You may have heard that the federal Drug Enforcement Administration (DEA) is setting up an office in Montrose. And, that news may have you wondering how our drug abuse situation—including the national opioid epidemic—became so serious. Montrose native Helen Peak Kaupang, daughter of retired physician Dr. Jim Peak, recently provided some context on that.
Kaupang is a retired DEA diversion investigator. “I was not a DEA special agent (armed agents who do undercover work and go after street drugs). I was an Office of Diversion Control investigator,” she explained to an audience at The Forum. “The DEA’s Office of Diversion Control covers legitimate pharmaceuticals that have medical need.”
“The work we did involved raw products being brought into the country to produce narcotic drugs to create morphine and other narcotics, through the whole manufacturing and distribution realm, out to the doctors, pharmacists, veterinarians and scientists.”
Researchers and pharmaceutical companies that wanted access to those narcotics had to file applications, passed up through a chain of federal agencies. “There are particular entities within that chain that have to have registrations from DEA. We were the ones that granted that registration, and if need be, the ones who took that registration away,” Kaupang explained.
Essentially, her work was about keeping controlled substances controlled. A controlled substance is a drug that the FDA and DEA have decided has a legitimate medical use, but also has potential for abuse. “There are five schedules of drugs,” Kaupang explained. Schedule 1 drugs are the most dangerous and least useful, such as heroin. “Schedule 2 being the most potent drugs with the highest potential for abuse and misuse that is medically acceptable, down to a schedule 5 drug which has very little abuse potential, but there is still some there,” she said. “So, the world of controlled substances is the world I lived in for 29 years.”
After graduating from school, Kaupang was hired by the Montrose office of the Colorado Bureau of Investigation in 1983. That was her “springboard” into a 29 year career with the DEA.
Kaupang spent the latter part of her career doing investigations related to the national opioid epidemic. She retired from the DEA in 2017, and is currently doing consultant work involving litigation against pharmaceutical companies.
The opioid epidemic is getting much needed public attention. However, Kaupang said, “It’s really interesting when I hear people talking about the epidemic that’s going on right now as if it’s something new. The opioid epidemic is as old as we are—and older.”
So what exactly are opioids? The Drug Policy Alliance describes them as “ a class of drugs that act on opioid receptors in the brain. Signals sent to these receptors can block pain and lead to feelings of euphoria.”
Opioids include heroin (Schedule 1) and morphine (Schedule 2), both of which have been around since the 19th century. But, 21st century technology and marketing has brought a pharmaceutical sea change.
Kaupang said, “In 2000, Purdue Pharma produced a drug called OxyContin (Schedule 2). It was an immediate hit.” OxyContin is the brand name of oxycodone, which is basically synthetic morphine, made from opium poppies, highly effective against severe pain, and extremely addictive.
It soon found its way into the local economies of small towns along the Ohio River, in Kentucky, W. Virginia, and Pennsylvania. It eventually spread around the country.
The retired DEA investigator described Purdue Pharma’s ingenious and insidious sales strategy. “The marketing plan for OxyContin was to take it directly to the doctors—not to oncologists or other specialists, the ones you would anticipate having access to something like this—but to general practitioners who had never dealt with a drug like that, a killer and so highly addictive.
She said that, at first, the DEA saw a few patients and a few doctors getting hooked on the stuff. In Columbus, Ohio, where she was then based, “ a few doctors got in trouble with the law; we were able to get them stopped, to a degree. But if you take away the source, you still have those addicts, and the addicts still have a powerful motivator in whatever they are addicted to.”
A letter written by two doctors unintentionally contributed to the OxyContin epidemic, according to Kaupang, “In 1981, a couple of doctors put in a couple of lines that were simply an observation, not research. Their comment was, ‘From observing a few cases in their practice (in a hospital room, not patients going out on the street) addiction seemed to be very rare if these narcotics were properly used.’ They never meant for that to gain the traction it got,” she emphasized. “It was published as a footnote in the New England Journal of Medicine. From there, it got misquoted and misused, and Purdue Pharma was one of the biggest offenders.”
Before long, some unscrupulous physicians, pharmacists, and pain clinics began selling opioid prescriptions and pills to anybody who had the money. The epidemic began about 25 years ago, and continues today; so does the tsunami of overdose deaths, and hundreds of millions of dollars worth of lawsuits against Purdue Pharma.
For more information about opioids, please visit http://www.drugpolicy.org/drug-facts/synthetic-opioids-fentanyl