pill mill

American Pain: How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic
by John Temple
Published 28 Sep 2015

He had two major pain clinics in South Florida, another new one starting up soon outside of Atlanta, pharmacies in Boca Raton and Orlando, all in the names of various straw owners: tens of thousands of patients, dozens of employees, eight full-time doctors, lawyers, private investigators. American Pain—and the whole industry, really—had exploded in the year since Jennifer Turner began her investigation. There was no easy way to shut down the pill mills, or her task force would have done it months earlier. Traditional drug-enforcement strategies, such as searching patients’ cars or doing buy-and-busts, had proven relatively useless against pill mills. Even if they caught a patient selling pills, it rarely led to bigger fish. The pills originated from the same source—a doctor’s office—and it was next-to-impossible to prove that a doctor knew, beyond a reasonable doubt, that a patient was faking pain.

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Jacobo Dreszer. 7 Early in 2009, Jennifer Turner flew to Kentucky to take a look at the flip side of the pill mill disaster—the Appalachian front. The FBI special agent was no longer working alone. She was now heading up a rapidly growing task force that included the IRS, the US Attorney’s Office, the Broward and Palm Beach sheriff’s offices, local police departments, and the initially reluctant DEA. It had been only a few months since Turner had overheard the group of cops talking about pill mills at the watercooler, but there was a fresh urgency around her investigation. The state’s prescription drug overdose death rate had risen to eleven a day, topping cocaine’s.

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Board of Medicine members had been calling reporters at the major South Florida papers for some time, trying to get them to write about the proliferation of pain clinics, to little avail. The phrase “prescription drug abuse” sounded lackluster, especially to reporters who were used to covering huge, international, illegal cocaine busts. But suddenly the pill mills were everywhere, and business owners and residents in oxy hotspots seethed and politicians mulled legislation. A Broward County grand jury was appointed to study pill mills. And reporters at the Palm Beach Post and the Sun-Sentinel began to pay attention. The Sun-Sentinel ran a story in April 2009 that said every single one of the fifty largest-selling oxycodone clinics in the United States was located in Florida.

Dreamland: The True Tale of America's Opiate Epidemic
by Sam Quinones
Published 20 Apr 2015

By the spring of 1998, Oxy addicts were everywhere, mostly young and white. “It was like a wildfire,” Hughes remembered. This drug scourge had a different origin from others he had seen. In Portsmouth, it began with what came to be called pill mills, a business model invented in town, but growing from the aggressive nationwide prescribing of opiates, particularly OxyContin. A pill mill was a pain-management clinic, staffed by a doctor with little more than a prescription pad. A pill mill became a virtual ATM for dope as the doctor issued prescriptions to hundreds of people a day. “There were doctors putting a lot of this stuff out on the street,” Hughes said.

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But addicts grew to love the two together as benzos seemed to enhance the euphoria of the opiates. The combined prescription of opiates and benzos was a hot ticket at pill mills in Portsmouth and elsewhere. I asked a detective, seasoned by investigations into many of these clinics, to describe the difference between a pill mill and a legitimate pain clinic. Look at the parking lot, he said. If you see lines of people standing around outside, smoking, people getting pizza delivered, fistfights, and traffic jams—if you see people in pajamas who don’t care what they look like in public—that’s a pill mill. And that’s what popped up all over Portsmouth, growing from David Procter’s first clinic.

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Jody Robinson cashed in his car stereo shop to open a pain clinic through which he became, according to a later indictment, one of the region’s biggest pill distributors. Portsmouth became America’s pill mill capital. The clinics were some of the only locally owned businesses to form in decades in Scioto County. People said the area’s entrepreneurial spirit had drained from Portsmouth. In a twisted way, the pill mill showed that locals could still be as entrepreneurial as anyone. Billboards for pain clinics greeted travelers along the highways entering town. Drug dealers and users for miles around came to Portsmouth to stock up on pills. One key to the pill mill explosion was the discovery of locum tenens lists, a clearinghouse for doctors around the country seeking temporary employment.

Pain Killer: An Empire of Deceit and the Origins of America’s Opioid Epidemic
by Barry Meier
Published 29 Oct 2020

His Purdue bosses, Ross explained, told him he was paid to sell drugs, not to determine if a doctor was running a pill mill. Prosecutors also subpoenaed the Purdue sales officials who covered the pain clinic in Myrtle Beach, South Carolina, that the DEA shut down in mid-2001. Purdue had once attributed the boom in OxyContin prescriptions written there to the area’s aging population. But company sales officials admitted in their testimony that they long suspected the clinic was a pill mill and were aware that state officials had suspended the medical license of its owner, Dr. David M. Woodward. Still, a Purdue district manager had recommended that Woodward, who directed how doctors he hired at his clinic prescribed drugs, undergo training as a paid speaker for Purdue.

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Six months earlier, in the fall of 1999, the drug had accounted for just a small fraction of police undercover drug buys in southwestern Virginia. But by the following spring that figure had skyrocketed, in some areas to 90 percent. This flood of pills on the street seemed to have multiple sources. Some unscrupulous doctors were running “pill mills,” practices where prescriptions are written without a legitimate purpose in exchange for the price of an office visit. Other doctors were fooled into prescribing the drug to abusers who came in pretending to be patients in pain. People were also forging prescriptions for OxyContin or making duplicate copies of real ones.

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In the mid-1990s, such systems existed in only fourteen states, and law-enforcement authorities used them to identify doctors who wrote an unusually high volume of prescriptions for opioids. In some cases, those numbers might simply reflect the nature of a doctor’s specialty. But in other cases, a large number of prescriptions for painkillers could be a sign that a physician was running a “pill mill.” States such as New York, which monitored prescriptions for Schedule II narcotics like morphine and oxycodone, had typically adopted the systems in response to outbreaks of prescription-drug abuse. For years, both drug companies and the American Medical Association, the professional group that represents doctors, had fiercely opposed prescription monitoring.

Dopesick: Dealers, Doctors and the Drug Company That Addicted America
by Beth Macy
Published 4 Mar 2019

That year, a former Purdue rep remembered, the salesperson attended one of the company’s new seminars on diversion and abuse, meant to educate reps so they could inform authorities about suspected diversion. It was now possible for a rep who called on indiscriminate prescribers to earn as much as $100,000 a quarter in bonus pay alone, the rep told me. “It behooved them to have the pill mills writing high doses,” the rep added. “The [diversion/abuse] seminar was just a cover-their-ass type of thing.” * “Let’s be clear,” a Purdue Pharma spokesman said in August 2001, in a meeting with Virginia’s attorney general. “The issue is drug abuse, not the drug.” The product shouldn’t be blamed for deaths, because in many cases the victims were also drinking alcohol and taking other drugs.

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It was another game of telephone, only this message remained tragically on point: “Beth, you wait,” pharmacist Stewart had told her on the phone. “They’re saying it’s nonaddictive, but you mark my words: This is the beginning of a disaster for us.” The disaster was now in full bloom. And Sue Ella and Sister Beth guessed exactly where it was headed. Even if Big Pharma and the pill-mill doctors could be brought to justice, the morphine molecule was so deadly, its lure so intractable, that those who were already addicted were likely to be ruled by it for the rest of their lives. Sister Beth threatened to quit the coalition if anyone accepted Purdue Pharma’s $100,000 grant, and Van Zee’s letter of acceptance was never sent.

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And he was astounded,” Van Zee recalled.) In 2000, Norton was sentenced to five years in federal prison, not for overprescribing OxyContin but for his role in an unrelated hospital corruption scheme. According to sales-rep notes subpoenaed in the McCauley case, federal prosecutors were also investigating Norton for operating a pill mill but opted to front-burner the wider and more urgent corruption case. Stallard, the Big Stone Gap drug detective, remembered an informant unpacking the life of a Norton patient: “He told us, ‘Dr. Norton wrote prescriptions for Lortab, forty-milligram OxyContins, and eighty-milligram Oxys all in the same visit.’”

Empire of Pain: The Secret History of the Sackler Dynasty
by Patrick Radden Keefe
Published 12 Apr 2021

But when it came to the other 92 percent of physicians who appeared to be inappropriately prescribing, the company said that it had no duty to act. “We don’t have the ability to take the prescription pad out of their hand,” a Purdue attorney, Robin Abrams, said. Of course, until a pill mill was actually shut down by the medical board or the police, Purdue continued to reap the proceeds from all those fraudulent OxyContin prescriptions, and while company officials might want a pat on the back for steering sales reps away from such establishments, pill mills were, generally speaking, pretty reliable prescribers. “Nobody needed to call on the really shady doctors,” the former Louisiana rep Dodd Davis pointed out. “That business was going to come, regardless.”

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But what if you superimposed that map onto the map that law enforcement and public health officials were beginning to draw of the townships and counties with the most emergency room visits, the most pharmacy break-ins, the most overdoses and deaths? Meier decided to write a story about the sales region of the number one rep on the list, a man named Eric K. Wilson, whose territory was Myrtle Beach, South Carolina. As it turned out, Myrtle Beach was home to a number of “pill mills.” These pain clinics, which were run by physicians who were either unscrupulous or impossibly naive, had cropped up across the country to satisfy the demand for OxyContin and other painkillers by issuing prescriptions to almost anyone who asked for one. At Comprehensive Care, a strip-mall clinic in Eric Wilson’s territory, there was often a line out the door, with fifteen or twenty people waiting for prescriptions, and cars with out-of-state license plates jammed in the parking lot from morning until night.

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He had asked his colleagues to make the trip from Washington just before Labor Day weekend to hold a discussion about the impact of OxyContin in a community where that impact had been felt. A local osteopath named Richard Paolino had recently been arrested after it was revealed that he was running a massive pill mill out of his practice. Michael Friedman from Purdue Pharma had been asked to testify and had arrived, along with Howard Udell and a thin man with a mustache and a professorial air named Paul Goldenheim, the company’s chief medical officer. This had become a familiar ritual for the trio. Richard Sackler might have been running Purdue, and he might have felt great personal pride and satisfaction in having made OxyContin such a success, but he had no desire to be the public face of his company.

Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis
by Beth Macy
Published 15 Aug 2022

As David complained to Vanity Fair writer Bethany McLean: “My four-year-old came home from nursery school and asked, ‘Why are my friends telling me that our family’s work is killing people?’” The irony was not lost on South Floridians when the couple set up house in Palm Beach County, once the epicenter of an OxyContin-fueled pill-mill industry. It was now the relapse capital of America, a place where rehab-patient brokering and insurance-fraud schemes took advantage of desperate families of the dopesick and addicted. In 2019, the region counted more rehabs and sober-living homes than it had elementary schools. “I, for one, do not welcome the Sacklers to my county,” wrote Palm Beach County Commissioner Melissa McKinlay.

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On her break from work as a home health aide, Alisha Martin told me how Tim’s low-barrier approach had saved her life—mainly because, for the first month, he was willing to overlook the fact that she was still using marijuana, Xanax, and opioids while taking her prescribed Suboxone. Before that, she’d been homeless, staying in motels and selling drugs, recalled Martin, thirty-seven, of Morganton, North Carolina. She was twenty-one when she got hooked on prescribed OxyContin in the wake of gallbladder surgery. In a small town where pill mills had replaced the shuttered furniture factories, black-market follow-ups were easy to find. Martin just drove around looking for groupings of cars. “You’d see people’s driveways filling up on pill day,” she recalled. “Drug dealers never have company unless they have something somebody wants.” Martin’s drug use spiraled in waves befitting a Johnny Cash song.

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People who needed opioids were refused access. Others with decades-long chronic conditions like extreme rheumatoid arthritis were abandoned by doctors and were now left bedbound. Some who were denied the opioids they’d been taking for decades attempted suicide or resorted to illegal drugs. “They should have known that clamping down on pill mills and overprescribing would lead people to the black market,” said Dan Vergano, the veteran science reporter. Between 2011 and 2020, opioid prescribing fell by 60 percent while overdose deaths doubled. Vergano and I had both been criticized for drawing too much attention to overprescribed opioid pills by chronic pain patients who blamed us for ignoring their suffering.

Our 50-State Border Crisis: How the Mexican Border Fuels the Drug Epidemic Across America
by Howard G. Buffett
Published 2 Apr 2018

It seems to minimize the impact of these drugs. From my experience in law enforcement, I feel the evidence is so clear that drug use both directly and indirectly is doing serious harm to our country. Framing these legalization campaigns as if we’re just voting to approve a new golf course or a theme park seems wrong and self-defeating. Pill mills and suspicious pharmacies If you think regulating drugs ensures fewer negative impacts, pay attention to the skyrocketing opioid epidemic. Many experts have documented that patients who started with legal, prescribed, regulated opioid painkillers and became addicted, then switched to heroin when their doctors cut them off or they could no longer afford the pills.

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Some addicts originally were workers injured on the job, victims of auto accidents, or even young athletes with sports injuries who started taking opioid-based pain medication like Vicodin or OxyContin for a legitimate pain condition and end up addicted.7 Regulators, among others, dropped the ball. In some regions of the country crooked, unethical doctors set up “pill mill” storefronts and essentially sold prescriptions for opioid pain relievers. In West Virginia, unethical prescribing of legal opioids was ignored by drug distributors, state regulators, and pharmacies who filled enough orders between 2007 and 2012 for every man, woman, and child in the state to have taken 433 pills, which was revealed in a Pulitzer Prize–winning investigative series by the Charleston Gazette-Mail.8 Lawsuits are starting to pile up.

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Quinones says Mexican drug dealers pushed heroin into the same territories where drug companies were aggressively promoting opioid painkillers like OxyContin roughly a decade ago, and that created “catastrophic synergy, and presaged the transition from pills to heroin that would happen in the rest of the country years later.”12 Greg Burns, the assistant chief of police of Louisville, Kentucky, told PERF in 2017: “When we started to crack down on the prescription drug pill mills, that’s when we started to notice the heroin problems shoot up, because it was relatively cheap, and the pills are so expensive now.” During 2016, he added, “We used 688 doses of Narcan” for 480 patients. To me some of the most concerning risks of legalizing drugs are the unintended and unforeseen consequences.

Sunbelt Blues: The Failure of American Housing
by Andrew Ross
Published 25 Oct 2021

“THE PAIN THEY ALL SEEM SO SCARED OF” The kind of addiction that Hector and Jake see on a daily basis is a staple of motel living across the country, especially in semirural areas hit hard by the opioid crisis. Florida is particularly implicated in the country’s opioid problems. In the first decade of the twenty-first century, its largely unregulated “pill mills” were the primary supplier of oxycodone products to the East Coast and Great Lakes states.1 “Doctor shoppers” drove down and back up Interstate 75 all the way into New England, picking up and delivering pills on a route known as the “Oxy Express.” Between 2006 and 2012, pharmaceutical firms sent 5.6 billion pills to Florida’s pharmacies and drugstores.2 By 2010, ninety of the top hundred opioid prescribers in the country were Florida doctors, and 85 percent of the nation’s oxycodone flowed from the state.

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The humanitarian crisis also sorely tested the Hope Center philosophy of encouraging self-sufficiency. Responding to the most urgent need of food insecurity, the center stepped up to run one of the county’s many food distribution operations, serving several hundred families a week. CHAPTER 3: DOPESICK AND HOMESICK   1.  John Temple focuses on the most infamous Florida pill mill, Amer-ican Pain, based in Palm Beach County, in American Pain: How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic (New York: Lyons Press, 2015).   2.  Aric Chokey and Skyler Swisher, “5.6 Billion Opioid Pills Flooded the State,” South Florida Sun Sentinel, July 27, 2019, https://www.sun-sentinel.com/news/florida/fl-ne-opioids-flood-florida-data-20190726-3gltamcwojbltehe45aj73fyoy-story.html.   3.  

Deaths of Despair and the Future of Capitalism
by Anne Case and Angus Deaton
Published 17 Mar 2020

Here is our own account and interpretation of what happened. While there was plenty of misbehavior and greed by all of the players in the drama, we think it is a mistake to think of doctors as little better than drug dealers. Certainly, there were some doctors who took the opportunity to operate “pill mills,” selling prescriptions for cash (or for sex) without examining or even interviewing the “patient.”26 Many of those doctors are now (or have been) in jail. But few physicians are corrupt and, given the state of medical knowledge in the mid-1990s, they had good reason to prescribe opioids to patients in pain, and little reason not to.

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See also job loss overeating, 44 oxycodone, 118 OxyContin, 10, 40, 112, 114, 117, 118, 127–28, 129, 259; approved, 247; heroin and, 119 Page, Marianne, 277n15 pain, 3, 72, 76, 82, 117, 121, 182, 185, 272n10; addiction and, 4; advocacy organizations for sufferers of, 124; African Americans and, 90–91; aging and, 90; American Pain Society, 116; bachelor’s degrees and, 90; chronic, 84, 89, 121; education and, 86; emotional, 73; geography of, 86; increase in, 92; management, 112; in midlife, 89; normal increase in, 88; on-the-job, 91; opioid painkillers, 93; physical, 73; postsurgical, 116; rising levels of, 123; Schweitzer on, 84; social, 83; suicides and, 83, 86, 101; in United States, 93; in United States and comparison countries, 87; white non-Hispanics and, 89; women and, 93; work and, 85 Papanicolas, Irene, 282n11, 282n15, 282n19 paradox of patents, 255 Parekh, Natasha, 282n7 Parfit, Derek, 289n3 Parker, Kim, 269n12 Passaro, Douglas J., 268n10 Patel, Jugal K., 269n13 patents, 209, 255, 256 patients, 200; healthier, 208; not knowing how much treatment will cost, 204; trials of new drugs for, 202 patient satisfaction surveys, 117 Patterson, Christina, 287n8 Pearlstein, Steven, 286n6 pensions, 35, 108, 144, 152, 159, 221, 224, 225, 240, 252 Pescosolido, Bernice, 265n1, 270n21 Peterson, Paul F., 280n4 Petkova, Neviana, 269n8 PET scanner, 215 pharmaceutical executives, 126, 202 Phelps, Edmund, 255, 290n24 philanthropists, 110, 111, 128 Philippon, Thomas, 286n6, 286n7, 287n21, 288n24 Phillips, Julie A., 277n11 physical examination, 75 Pickett, Kate, 276n4 Pierce, Justin R., 278n21 Pierson, Paul, 266n23, 288n38 Piketty, Thomas, 269n5 pill mills, 121 Plath, Sylvia, 99 Platt, Stephen, 109, 273n1, 273n2 pneumonia, 23 political power, 9, 10, 13, 120, 210, 213; of wealthy people, 11, 241 population density, 100–101 population growth, 217 populists, 4, 54, 252; immigration and, 214 Posner, Eric A., 290n23 Posner, Richard A., 272n7 postsurgical pain, 116 Poterba, Jim, 264 poverty, ix, 65, 87, 133–34; African Americans and, 137; Census Bureau on, 219; midlife, 137; misery of, 135; official counts of, 136; racial patterns of, 137; responses to, 136; suicides and, 138; typhus and, 25; white non-Hispanics and, 138 Powell, Eleanor N., 284n56 Powell, Lewis, Jr., 241, 288n41 pregnancy, 170–72.

Experience on Demand: What Virtual Reality Is, How It Works, and What It Can Do
by Jeremy Bailenson
Published 30 Jan 2018

In the same period, heroin overdoses increased 439%. A study done in 2014 revealed the remarkable fact that 12 US states had more opioid prescriptions than people.3 By 2010, the flood of opioids into the health care system and rising rates of addiction had grown so alarming that regulations were tightened to control “doctor shopping,” “pill mills,” and the widespread abuse. But these moves had a few unintended consequences. Demand for prescription painkillers in illegal markets skyrocketed, with an individual pill in 2014 costing as much as $80. This drove new addicts to street heroin, which could be obtained for as little as $10.4 A new pattern of abuse began to emerge.

Underwater: How Our American Dream of Homeownership Became a Nightmare
by Ryan Dezember
Published 13 Jul 2020

Repo men snatched the luxury vehicles out of the driveway of one neighbor. He’d gone from working something like sixty hours a week installing granite countertops to hardly any at all. Opioids poisoned the neighborhood. People who were laborers during the housing boom didn’t have much trouble convincing pill-mill doctors to prescribe for old aches suffered on the job. Enterprising addicts could fill a prescription in four states on the same day if they hustled along Interstate 10 between Florida and Louisiana. A young woman who was renting next door to me lost custody of her children and began shuffling in her pajamas to a party house down the street.

Servants of the Damned: Giant Law Firms and the Corruption of Justice
by David Enrich
Published 5 Oct 2022

Or, to be more precise, it was only a small part of a big problem: Walmart pharmacies in numerous states had for years been filling opioid prescriptions that didn’t appear to have any legitimate medical purpose. The prosecutors soon discovered that Walmart’s legions of local pharmacists had repeatedly warned corporate brass about doctors who individually wrote tens of thousands of OxyContin prescriptions—a sign of being part of a “pill mill.” The response from headquarters was always the same: The pharmacists could refuse to fill particular prescriptions, but they were not permitted to cut off doctors altogether. In fact, they were pressured to keep dispensing drugs as quickly as possible. At one point, a Walmart compliance manager told colleagues that they should focus on “driving sales” rather than policing doctors.

The Road to Unfreedom: Russia, Europe, America
by Timothy Snyder
Published 2 Apr 2018

Marketing representatives for the company that produced it, Purdue Pharma, told doctors that a miracle had occurred: the pain-killing benefits of heroin without the addictiveness. In the late 1990s in southern Ohio and eastern Kentucky, Purdue Pharma marketing representatives earned bonuses of more than $100,000 a quarter. In 1998, the first “pill mills” began to emerge in Portsmouth, Ohio; these were purported medical facilities where physicians were paid to prescribe Oxycontin or other opioids. Residents of Portsmouth and then other towns soon became addicts and began to die of overdoses. Some switched to heroin. Scioto County, Ohio, of which Portsmouth is the county seat, has a population of about 80,000 people.

The Viral Underclass: The Human Toll When Inequality and Disease Collide
by Steven W. Thrasher
Published 1 Aug 2022

Between 2006 and 2016, nearly 21 million opioid pills were shipped to Williamson, West Virginia, alone—a town of just 2,900 people. By 2019, the state had settled with thirteen different drug companies for a total of $84 million. But these lawsuits and Big Pharma payouts have so far done little to stem the tide of overdose deaths. After the “pill mills” flooding the state with opioid pain relievers were shut down, a toxic mix of heroin and illicitly manufactured fentanyl was there to meet demand and drive up the overdose death rate to new highs. When I look at the lucrative opioid pharmaceutical industry, it seems to me that people overdosing on their products might just be a cost of doing business.

San Fransicko: Why Progressives Ruin Cities
by Michael Shellenberger
Published 11 Oct 2021

They did not, however, have to accept the idea that they might, say, eat better and exercise more, and that this might help them lose weight and feel better. Doctors, of course, couldn’t insist . . . [and] patients didn’t have to take accountability for their own behavior.”50 OxyContin was seen as vastly more effective than existing painkillers.51 Across the United States, unscrupulous doctors set up “pill mills” to give out prescriptions for opioids to people who didn’t need them. Companies used deceptive marketing. They convinced doctors, regulators, and patients that the prescribing of opioids to treat chronic pain long term was a safe and effective treatment.52 Until the scale of the problem became clear, it was difficult for doctors to refuse to prescribe opioids to patients who expected instant pain relief.

Three Felonies a Day: How the Feds Target the Innocent
by Harvey Silverglate
Published 6 Jun 2011

But what’s shocking is the lengths to which one prosecutor went to silence this activist. xii preface to the paperback edition The case of Dr. Stephen Schneider and his wife, Linda, was much like others that attracted the PRN’s support. The Kansas-based doctor and nurse were accused of over-prescribing pain medication—or, in the prosecutorial parlance, running a “pill mill.” Reynolds assisted the Schneiders by helping them find legal counsel and expert witnesses for their defense, as well as publicly advocating for their innocence. Even though she had no formal role in the case, the government sought in April 2008 to gag Reynolds from making “extrajudicial statements” about the Schneider prosecution, a plainly unconstitutional request, which the district court wisely denied.

The Controlled Demolition of the American Empire
by Jeff Berwick and Charlie Robinson
Published 14 Apr 2020

Is the opioid crisis an accident, or could it be the new crack cocaine push to target the poor white communities? It should be obvious by now that nothing like this happens accidentally, and that the intentional push of these drugs, in association with rampant over-prescribing by medical professionals, is by design. If law enforcement wanted to stop this, they would shut down the “pill mills” that exist in most states in the southeast United States and the Rust Belt, but so far that idea has not really been taken seriously. It is the most confusing of drugs because it is legal for some people, and totally illegal for others. You can have the drug prescribed for a host of legitimate physical ailments, by real doctors, but there is a monster in there.

Palo Alto: A History of California, Capitalism, and the World
by Malcolm Harris
Published 14 Feb 2023

The United Nations Office on Drugs and Crime estimates that the number of Mexican hectares devoted to opium poppies increased from 1,900 in 2000 to 44,100 in 2017.viii 46 The 2009 70-pound heroin bust in EPA came in the wake of that explosion in supply. Producers needed more U.S. distribution, and so Sac Street got a promotion. This boom also coincided with a government crackdown on the prescription opiate OxyContin and the “pill mill” pharmacies that played a central role in its recreational distribution. In 2010, a reformulation of OxyContin for abuse deterrence led to an immediate decline in pills and an immediate increase in heroin as users shifted to the street substitute.47 These direct population-level effects make a mockery of the prevailing “Just say no” state rhetoric on illicit drugs, as the top-down global process of gangsterization makes the individual pathologization of crime look childish and silly.