Randy said his habit eventually amounted to a full-time job. He would fib to doctors about vague injuries, and receive prescriptions for painkillers. The opiate trade — from doctors to pharmacists to users — was a cash business, he says. His system was to build up a stockpile of pills, then sell them on the street at a markup in order to fund his next quest for prescriptions.

He acknowledged following the path Rotundo described, eventually giving up prescription drugs in favor of street heroin when the former became too expensive. He still visited his ring of doctors and pharmacists to obtain pills, he said, but he sold all his “legal” drugs in order to buy illegal ones.

For the 18 months leading up to his latest rehabilitation — he has sought to get clean on five occasions, in three states, he said — he resorted to increasingly devious means to support his habit. Even when selling 200 or so OxyContin pills at up to $60 apiece, Randy said, he still had to come up with ways to get money from his parents, grandparents and others. He also admitted that he has burned through the bulk of a $70,000 legal settlement he received after a car accident at age 17.

“It’s upsetting now how much money I could …,” he said, shaking his head in disbelief and trailing off into silence.

The opiate economy

It is the addicts’ insatiable need and the high volume of currency they are able to beg, borrow and steal that drives the drug trade, Randy said. Asked why a medical professional like Conway would become a healer as a young man, only to become a dealer at 70, Randy said the answer was simple: cash.

“It’s crazy amounts of money,” he said. “It’s not just going from 200 grand to 600 grand. You’re going from 200 grand to millions. They busted one doctor and they were taking gold bars out of the guy’s safe.” (Dr. Shaikh Monirul Hasan, a 57-year-old doctor born in Bangladesh, was arrested in June 2012 with $150,000 in cash and gold bars in his Woodmere home. He reportedly charged around $80 for a prescription of painkillers.)