In 2011, Florida ignited an epidemic.

Here's how.

Between 2001 and 2010, Florida’s refusal to regulate pill mills created a pipeline of illicit oxycodone and other pills to users and traffickers across the United States.

Florida dominated the oxy market

In the first half of 2010,
drug distributors shipped
40.8 million
oxycodone pills to Florida
health professionals.

Every other state combined
got only
4.5 million.


Florida pill mills sold the oxycodone to users and traffickers from other states.

Other states cracked down on their pill mill problems.

Florida didn't.

As long as Florida pill mills stayed open, oxycodone deaths kept rising.

And Florida oxycodone spread

In 2010, the DEA reported Florida pill mills were spreading oxycodone in the Southeast, Great Lakes, Northeast and Mid-Atlantic regions - virtually every state east of the Mississippi.

A national oxycodone ring even bought South Florida pills to sell in Denver, Salt Lake City, Nevada, Washington, Oregon, Texas and Alaska.

2011: Florida cracks down

After years of ignoring the crisis, Florida started arresting doctors, shutting down bogus clinics and tracking oxycodone and other opioid prescriptions.

Goodbye, oxy. Hello, heroin.

Oxycodone became harder to get. People began switching to a much cheaper, easier-to-find and equally powerful substitute:


Cost of equivalent doses





Source: Drug Enforcement Administration

Why would people switch from a prescription drug to a street drug?

The molecular structure of oxycodone and heroin are nearly identical. So is their high.

Oxycodone related deaths fall, heroin deaths rise

East of the Mississippi illicit Florida oxycodone had flowed freely.

In 2012, the first full year after the crackdown, heroin death rates rose by 53 percent as people switched drugs.

West of the Mississippi, where Florida oxycodone trafficking was not common, the rate of heroin-involved deaths rose by 3 percent.

But in seven Western states where a Florida oxycodone ring had operated, heroin death rates rose by twice that, 6 percent.

Dig deeper and other patterns emerge

From the year before the crackdown to the year after, death rates from oxycodone and similar pills fell in Florida and the Southeast region. Heroin deaths surged.

In the Mid-Atlantic region, pills also began claiming fewer lives. Heroin began claiming more.

And it happened again in the Northeast.

The same pattern emerged in the Great Lakes region, another place where Florida oxycodone went.


Just being close to Florida could be deadly

Along a South Florida to New England oxycodone smuggling route, death rates tied to oxycodone and similar pills dropped, slowed or stalled after illicit Florida-supplied oxycodone started going away.

But heroin death rates skyrocketed

In the first full year following the crackdown, heroin-linked death rates in the South and Southeast rose by 107 percent, the most of any region.

The Mid-Atlantic region recorded the second-highest increase, 72 percent.

The Northeast recorded a 47 percent hike, the third-highest increase.

The Great Lakes region recorded the fourth-highest increase, 42 percent.

Where Florida oxycodone was trafficked less often, heroin death rates rose by much less. The Mountain region recorded a 12 percent hike.

The Pacific region reported 4 percent.

Heroin deaths dropped in one region only: The Great Plains states.


It was the only region in the country where Florida oxycodone was not known to have been trafficked at all.

Heroin deaths continue to climb. But oxycodone and prescription opioids never went away. Today, the two claim an estimated 115 lives a day, with no end in sight.

2016-2017 All overdose deaths: CDC

Click here to find out how it happened.