This document investigates the dynamics of extortion payments made to gangs in El Salvador, revealing that collusion among gangs through a non-aggression pact in 2016 increased extortion rates by 15% to 20%, despite a decline in violence. The economic implications include higher prices for pharmaceuticals and increased hospital visits for chronic illnesses, suggesting that reduced competition can adversely affect consumers. Using extensive data on over 50,000 extortion payments and retail sales, the study sheds light on how gang competition and collusion shape extortion practices and their impact on public health and welfare.