Former U.S. President Bill Clinton spoke at the U.S. Conference of Mayors in Miami about the growing opioid overdose crisis, where his hand in creating the crisis was largely ignored.

1) Bill Clinton’s FDA Opened the Floodgates to Big Pharma’s Pill Pushing

“In the beginning, this despicable epidemic had a less violent delivery system. Our kids were delivered and a lot of our adults were delivered into a paralyzing addiction by doctors, pharmacists and drug manufacturers, not by armed gangs,” explained Mr. Clinton to the mayors.

In 1983, Big Pharma aired its first direct-to-consumer television advertisement for a prescription drug in the US. To this day, only the US and New Zealand allow Big Pharma to push drugs directly to the user.

By 1985, the FDA had set stringent rules regarding the Big Pharma ads. Primarily, they couldn’t express that a specific drug could treat a specific claim. This mostly kept Big Pharma’s TV drug pushers at bay.

That all changed in 1996, in Bill Clinton’s first term. That’s when Big Pharma figured out the “ask your doctor” loophole – advertising a medicine without saying what it is or what it does.

1996 is also the year Purdue Pharmaceuticals starts marketing OxyContin as being an abuse-and-addiction-resistant opioid that could be taken safely more often than the recommended twice-per-day maximum.

In 1997, at the start of Bill Clinton’s second term, his FDA relaxed its rules to allow specific-drug-for-specific-ailment claims.

Clinton’s oversight of the industry was so lax that Purdue was promoting OxyContin on giveaway swag like beach hats, coffee mugs, and fanny packs, a marketing scheme that didn’t cease until Purdue was fined over it in 2007 following consumer lawsuits.

2) Bill Clinton’s FDA Does Nothing as OxyContin Sales Soar

“We should all acknowledge that we should have seen more of this before,” Clinton told the Conference of Mayors. “But what we have to acknowledge now is we have a chance to deal with this in a comprehensive way, and we’re not close.”

In 1995, Purdue Pharmaceuticals started manufacturing OxyContin, their version of oxycodone, a drug developed in Germany in 1916. The FDA approved it for sale in 1996 and the company made $45 million selling OxyContin.

Painkiller prescriptions in the early 90s were increasing 2-3 million per year. Then, from 1996 to 2000, Purdue doubles its pushers – whoops, sales force – dedicated to selling OxyContin.

The results were immediate. In 1996, painkiller prescriptions jumped by 8 million. In 1998, following a successful promotional video featuring a doctor proclaiming “[OxyContin does] not have serious medical side effects,” prescriptions jumped by 11 million.

By 2000, Purdue is selling $1.1 billion in OxyContin, and its sales reps are getting average bonuses of $70,000 a year, with some bonuses as high as a quarter-million dollars for reps who pushed the most pills.

3) Bill Clinton’s DEA Opened the Floodgates to OxyContin Manufacturing

“As the government got better at dealing with opioids,” Clinton told the mayors, “more people moved into heroin.”

“Better at dealing with opioids” would be better expressed as “finally pumped the brakes on opioid manufacturing.”

OxyContin is a Schedule II drug. That means that its production is strictly monitored by the Drug Enforcement Administration, particularly within a bureau called the Office of Diversion Control (ODC).

In 1996, the first year after OxyContin was released, the ODC approved a quota of just over 5,500 kilograms (kg) of oxycodone. It rose every year of Clinton’s second term, to over 35,000 kg by 2000.

(Clinton wasn’t alone in this failure. By 2013, the quota had risen to over 153,000 kg, and this year it’s over 108,000 kg.)

The maddening part is that ODC approved the massive increases so Big Pharma could make enough OxyContin for recreational market.

No, seriously. In a 2011 interview with Salon, DEA supervisory special agent Gary Boggs explained that DEA is required by statute to set quotas so there is “an uninterrupted supply for the legitimate medical and scientific research needs of the United States.”

Boggs then explained that illegal users threatened to interrupt that supply. “What you have to understand,” Boggs told Salon, “is that you do have legitimate patients and they’re fishing from the same pond that the illegitimate patients are fishing from, so you have to be cautious not to restrict the quota to the point that when the legitimate parties go to the pool, all the fish haven’t been taken out by the illegitimate parties.”

4) Bill Clinton’s NAFTA Opened Up the Floodgates to Mexican Drug Cartels

“Heroin is even cheaper now because it is now being grown in Mexico in the hidden parts of the Sierra Madre Mountains and being harvested by preteens,” Clinton said to the mayors.

Bill Clinton wins the election for president in 1992. By 1994, Clinton has successfully pushed Congress to pass the North American Free Trade Agreement, or NAFTA. The trilateral agreement between Canada, United States, and Mexico opens up the borders to increased trade.

That suddenly made the Mexican land routes far more attractive to drug traffickers than air and sea transport. NAFTA “has certainly attributed to increasing drug traffic over the border,” says a 2015 report from the Council on Hemispheric Relations.

That NAFTA would increase drug trafficking was no mystery, either. In his book “Border Games: Policing the US/Mexico Divide,” author Peter Andreas explained that “pushing NAFTA through Congress… required deflecting concerns that opening the border to legal trade might unintentionally open it to illegal drugs.”

Indeed, in the early 1990s, the US crime rate was at an all-time high and the crack epidemic had reached its apex. Had Congress been fully aware that NAFTA was guaranteed to increase drug trafficking, it’s likely it never would have passed. Bill Clinton’s administration purposefully kept quiet about knowing NAFTA’s dark Mexican drug secret.

5) Bill Clinton’s Crime Bill Created the Perfect Street Dealer Labor Force

“Now it’s becoming attractive to urban gangs,” Clinton warned the mayors. “It’s going to eat us all alive.”

Bill Clinton promised to get tough on crime and signed the 1994 Crime Bill, which mandated “three strikes and you’re out” penalties and strict mandatory minimum sentences for drug trafficking.

While the get-tough-on-drugs policies had already been started in 1986, pushed primarily by then-Democratic Senator Joe Biden, during the Clinton years the effects became more pronounced. Though designed to take down the so-called drug kingpins, the policies actually cracked down on mid- and low-level dealers, who spent increasingly longer times in prison.

More dealers in prison for longer times just opened up more drug dealing jobs for the people on the street. The revolving door from street to prison to street continued turning out people who, tarnished by the label “convicted drug dealer,” could only find work by returning to the drug trade.

Combined with NAFTA, the Crime Bill made it possible for the Mexican drug cartels to wage increasingly violent wars south of the border for control of the lucrative border crossing routes and to build increasingly sophisticated gang networks north of the border to distribute the product.

That product – increasingly, as marijuana legalization makes that crop less profitable – is the cheaper heroin sought by those dependent on expensive oxycodone.

6) Bill Clinton’s Drug Czar Fought to Prevent Safer Alternatives to Opioid Painkillers

“Now, what has happened is this addiction has become more expensive and more hazardous because the government’s finally doing a better job of dealing with it. So it is morphing into a heroin epidemic in all kinds of small towns and rural areas all across America,” Clinton said at a fundraiser in 2015.

In the 1996 election, as Bill Clinton won his second term, California passed the Compassionate Use Act, the nation’s first medical marijuana law. Patients began to use cannabis for a myriad of purposes, specifically for the kind of neuropathic pain that is resistant to opioid treatments like OxyContin.

Today, we have the studies showing that states with access to medical cannabis show a great reduction in the harms from opioids, including fewer deaths from, overdoses from, addictions to, use of, and prescriptions for opioids. Back in the late 1990s, these were just anecdotes from patients being relayed to doctors.

But Bill Clinton’s Drug Czar not only tried to halt the expansion of medical marijuana in California and elsewhere, referring to it as “Cheech & Chong medicine,” he threatened doctors’ prescription licenses if they even talked about medical marijuana.

It took a lawsuit against the federal government to recognize the free speech rights of doctors to talk about – not prescribe – medical marijuana to their patients. That’s why all 29 states with working medical marijuana laws allow doctors to recommend medical marijuana, not prescribe it, which is barred by federal law.

It’s great that Bill Clinton is calling for smarter ways of dealing with our nation’s opioid overdose epidemic, but let’s not forget how much of it was created and enabled by his administration’s drug and crime policies.