In 1995, Purdue Pharma was granted permission by the Food and Drug Administration to market a new opioid called OxyContin. Within five years, the drug was generating a billion dollars annually. No wonder. The company funded research and paid doctors to overstate the benefits of the new drug while understating the risks. Sales representatives marketed OxyContin as a product “to start with and to stay with.”

This was a widely successful strategy that resulted in unspeakable tragedy. Opioid painkillers such as OxyContin fueled an epidemic in America. The Centers for Disease Control and Prevention estimates that between 1999 and 2018 almost 450,000 people died from an overdose involving an opioid.

Twenty-five years after OxyContin’s launch, Purdue is facing a reckoning in court for its role in America’s crisis of addiction and death. On Oct. 21, the U.S. Department of Justice, Purdue and the Sackler family, who founded the company in 1952, reached a historic settlement. Purdue pleaded guilty to three criminal felonies and agreed to pay $8.3 billion in penalties, which is the largest ever for a pharmaceutical company in the U.S. The Sackler family insists it did not act illegally but agreed to pay $225 million in damages.

By 2003, the Drug Enforcement Administration concluded that Purdue’s “aggressive methods” had “very much exacerbated OxyContin’s widespread abuse.” Rogelio Guevara, a senior official at the DEA, concluded that Purdue had “deliberately minimized” the risks associated with the drug. Even after it became clear that OxyContin was being widely abused, Purdue refused to concede that it posed risks.

According to internal memos, the company’s sales force was described as its “most valuable resource,” and they were heavily incentivized to push the drug. The company’s sales team convinced doctors of the drug’s safety by using literature that had been produced by doctors who were paid by the company.

The spike in opioid overdoses included both prescription opioids and the illegal market. Many addicts turn to heroin when they find that prescription painkillers are too expensive or too difficult to obtain. According to the American Society of Addiction Medicine, 4 out of 5 people who try heroin today started with prescription painkillers.

A study by Anne Case and Angus Deaton of Princeton University has suggested that the overprescribing of pain-relieving drugs was a factor in the increase in mortality among middle-aged whites that has occurred since 2000.

The Council of Economic Advisers estimated that, in 2018, the costs of opioid addiction, including the value of lives lost, was $696 billion. In 2017, Princeton’s Alan Krueger showed that labor force participation had fallen in American counties where more opioid pain medication had been prescribed.

The system, that for so long put sales and “customer satisfaction” before patients’ well-being, is now coming to terms with the role it played in the enormous death toll and the terrible ongoing damage to millions of lives. Legal redress was required. Some of the Sackler fortune can go to funding addiction treatment and education, as well as advertising campaigns on the drug’s dangers.

The United States is not out of the grip of this crisis. Overdose deaths increased by 11% in the first four months of 2020 compared with last year. Isolation only exacerbates despair and it could be a dark winter ahead. Nonetheless this settlement should be celebrated as a small victory in the fight for accountability and transparency.

FROM AN EDITORIAL IN THE PITTSBURGH POST-GAZETTE