly the Sackler family and Purdue Pharma that was really responsible in many people's eyes? Is that a reality or is that a exaggeration? 

[00:20:44] Aaron Weeter: In a view from a thousand feet above it, it certainly seems that way. That this fire really started with the advent and the marketing of OxyContin. From there, what actually always puzzled me was OxyContin is a brand name drug. If you were paying cash for it at the pharmacy, you might be paying $15-18 for a pill. There was generic oxycodone available. And that was a generic drug, there were no trademarks or anything on that. Generic pills were available for less than a dollar a pill in a 30-milligram variety.

And so what we saw, as an accountant before I became an agent, kind of boggled my mind that people would pay $18 for a pill at the pharmacy when they could pay a dollar for a pill and get about half the dosage for the dollar. So why don't you just double, triple, quadruple your money on that and get the generic?

And what happened is once the abuse deterrent features were put into OxyContin, which happened later on, all of a sudden the market for OxyContin dropped off because people could no longer really effectively crush and snort them or crush, dissolve, and inject them. It was no longer abusable in the way it had been.

All of a sudden, people switched over to oxycodone 30s, the generics, which in my mind always made complete sense anyways. Why are you gonna pay 20 bucks or 18 bucks for a pill when you could pay a dollar and get just about as much? 

[00:22:13] Carole Blueweiss: First of all, if you could just clarify real quick the difference.

[00:22:16] Aaron Weeter: Sure. So oxycodone is the chemical name for the drug, the opioid that is in OxyContin. So OxyContin is a brand name that has layers within the pill that allow the narcotic contents to be dosed into the system over time. Oxycodone is the the chemical name for the drug, and it's available in generic as oxycodone.

[00:22:38] Carole Blueweiss: So which one was the one that was like $13 a pill?

[00:22:43] Aaron Weeter: OxyContin, the brand name. 

[00:22:46] Carole Blueweiss: So why did people not take the less expensive version? 

[00:22:50] Aaron Weeter: That's a great question. And it's like anything else, right? Just became like fashion. People wanted the green OC 80s. And that's what everyone wanted and felt was the best thing out there. It's the new brand that everybody wants to wear on the streets, and so people were drawn to what they knew to be the real deal, just like, you know, anything else in society. Fashion, cars. 

[00:23:18] Carole Blueweiss: Driven by marketing. 

[00:23:19] Aaron Weeter: Correct. Driven by marketing, right. So if you knew you were getting green OC 80s, that was the top of the top. That was the best of the best. And so demand for that was high and people were willing to pay more for that.

[00:23:33] Carole Blueweiss: So, it's complicated. 'cause first of all, the names are similar, and second, it's hard to wrap your head around buying a more expensive pill when you can get it for less. I wanna make sure that we get to the part of how this became an international situation.

[00:23:48] Aaron Weeter: The precursor chemicals that are used to create the drug fentanyl primarily originate in China. And those precursor chemicals are then brought into Mexico at this point in time. And the cartels are involved in the laboratories in which those drugs are created. Those pressed Fentanyl tablets are created and made to look like OxyContin 30s, the blues, basically they're a little blue tablet, or a little pale blue tablet depending on the manufacturer of the formulation. They can put the etching, the marks on 'em and make 'em look exactly what you'd pick up at the CVS after having a surgery. 

But yeah, the cartels basically in Mexico are taking those precursor chemicals, turning them into fentanyl and then pressing them into tablets, which they then through time tested means of tunnels, airplanes, mules, drug mules, in other words, people bring those across the border from Mexico and then distribute throughout the US. 

[00:24:53] Carole Blueweiss: How did they do that so easily? 

[00:24:55] Aaron Weeter: I don't know if it's easy. It's certainly dangerous and it's certainly arduous, painstaking to get the precursor chemicals, to manufacture them in the laboratory, to compete with the other cartels to protect their product, to get their product from point A to point B.

The United States has a long border with Mexico, and this is not something new to our country or theirs. A means of, you know, tunneling underneath, going over top, or transporting through our border crossings. There are a lot of ways that they can, you know, get those across the border. And typically they're not transporting, it's, it is not a tractor trailer full of these medications. 

I've seen fentanyl coming in basically cast figurines where crack the figurine open and they're all, you know, stuffed into baggies there, shrink wrapped, you know, they tried to eliminate the scent for drug sniffing dogs. Vehicles coming across the border are very frequently used and they have compartments, hidden compartments in them and places where the border guards have to be trained and understand and figure out.

But if you think about the volume of traffic that's transmitting between Mexico and the US legitimately, and you think about what it takes to bring a thousand pills, you can fit a thousand pills into a very small container. It doesn't take a lot of space to get that over, and they'll certainly recruit people to do that work.

You know, one of the methods was they would have people, drug mules. Those are people that literally would take drugs and they would be put inside of either condoms or other kind of latex packaging, and they would swallow these drugs and they would swallow dozens and dozens of packages into their system and they would basically come across the border.

How are you gonna find that short of an x-ray? Right? And short of intel that person is carrying those drugs on them. And literally those drugs work their way through the person's GI system, come out the other end, and then are distributed from there. So there's no lack of rudimentary or sophisticated techniques to get the drugs across.

[00:27:09] Carole Blueweiss: China is the country where it starts. 

[00:27:13] Aaron Weeter: Correct. From what I have read and understand, China is basically the primary source for the precursor chemicals. And the US has taken steps. There was a recent article, I think, where they took steps and, and put sanctions against individuals and companies that the US had identified in China who, you know, manufacture and import these precursor chemicals.

But again, you're trying to control something that's really outside of our country and work with a country like China where it, it's not like working with Canada to our North or even Mexico to our South. It's a different, whole different type of relationship. 

[00:27:49] Carole Blueweiss: And this, is this specific to this opioid crisis, these pill cases, that it's a China connection?

[00:27:55] Aaron Weeter: These drugs, when you talk about opioids, many of them originate from the poppy plant. And poppy plants have been grown through the centuries throughout I think Southeast Asia, the Middle East. Afghanistan, at one point, was a major supplier of those plants. Those opium poppies do have a legitimate basis for growing them and turning them into pharmaceutical grade, you know, medications that help people who need treatment for their pain. But they can also be turned into heroin. And so there has always been a network, you know, in Southeast Asia and also, you know, the Middle East.

[00:28:35] Carole Blueweiss: Because fentanyl isn't coming from the opioid plant. 

[00:28:38] Aaron Weeter: It's created synthetically with chemicals, yes. Not with a natural substance to start with. So you have synthetic opioids and then you have natural kind of opioids. And I think the basic difference there is one is coming from the opium poppy and the other is coming from some mixture and formulation of chemicals.

[00:28:56] Carole Blueweiss: And oxycodone and OxyContin were which one?

[00:29:00] Aaron Weeter: I believe they consider oxycodone to be a semi-synthetic opioid. 

[00:29:07] Carole Blueweiss: And then Percocet. Where does that fit into this vocabulary? 

[00:29:11] Aaron Weeter: Percocet is something that is available in, you know, much smaller dosages of oxycodone. So 5 milligrams, 7.5 milligrams. I believe there might be a 10-milligram version of Percocet as well. But Percocet is mixed with, the formulation it's oxycodone and it has acetaminophen in it as well. So Tylenol. Yeah, so it's a combination drug. 

[00:29:34] Carole Blueweiss: That was abused as well.

[00:29:36] Aaron Weeter: It was, but it wasn't as popular because number one, it was a much bigger tablet than an OxyContin 80, even though it had a one-sixteenth quantity of narcotic in it. It had all of the acetaminophen in the Percocet tablet, so it was a larger pill. And people don't wanna snort acetaminophen, and they didn't want to inject acetaminophen. And then the other issue with taking it in quantity by mouth is acetaminophen has liver toxicity. You really start to damage your liver if you take too much of it. 

So in order to get as much oxycodone as one 80-milligram OxyContin, you'd have to take 16 Percocet. And doing that on a chronic basis, number one, they were huge tablets comparatively. And number two, you're taking in all the acetaminophen and creating all these other issues for yourself. 

[00:30:30] Carole Blueweiss: Which, but I think of people that abuse drugs, they don't think about their livers right? 

[00:30:33] Aaron Weeter: Probably not over the short term, but it probably would create issues for, you think about taking 16 of these giant pills.

[00:30:41] Carole Blueweiss: Yeah, now that the visual helps. 

[00:30:43] Aaron Weeter: Versus taking one. You have folks that are younger and newer to maybe the party and drug scene, Percocet might be something that people are familiar with by name that their mom took or their dad took after a foot surgery. And so I think there's certainly a risk that a Percocet that's distributed at a party is actually a Fentanyl tablet because it's thought of as a lower level drug as far as levels of abuse. 

So it's not sought after by folks that want to crush and snort. It's sought after by people legitimately who have pain and are getting a Percocet by prescription as prescribed by their doctor. And/or maybe at parties. Oh, it's just a Percocet. It doesn't have that much, you know, stuff in it. It's weak relative to the other stuff. And so I could see where it might have an appeal as something to distribute at a party. 

And the problem with that, of course, is that maybe that one quote unquote Percocet with fentanyl that he got made him feel great. The next one that he gets comes from a completely different source and manufacturing process through, again, China, Mexico, across the border, and it has five times as much fentanyl as the first one, and they're overdosing and dead at that point. There's no control over what's in that pill.

Also you had mentioned, what should you do with medications that you have in the house that are left over, perhaps from a surgery that you had to ensure that those aren't taken by anybody else? I definitely recommend getting rid of those. I recommend keeping them locked up when you do have 'em, even when you are taking them. It's just a good idea to keep those things locked up. And I know that's inconvenient, but it may be very important depending on your situation. 

And then if you do not finish using all the medications, look for ways to return those. Again, the DEA Diversion site should point you in directions. Health and Human Services website, if you did a search on there for drug take-back programs within your own community. Take what you don't need anymore and make sure it gets disposed of properly. The days of flushing things down the toilet, nah, that's probably not the best idea.

[00:33:03] Carole Blueweiss: The Adderall and the Ritalin, how does that fit in? Similar to the opioid issue or is it completely different? It's a stimulant. It's not an opioid. 

[00:33:12] Aaron Weeter: Right. It's a stimulant. It has a different impact on the body and the mind. But is it distributed in similar ways? Yes and no. I mean, certainly at parties, I think you'll run across Xanax for sure. Adderall is another one that you'll often run across. And oxycodone, just depends on who shows up to the party and what they have. 

[00:33:32] Carole Blueweiss: Those could be laced with fentanyl as well. 

[00:33:34] Aaron Weeter: Absolutely. Absolutely. And I think nowadays if you are being offered them at a party, you have just as much reason to believe that they do have fentanyl in them than you do to to think they don't. I just recently talked to a colleague of mine who's still doing this type of work, and he said it's just pretty much all of what's being seen out there is illicit, as far as what's on the streets in the form of pills. We're not seeing the real oxycodone 30s or the real OxyContin 80s or the real Adderall tablets or Valium tablets, as much as we're seeing pills and tablets that are made to look exactly like it but don't have the actual pharmaceutical ingredient in it. They actually have fentanyl instead.

It's talking to the people on the street who are struggling with the addiction that teaches you the most about every aspect from enforcement and what works, what doesn't. People write me. I, you know, got Christmas cards from people who thanked me and would say, hey, you know, the only reason I'm alive is because you arrested me.

And it was a woman who spit on me as I took her to jail. And she absolutely hated me. And, you know, after she ended up serving her time and got out, I got a Christmas card from her later. I saved that. I can assure you there are many others who would've never sent me a Christmas card and who despised me.

I got one that was a, I think a handwritten letter from another family member whose wife had overdosed and died, who thanked me for working that case. And it's not as surprising to get a letter from a victim. It was definitely surprising to get a letter or a card from someone who I had arrested. A lot of those folks did kick their habit at least for a time after getting dried out. It certainly wasn't fun. 

[00:35:30] Carole Blueweiss: Thank you for bringing light to something that you hear about in pieces, and it's hard to get the whole story, the deeper look into what happened, what is happening, and hopefully this information can help people one way or another. Is there anything you wanna say that I haven't asked you?

[00:35:45] Aaron Weeter: This is just my perspective. I'm retired from the FBI I'm not giving any opinion on behalf of the FBI. But I think anybody that has worked opioids, pill cases, fentanyl for a period of time, will agree that it is a huge issue in our country. It is an epidemic and it is terribly sad to see, you know, all the impact it has had on our country. And deaths just continue to escalate and I wish I had the solution. 

I wish I knew exactly how to fix this problem, but I certainly don't think only enforcement of our laws in this country that's going to help this issue. But I do think it's an important part of it. We have to stem to some degree this constant flow of drugs out onto the streets and into the hands of those who really don't have the capacity to assess what it's gonna do to them or where it's gonna take them. And from our children to our parents, doesn't matter. They're all impacted by the opioid epidemic. I hope we continue to work on it on multiple fronts.

[00:36:52] Carole Blueweiss: In this episode, we heard about how the opioid epidemic of the 90s spread to become the fentanyl epidemic we have today. Fentanyl overdose death rates have tripled from 2016 to now. More than a hundred thousand reported fatal overdoses related to illicit fentanyl in a one year period. 

Addiction and overdose can happen to anybody. If you buy pills from any source other than an accredited pharmacist or licensed doctor, chances are they will contain fentanyl. These street pills look exactly like the real Percocet, Xanax, Adderall, and others, but they aren't the same at all, and it takes just a little fentanyl to cause a potentially deadly overdose.

There is good news here. There's a product that is now available at most pharmacies, and it's available to anyone without a prescription. It's safe and it can actually reverse an overdose if given in a certain window of time. That life-saving product is called Naloxone, which comes in an easy-to-use nasal spray called Narcan.

Narcan fits into a pocket or a purse, and it's designed to be easy to use even by people without medical training. And if you use Narcan on someone who you think has overdosed on opioids, but that person has no opioid in their system, no harm is done. Having Narcan in your pocket can save a life. It's been hailed a miracle drug, but this is the thing. The miracle isn't just in the saving. It's in the simple act of caring enough to be prepared. So go out to your pharmacy and keep Narcan close just in case. 

If you or someone you know is struggling with substance use, you are not alone. The Substance Use and Mental Health Service Administration national helpline is 1-800-662-HELP, and it's available for support. This and other resources can be found in the show notes. 

The next episode of Wisdom Shared, we will hear how Aaron used undercover agents, how he found his informants, and much, much more. 

[00:39:16] Aaron Weeter: The majority of folks that we used to record their interactions with the physicians were existing patients. We did, however, use undercover officers as well.

[00:39:25] Carole Blueweiss: You don't want to miss this. Thank you so much for listening to Wisdom Shared. If you enjoyed this episode, please be sure to check out all the other episodes. Go to caroleblueweiss.com or wherever you listen to podcasts. If you like what you're hearing on Wisdom Shared, please spread the word and share this podcast with your friends. Leave a review and subscribe so you can receive wisdom every month. Thanks for listening.