The Opioid Epidemic

Mortimer David Sackler and Raymond Sackler become co-chairmen of the Purdue Frederick Company, a small Greenwich Village pharmaceutical firm financed by their brother Arthur. The company later becomes Purdue Pharma, based in Stamford, Connecticut, and grows into a global pharmaceutical enterprise under Sackler family ownership.

The US Food and Drug Administration approves OxyContin (controlled-release oxycodone), developed by Purdue Pharma as the first oxycodone formulation allowing 12-hour dosing. The FDA notes that soon after approval, OxyContin became a focal point of opioid abuse. Before the 1990s, most opioid pain medications were used for acute or cancer-related pain only.

Purdue Pharma begins a large-scale marketing campaign for OxyContin, claiming that as a long-acting opioid, it posed a lower risk of addiction than shorter-acting painkillers like Percocet. Purdue funded over 20,000 pain-related educational programs through direct sponsorship or grants between 1996 and 2002. The campaign coincided with a broader movement in pain medicine advocating for better treatment of chronic pain, including the American Pain Society's designation of pain as a "fifth vital sign." Internal Purdue documents from 1997 show that sales representatives discussed the words "street value," "crush," and "snort" in internal notes recording their visits to doctors.

Annual OxyContin prescriptions reach more than 14 million in 2001 and 2002, up from 316,000 prescriptions in 1996. Annual sales reach approximately 3 billion dollars, compared to 44 million in 1996. Purdue CEO Michael Friedman reports that the company spent 200 million dollars marketing OxyContin in 2001 alone. A New York Times investigation by journalist Barry Meier reveals the company's awareness of the drug's abuse potential.

The Purdue Frederick Company pleads guilty to a felony charge of misbranding OxyContin by claiming it was less addictive and less subject to abuse than other opioids. Three top executives — President Michael Friedman, top lawyer Howard Udell, and former chief medical officer Paul Goldenheim — plead guilty as individuals to misleading the public. The company pays 634.5 million dollars in fines, one of the largest pharmaceutical settlements in US history at the time. The executives receive probation and community service sentences.

The US Centers for Disease Control and Prevention publishes its first guidelines for prescribing opioids for chronic pain, recommending that doctors prioritize non-opioid alternatives and prescribe the lowest effective dose. The guidelines mark a formal federal acknowledgment that widespread opioid prescribing had fueled the addiction crisis. By this time, more than 183,000 Americans had died from prescription opioid overdoses since 1999.

The Trump administration declares the opioid crisis a nationwide public health emergency, announcing new funding and policy measures to combat addiction and overdose deaths. By this point, the epidemic had evolved beyond prescription opioids to include heroin and illicitly manufactured fentanyl, contributing to over 70,000 drug overdose deaths in 2017 alone. Fentanyl, a synthetic opioid 50-100 times more potent than morphine, had become the dominant driver of overdose fatalities.

As states and federal agencies tightened opioid prescribing guidelines, chronic pain patients and patient advocacy organizations reported increasing difficulty accessing medication they had used safely for years. Some patients documented increased suffering, loss of function, and in some cases suicide following forced tapering. Pain advocacy groups argued that the response to the opioid crisis had conflated legitimate pain treatment with addiction, while addiction specialists and public health officials maintained that reducing excess prescribing was necessary to prevent new addiction. The tension between pain treatment access and addiction prevention became a defining policy challenge of the crisis response.

Purdue Pharma files for Chapter 11 bankruptcy protection as part of a tentative settlement agreement with more than 2,000 municipalities and two dozen states. The company faces over 2,600 lawsuits accusing it of deceptive marketing practices that fueled the opioid epidemic. The filing marks a major turning point in the legal battle against the company and the Sackler family, though the terms of the settlement remain contested among states.

Management consulting firm McKinsey & Company agrees to pay 573 million dollars to 47 states, the District of Columbia, and five US territories to settle claims that it advised Purdue Pharma and other drug makers on strategies to increase opioid sales. Court documents revealed that McKinsey proposed strategies to boost OxyContin sales, including targeting high-volume prescribers and countering addiction-treatment alternatives.

A 7.4 billion dollar settlement between Purdue Pharma, the Sackler family, and state attorneys general goes into effect, resolving thousands of lawsuits. The Sackler family contributes up to 6 billion dollars of the settlement. Purdue Pharma is dissolved and restructured into a new company, Knoa Pharma, whose profits are directed toward opioid abatement programs. The settlement includes provisions that release Sackler family members from future civil liability, a component that drew criticism from some state officials and addiction advocacy groups.