Rotolo was actively involved in heroin trafficking in the 1980s. According to Tommaso Buscetta, three Palermo Mafia families dominated heroin trafficking around 1980: the Porta Nuova family with Nunzio La Mattina as the main organizer; the Brancaccio with Giuseppe Savoca and the Pagliarelli family with Antonino Rotolo. Rotolo received morphine base from the Turkish trafficker Yasar Avni Mussulullu who delivered the shipments close to the coast of Sicily on Rotolo's indications where they were picked by smaller fishing boats. The morphine base was refined into heroin at laboratories on Sicily and smuggled to the United States to feed the famous Pizza Connection. One of Rotolo's heroin refiners was Francesco Marino Mannoia after Bontade was killed. Rotolo was also managing the money flow of the proceeds through Swiss bank accounts.