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So, organized crime:
-Loan sharks
-Hit men
-Drug trafficking
-Arms trafficking
(just thinking 'out loud')
Just putting this out there: there has always been talk of organized crime in that region.
Example of a news story from a couple of years ago - the wife of a Scioto county sheriff was the owner of a "pain clinic" that sold large quantities of painkillers.
http://www.cleveland.com/open/index.ssf/2011/02/prescription_drug_epidemic_bri.html