In 2004, a physician specializing in pain management, opened a clinic. The prosecution asserted that the clinic was nothing more than a "pill mill" catering to people who were hopelessly addicted to pain medicine, primarily opioids. The evidence showed that defendant engaged in only the most cursory examinations and rarely ordered diagnostic scans. Notwithstanding the options for treating pain, the doctor regularly prescribed opioids as a first resort. Appointments were not necessary and all payments were required to be made in cash. From 2008 through October 2011, defendant wrote over 21,000 prescriptions for controlled substances, at an increasing pace, with more than half for substances containing the opioid oxycodone, and more than a quarter for alprazolam (Xanax).