How crime syndicates govern systematically

and why they get away with their crimes

Intimidation is always the primary factor in criminal governance.

MAID is a large systemic killing field in Canada. It is equaled by another large systemic killing field in Canada, drug death. Soon the two combined will equal 50,000 deaths per year. 

The drug ODs sustain a large harvest of organs for transplant. Why not profit from your crimes? I mean, isn't that what it's about? At the same time, why not eliminate needless drains on your annual budget? The MAID terminates long term medical care demands. 

If it's going wrong, it had to start somewhere

Could this be it?