In addition to potentially scuttling his chances of securing a top job with the incoming administration of US President-elect Donald Trump, Rudolph Giuliani’s controversial prior work on behalf of an opioid pain medication manufacturer helped facilitate an explosion of drug violence in Mexico.

The New York Times reported on November 15 that Giuliani’s work for Purdue Pharma and several other organizations during the 2000s is complicating the former New York City mayor’s odds of being nominated for the job of Secretary of State under the incoming Trump administration.

After forming the consulting firm Giuliani Partners upon leaving office as mayor, Purdue became one of Giuliani’s earliest clients. According to a 2007 article in the Times, Giuliani was tasked with “convincing public officials that they could trust Purdue because they could trust him.”

In practice, this meant Giuliani attended meetings on behalf of Purdue with US law enforcement agencies, which were seeking to build a case that Purdue had misled the public in downplaying the powerful painkiller OxyContin’s likelihood to lead to addiction and that the firm was negligent in cracking down on the drug’s availability on the black market.

Giuliani also served as a liaison with members of Congress inquiring about the same topics, attempting to reassure them of the company’s committment to addressing threats to public health.

Giuliani’s work for other clients, including the Qatari government and an Iranian opposition group that used to be on the US State Department list of terrorist groups, has added further controversy to his potential nomination as Secretary of State.

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Giuliani’s work for Purdue goes beyond the typical cashing-in of a recently retired public official. The pharmaceutical manufacturer’s aggressive marketing of OxyContin — which eventually led to guilty pleas by three officials and the company, despite Giuliani’s lobbying efforts — was the spearhead of a revolution in medical practice that may not have otherwise occurred. This vigorous new approach to pain perversely sparked a public health crisis in the United States and aggravated a public security crisis in Mexico.

As InSight Crime has noted in the past, the overpresciption of painkillers like those produced by Purdue created a vastly increased nationwide appetite for opioid drugs. And many who became addicted to these prescription painkillers eventually turned to heroin as a cheap alternative. 

Government actions and inactions fed this dynamic in several ways, though two stand out: Law enforcement waited until the 2000s to crack down on companies’ loose controls over the opioid medicines, thereby facilitating a thriving black market for recreational users; and Medicaid reimbursement policies created perverse incentives for doctors heading so-called “pill mills” to distribute greater amounts of these drugs than could be medically justified.

In this sense, Giuliani worked to prevent measures that could have limited harm created by opioid medicines and saved thousands of lives. Such measures would likely have cut into his client’s profit margins.

SEE ALSO: Coverage of Heroin

The increased usage of opioid pain medication fostered a renewed epidemic of heroin abuse, a scourge that had largely disappeared in the 1990s. Statistics from the Centers for Disease Control and Prevention indicate that, after rising for 15 consecutive years, heroin overdoses killed more than 11,000 people in the United States in 2014 — more than three times the number of overdose deaths recorded in 2010. The United Nations Office on Drugs and Crime estimated that there were about one million heroin users in the United States as of 2014, up nearly threefold from a decade earlier.

This explosive demand for heroin, in turn, has fueled the redoubled Mexican production of the drug in states like Guerrero, Jalisco, and Sinaloa, and it has sparked conflict among criminal groups operating in those areas. Not coincidentally, Guerrero has turned into the bloodiest state in Mexico, and violence in Jalisco has increased substantially as well. Sinaloa has long been among the most violence-addled states in Mexico.

Insofar as it enabled Mexican violence, Giuliani’s service for Purdue worked at cross-purposes with one of his most famous private-sector projects: tackling insecurity in Mexico City in the early 2000s, with limited success.

Giuliani’s work for Purdue also stands in stark contrast to Trump’s campaign rhetoric, which frequently assailed heroin traffic as evidence of the porous border between Mexico and the United States. As the president-elect said in the third presidential debate, “The single-biggest problem is heroin that pours across our southern borders, just pouring, and destroying their youth and is poisoning the blood of their youth and plenty of other people.”

Giuliani’s ties to Purdue — and by extension, his ties to a revitalized heroin epidemic — offers a powerful demonstration of the gap between Trump’s rhetoric and his campaign’s actual track record.

It also offers further evidence of the hypocrisy in US drug policy in general. While US officials from former President Richard Nixon to current President Barack Obama have pursued a drug war with varying degrees of enthusiasm, the inability to tamp down on demand for recreational drugs has long ensured the existence of a multi-billion-dollar illicit market. And the official unwillingness to get in the way of the pharmaceutical industry’s profit margins enabled a wrongheaded medical revolution that has created hundreds of thousands of new addicts and killed tens of thousands of Americans.

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