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.
Here's how.
Florida dominated the oxy market
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
Goodbye, oxy. Hello, heroin.
Why would people switch from a prescription drug to a street drug?
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.
East of the Mississippi illicit Florida OxyContin had flowed freely.
In 2012, the first full year after the crackdown, heroin death rates rose sharply by 53% as people switched drugs.
West of the Mississippi, where Florida oxycodone trafficking was not common, the rate of heroin-involved deaths rose by a much smaller 3 percent.
But in seven Western states where a Florida oxycodone ring had operated, heroin deaths collectively rose by double that amount, 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.
From the year before the crackdown to the year after, death rates from oxycodone and similar pills fell for the first time in years in Florida and the Southeast region. Heroin deaths surged.
In the Mid-Atlantic region, the second leg of the route, pills also began claiming fewer lives. Heroin began claiming more.
And it happened again in the third and final leg of the smuggling route, the northeast region.
Outside the route, the same pattern emerged in the Great Lakes region, where Florida oxycodone was known to have been trafficked.
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.
Over From the year before Florida's crackdown to the year after, heroin-linked death rates in the Southeast rose by 107 percent, the most of any region in the U.S.
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.
There was only one region in the U.S. where heroin deaths dropped: 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.