The following are remarks by Zachary T. Fardon, United States Attorney for the Northern District of Illinois, as prepared for delivery at Northwestern University Pritzker School of Law's "Opioids: An Interdisciplinary Symposium," on Oct. 20, 2016:
Thank you Professor Geraghty for that kind introduction, and thank you Northwestern for having me. It’s great to be here. I’m grateful that you’re shining your light on this terrible epidemic.
Opiate consumption is a full-on crisis in this country. It is nothing shy of an historic national public health and safety epidemic. Opioids are now killing more people in this country than gun violence. Opioids are now killing more people in this country than car crashes.
Heroin is everywhere. It’s in our cities, suburbs, schools and homes. The good old days of black tar heroin being expensive and hard to obtain, and ugly to use because it’s intravenous - those days are long gone. Now powder heroin is cheap; it can be snorted or smoked; and in some neighborhoods, it’s easier to find than a fresh head of lettuce.
Heroin is rampant in Chicago. You can go buy some right now for $10 on the West Side just off the Eisenhower Expressway, now known to some as the “Heroin Highway." And it’s all too cheap and easy to find heroin now in our collar counties as well: DuPage County, Lake County, Kane County, Will County and beyond.
In Chicago, about a person a day is dying right now from a heroin overdose. And about one additional person dies every day from an opioid other than heroin. In the collar counties, we’re now seeing about one person every three days, dying from heroin or opioid overdose.
Heroin is an equal-opportunity killer. It is killing men, women, Blacks, Whites, Hispanics, friends, neighbors, loved ones. It doesn’t discriminate; young and old, rich and poor, urban and rural, inner city and suburb.
According to the CDC, between 2002 and 2013, the heroin death rate across the country nearly quadrupled - from 0.7 deaths per 10,000 people to 2.7 deaths per 10,000. During that same time frame, heroin use doubled among women, it increased 114% among whites, and it increased 109% among all 18-25 year olds.
The mean age of first use of heroin in this country is now 18 years old. And heroin has one of the highest dependency liability profiles of any drug, licit or illicit. Only nicotine ranks higher. Of those who are offered heroin, about 20% will try it, and of those who do, 25% will become addicted.
And for those who become dependent, the prognosis is not good; mortality rates for heroin addicts are extremely high. Over 50% of heroin addicts will be dead before the age of 50, with the average age of death being 30.
If all of that is not scary enough, here’s the kicker - heroin isn’t necessarily the biggest threat this crisis presents. Heroin now has an even more dangerous cousin on the streets: fentanyl. We are seeing an explosion right now, from a law enforcement perspective, in presence of fentanyl and fentanyl analogues.
Many folks still don’t know what fentanyl is. Fentanyl is made in a lab. Traditionally, it has been a very powerful prescription pain medication used for end of life situations or for those in extreme pain. But now, it’s being cooked up in Mexican super labs run by drug cartels, and it’s being manufactured in China and sold to those cartels, or otherwise smuggled into the U.S. for illicit use.
Drug dealers are using fentanyl to dilute and increase the volume of the heroin they are selling on our streets. While heroin is cheap, fentanyl is even cheaper, and so dealers are juicing their profits by mixing fentanyl into their heroin street products.
And that means more people are dying. Fentanyl is 40 to 50 times stronger than heroin. Fentanyl is 80 to 100 times stronger than morphine. Fentanyl has the power to kill with the ingestion, inhalation or skin absorption of just two milligrams. By point of reference, that sweetener packet your kids play with at the restaurant table - that contains 1,000 milligrams per packet. Two milligrams of fentanyl can be lethal.
Fentanyl-laced heroin is increasingly killing people in our area. Cook County has seen at least 124 fentanyl-related deaths since January 2015. Many drug users don’t even know that heroin they are using may be laced with fentanyl. They don’t know until it’s too late.
And because of its potency, fentanyl poses an unwitting risk not only to those heroin users but also to first responders. For cops or agents who are seizing dope or searching a crime scene and unwittingly touch or inhale powder fentanyl, their lives are also at stake.
And fentanyl has analogues. We’ve recently seen one called carfentanil - an analogue literally used in zoos to tranquilize elephants. An elephant tranquilizer. Carfentanil is roughly 100 times stronger than common fentanyl. I mentioned that two milligrams of fentanyl is enough to kill a person. Well, that same two milligrams of carfentanil is enough to knock out a 2,000-pound African elephant.
So it’s no surprise then that carfentanil-laced heroin is a killer. Last month, it was responsible for at least 8 overdose deaths in the Cincinnati, Ohio, area. And unfortunately I can tell you that carfentanil is not limited to Ohio and points east. It is right here in Chicago. Right now.
Another similar analogue that has popped up recently is called W-18, which like carfentanil is 10,000 times more powerful than morphine. Earlier this month, the Will County Coroner confirmed that a man who died from an overdose in April of this year had W-18 in his system.
Fentanyl and its analogues are finding their way into heroin powder. By itself, that is frightening. But here’s more: we are now seeing a swell of illicit counterfeit pills containing fentanyl. Hundreds of thousands of counterfeit prescription pills - pills made to look like oxycodone or hydrocodone but containing fentanyl -- are now being trafficked in the U.S. Some of these counterfeit pills are manufactured outside the U.S. and smuggled in, principally through Mexico and Canada. But we also now are finding clandestine pill operations domestically.
Just two weeks ago, the Wall Street Journal ran a front page story about how two people in San Francisco were charged this summer with manufacturing fentanyl-laced pills. The pills were made to look like oxycodone but actually contained fentanyl. During a search of a San Francisco home, the DEA found fentanyl powder, mixing equipment, and a $1,000 pill press.
On the other coast, in January of this year, DEA, after making undercover purchases of about 6,000 counterfeit pills, arrested a counterfeiter in New York. Again, the pills were made to look like 30 milligram oxycodone pills but contained fentanyl. Just like the couple in San Francisco, this counterfeiter in New York was making those pills in his home.
And there’s a reason we’re seeing more and more of that. It’s called profit. The pill presses are easy to acquire and are fairly cheap. And you can purchase a kilo of fentanyl powder from China for a few thousand dollars. That kilo, plus the press, can generate millions in quick profit.
Let’s say you make a batch at 1.5 milligrams of fentanyl per pill. Then one kilo can generate about 666,666 counterfeit pills. According to DEA, counterfeit pills containing fentanyl are now retailing between $10 and $20 per pill. That means between $6.5 and $13 million in sales from pills made for a few thousand bucks. That is a serious problem.
And these counterfeit pills closely resemble the authentic medications. The presence of fentanyl is often only detected through laboratory analysis. The people taking these pills may have no idea that the pill contains a potentially deadly substance. They may not know until it’s too late.
That is a dire diagnosis. And I’m sorry for the parade of horribles to begin this speech, but I think it’s important that we be honest about the nature and scope of the problem before discussing solutions.
Let me talk now about some of the things we are doing federally to push back against this epidemic. And I’ll start with criminal enforcement, but first let me make this clear up front: while our primary function at the U.S. Attorney’s Office is to investigate and prosecute crimes, criminal enforcement alone cannot solve, and will never solve this crisis. Treatment and prevention are equally if not more important ingredients to any solution. This crisis demands a coordinated response across all elements of government and society. After I talk about criminal enforcement, I’ll offer some thoughts and ideas, from my Office’s perspective, about treatment and prevention.
Enforcement
First, enforcement. Under the leadership of the Drug Enforcement Administration, the FBI, and other federal, state and local law enforcement partners, we are working harder than ever right now to attack the illicit opioids supply chain.
The vast majority of heroin that’s flooding our Chicago region is brought here by international drug cartels and specifically Mexican-based cartels like the Sinaloa Cartel, the Juarez Cartel, the New Generation Cartel, the Zetas and others. While it is impossible to know exactly how much heroin the cartels are smuggling into the Chicago area, based on recent seizure and source information, I think it’s safe to say that thousands of kilograms are now being imported here every year.
Why is the heroin problem particularly acute in Chicago? Because we are a transshipment hub for cartels; because our location and transportation networks - air, rail and road - make Chicago an ideal transshipment point. So we have a profound supply problem, and of course that eases distribution to street gangs that plague so many of our communities.
So we are committing more and more federal resources here to investigating and prosecuting suppliers - heroin traffickers from the cartel leaders to the street gangs. Between 2005 and 2014, the number of heroin-related arrests by DEA surged more than 200 percent. 2014 was the first year ever that DEA arrested more defendants for heroin trafficking than cocaine. And that trajectory has only escalated since then. DEA Chicago has proclaimed combatting heroin and opioid crime its number 1 priority for our district.
At the U.S. Attorney’s Office, I’ve instructed all of our prosecutors who work narcotics cases that investigating heroin and opioid trafficking is now our number one narcotics enforcement priority. As little as three years ago, the majority of new case initiations in our office involved cocaine trafficking. Since the beginning of this year, over 75% of the major narcotics investigations we’ve logged in at the U.S. Attorney’s Office are heroin, fentanyl or other illicit opioid trafficking cases.
One recent example is Operation Over the Top. In the spring of this year, DEA agents, working with Assistant U.S. Attorneys in my office, identified a heroin trafficking organization that was responsible for transporting, in the hollowed out axles of tractor-trucks, 20-30 kilograms of heroin every week into the Chicago area. We made multiple seizures resulting in the recovery of almost 100 kilos of heroin. Until we made those seizures and stopped this particular distribution line, this group had been smuggling all of this heroin into our city for at least two years. And that’s just one organization and one investigation. We have many more charged and in the investigative pipeline.
Last year, in an Operation titled G.I. Joe, DEA agents and the Chicago Police Department took down what may have been the largest open-air heroin market in Chicago history, at Grenshaw and Independence on the West Side. CPD and DEA made over 70 undercover purchases of heroin from gang members operating the drug spot, and seized over two kilos of heroin. Before we took it down, conservative estimates based on the volume of customer traffic indicate heroin sales were in excess of $2.6 million per year at that spot alone.
So we’re going after the gangs and drug trafficking organizations that are moving heroin into our communities. We’re also committing significant resources to going after the cartels bringing the dope here in the first instance.
I hope most of you have heard something about the Sinaloa Cartel prosecutions we have brought recently in my Office. The Sinaloa Cartel is perhaps the single biggest transnational criminal organization in the world, responsible for the distribution of hundreds of tons of illegal drugs, including heroin, to virtually every corner of the world. Because Sinaloa has decided to use Chicago as one of its principal transshipment points in the United States, my office together with our law enforcement partners, have targeted the cartel with every resource and tool at our disposal.
And we have been successful. We have brought indictments against all levels of the cartel and its infrastructure - from the cartel’s command and control based in Mexico, to its Chicago-based distribution cells, and all the way down to the street gangs who push the cartel’s dope onto the streets of Chicago and the surrounding communities. We’ve indicted over 70 individuals, including Sinaloa leader Chapo Guzman, his sons and a slew of the other highest-ranking Sinaloa members in Mexico and here in Chicago. Of those, we have convicted all but 18, and among the rest some are awaiting trial and others are fugitives from justice, including some now in custody awaiting extradition from Mexico. And we have seized over eleven tons of Sinaloa cocaine, 80 kilograms of heroin, and $30 million in cartel assets - the lifeblood of their organization. Because Sinaloa is the number 1 importer of heroin into our district, we have, and will continue to, take the fight directly to them.
Our fentanyl enforcement activities here in Chicago are also a focus of my Office right now. We are working closely and constantly with our partners to track and prosecute fentanyl distributors. About a month ago, we joined the Cook County State’s Attorney’s Office, DEA, CPD and others, to announce new charges against more than 30 defendants for distributing fentanyl and heroin on the West Side of Chicago.
In addition to cartels and gangs and fentanyl, we’re also focused federally on diversion - which is a different kind of supply-side problem. Abuse of prescription medications like hydrocodone and oxycodone are a gateway to heroin use. According to the CDC, 45% of people who use heroin are also addicted to prescription painkillers. And nearly 80% of new heroin users previously used prescription medications. Just last month, HHS released new stats showing that at least 3.8 million Americans age 12 years and older are misusing prescription medications. That is, sadly, our future heroin and fentanyl overdose population.
To beat the heroin and fentanyl problem, we have to stem the tide of prescription medications diverted for unlawful use. To that end, my office and DEA are ramping up our investigations of doctors, pharmacists, and pharmacy employees who illegally prescribe and dispense hydrocodone and oxycodone. To give one recent example, at the end of last year, we brought federal charges against a doctor in Lockport, Illinois, who wrote an astounding 500-plus prescriptions to one person for both oxycodone and Adderall. From these prescriptions, 37,000 oxy and Adderall pills were illegally diverted from their intended pharmaceutical use to those who suffer from opioid addiction.
Because research shows that abuse of prescription opioids is a gateway to heroin use, it is vital that law enforcement identify and prosecute those in the medical field who abuse their oath by illegally diverting opioids for their own financial gain. That’s another important piece of our long-term strategy for success.
Treatment
So those are some of the things we’re doing on the enforcement front. Let me say a few words about treatment. Enforcement is all about supply side. Treatment flips the script; it’s about demand.
Cartels wouldn’t be importing heroin into our district if there wasn’t a market. The hard truth is that demand for heroin in our district appears to be at an all-time high.
According to an August 2015 study, admissions for heroin treatment in Illinois are significantly higher than the nation as a whole. Nationally, heroin-treatment admissions comprise about 16% of total state-funded treatment admissions, whereas in Illinois, heroin caused about 25% of all such treatment admissions. Heroin is now the second most common reason for citizens in our state to enter state-funded treatment programs, only behind alcohol addiction.
And the growing heroin addiction problem is not just an adult problem. It’s now affecting our kids, and that situation is rapidly getting worse. In 2013, 3.8% of Illinois youth reported using heroin in the past year. 3.8% of all kids in this state said ‘yes, I’ve used heroin within the last year.’ That is a disturbing reality and trend.
So, with this seemingly endless flow of heroin into our area, what can we in law enforcement do about demand and addiction? Here are a few quick thoughts and ideas.
First, from a criminal justice perspective, we have to make sure we are separating users and addicts from traffickers and profiteers. When we catch users in the act, or with heroin in their pocket, and we arrest and incarcerate that user without any attention to the underlying problem, we’ve not only ignored the problem, we’ve made it worse. Those addicts, without help, will use again upon release (if not while in jail). And meanwhile we are straining our jails and our budgets by locking up people who are sick and no risk to society.
This issue is principally a state and local justice systems issue. And across the state, I have seen many courts and prosecutors' offices recognize this dilemma and respond to it. In Cook, DuPage, Lake, Kane, McHenry Counties and others, there are now drug courts and diversion programs designed to separate drug users from other defendants and put those users on a pathway not of incarceration but of treatment and rehabilitation. Those efforts are laudable, and critical. And while a lot has been done on that front, we do need to make sure those kinds of efforts are being duplicated across our local justice systems, including in rural areas.
One great example is the partnership between the Chicago High Intensity Drug Trafficking Area, or HIDTA, and the Cook County State’s Attorney’s Office, where they have established a program under which individuals caught distributing heroin or other drugs but who themselves are substance abusers or addicts and have minor, non-violent criminal histories, those individuals are immediately evaluated by addiction treatment professionals and given the option of entering treatment. If the addict decides to avail himself of the treatment opportunity, then the arrest for distribution is dismissed. This is the type of forward-thinking approach to addiction and treatment that can make a real difference.
More broadly, inside and outside of our justice systems, we have to do a better job of providing addiction treatment for those who are in the throes of abuse. Whether public, private or philanthropic, we need to stretch and find ways to fund treatment for those who don’t have insurance or otherwise can’t afford it. While I realize that presents enormous challenges - and I also realize that I may be swimming outside my lane - the truth is that the alternative won’t work. If we don’t improve treatment, we will pay more in the end - more in connection with medical emergency responses to increasing overdoses, more through enforcement, arrests, and incarceration, and more as measured by lives lost. So, however we do it, we have to improve our game statewide on the treatment front.
As a component of that, we need to make sure our educators and community leaders understand the nature of opioid addiction and are prepared to help those who are opioid dependent. Rather than responding to someone’s heroin or opioid abuse as a crime, we need folks to respond to it as a threshold matter for what it is: an illness that requires medical treatment and a pathway to rehabilitation.
Lastly on the treatment front, I’d like to make a related but different point. I want to make a strong plug for the continued proliferation, particularly to our first responders, including fireman and patrol officers, of naloxone, most commonly referred to by the brand name Narcan. Narcan is an easy-to-use, lifesaving antidote for heroin and opioid overdoses. Used in hospitals for decades, the medication has no abuse potential, is not that expensive, and is easy to administer. Well over a hundred lives in the Chicagoland area have been saved already this year by use of Narcan, and that number will only increase as the heroin crisis continues.
I have heard some concerns and criticism that naloxone emboldens addicts to push their limits. If they believe they can be brought back from overdose, then the risk/reward analysis of that higher dosage arguably can change. I get that. But I also know that people are dying right now. And with the increased presence of fentanyl, more of those overdoses than ever are unexpected. So, for now, I don’t think we as a society have a next best responsible choice. We need to embrace training and investment in naloxone as a way to save lives. We have to keep spreading the word and making those investments.
Prevention
So that’s enforcement and treatment. Let me, as promised, say something briefly about prevention. I start from this base point: as I said earlier, we have to be honest and recognize that prosecutions alone will not solve this problem. Until we stem demand, the supply chain will continue to fight and find a way. So we have to get every bit as aggressive about education and prevention as we are already about enforcement.
One of the great attributes of this conference today is that it has brought together professionals from so many different disciplines that touch on this crisis. It is not every day that lawyers, doctors, economists, and law enforcement are all together under the same roof talking about the same problem. And having you all here together gives me the opportunity to mention a phenomenon that I worry contributes significantly to the heroin and opioid problem in this country. And that is the over-prescription of pain medications.
I have attended too many events where I hear the same story told, over and over. How a teenager or young adult playing sports is injured and goes to a doctor for treatment, receives a multi-week course of prescription opioid pain medications, and even though he or she may not need all of those meds to manage the pain, they take them and become dependent, leading to a crippling downward spiral of abuse that eventually leads to heroin.
And I’ve heard about parents who received a large prescription for pain medications after a surgery and took some, but nowhere near all, of those pills. And the pills then sat forgotten in the medicine cabinet, until one day they were found by a teenager living in the house. And so the downward spiral begins.
These stories, which are real and are happening every day across this country, give color to the sobering statistic that the United States, with roughly 5% of the world’s population, consumes more than 75% of the world’s prescription drugs. There is something wrong there.
When I say I love doctors, it’s literal. I am the son of an orthopedic surgeon. I know that the issue of prescribing pain medications is a difficult and complex balance. And I also know that the lions’ share of doctors work hard every day, patient by patient, to get that balance right.
But the system as a whole is not working; 75% consumption of the world’s opioids reflects a problem, an imbalance in our health care system in this country. And so I ask our physicians and health care providers to work even harder to come up with ideas and solutions for the underlying issue of over-prescription. It’s imperative that you stretch. It’s imperative that we all stretch.
Every one of us has to do more and do better at teaching our citizens and kids that pain medications can begin dependency that can lead to downward spiral into heroin use and death. We have to be open and honest about how common opioid addiction is in this country, about the stark realities of that downward spiral, about the ravages heroin reeks on the body, and the devastation it brings on an addict’s friends and family.
Everyone has to own this. We need to leverage every medium we can think of - from print to TV to internet and social media. We need to talk and educate in our schools, our churches, our businesses, and our community organizations. And maybe most importantly, we need to talk in our homes. No parent can any longer afford to wait and hope the opportunity to try heroin never finds your kid. It will. So let’s talk to our kids about it now, so they will be ready when that day soon comes.
And maybe most fundamentally, it’s time to de-stigmatize heroin addiction. For decades, heroin was linked in our public consciousness with dirty needles, dark alleys, and perforated forearms. That’s no longer our reality. Heroin and opioid abuse is all around us. It’s in our poorest communities and our wealthiest enclaves. It no longer knows socioeconomic bounds. It’s happening under city bridges, and at suburban high school proms.
Heroin is not a rich or poor issue, not a black or white issue, it’s not a man or woman issue. It’s a human issue. So let’s lift the shadows. No more hushed silence and whispering in shame. This not shameful. It’s tragic. We are all impacted, and we all are in this together.
Today’s event is an important step. We at the U.S. Attorney’s Office look forward to continuing this discussion and working with each and all of you until we reach a solution. Thanks for having me and for listening.
Source: U.S. Department of Justice, Office of the United States Attorneys
