Attorney General Ken Paxton’s Medicaid Fraud Control Unit played a pivotal role in an investigation leading to the successful federal prosecution of nine pharmaceutical distributor executives, sales representatives, and brokers involved in the unlawful distribution of nearly 70 million opioid pills and over 30 million doses of commonly abused prescription drugs. The drugs, valued at over $1.3 billion on the black market, were sold to Houston-area pill-mill pharmacies, contributing significantly to the deadly national opioid crisis. The defendants, including five pharmaceutical distributor executives and five pharmaceutical sales representatives and brokers, allegedly orchestrated the sale of high-potency opioid pills, including oxycodone, hydrocodone, and hydromorphone, to pill-mill pharmacies in and around Houston. These pills were often sold at inflated prices, with distributors providing prescription drug potentiators like alprazolam, carisoprodol, and promethazine to enhance the effects of the opioids. The distributors implemented sham compliance measures to evade detection by the DEA and other regulatory authorities. Nine of the ten defendants have now pled guilty and await sentencing.