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Opioid crisis and OxyContin

OxyContin, a strong opioid painkiller, was sold in the United States from the mid 1990s as less addictive than other opioids. About 806,000 Americans died of opioid overdoses between 1999 and 2023. Its maker and an affiliate have both pleaded guilty, and a $7.4 billion settlement with the company and its owners, the Sackler family, took effect in May 2026.

Updated 15 October 2026 (4 minute read)

AutonomyBeneficenceNon maleficenceJustice
  1. Letter reports addiction is rare in hospital patients
  2. Maker admits selling OxyContin as less addictive
  3. UK opioid packs must warn of addiction
  4. Supreme Court rejects legal shield for the Sacklers
  5. $7.4 billion settlement takes effect

Summary

  • Opioids are strong painkillers related to morphine, such as oxycodone, the drug in OxyContin. They work well for severe short term pain, but taking them for more than three months for pain not caused by cancer raises the risk of addiction. Since September 2020 every UK opioid pack has carried the words "Can cause addiction".
  • By the 1990s many American doctors believed addiction was rare when opioids were given for pain. A 2017 review argued that a 1980 letter helped build that belief. It described nearly 12,000 hospital patients with "only four cases of reasonably well documented addiction", and most of its 600 citations left out that their stays were brief.
  • Purdue Pharma, owned by the Sackler family, began marketing OxyContin in the mid 1990s. In 2007 an affiliate pleaded guilty to misbranding it, meaning selling it with false claims, as less addictive than other painkillers. In November 2020 Purdue Pharma pleaded guilty itself, admitting it paid doctors speaker fees to bring in more prescriptions.
  • The CDC, the US public health agency, describes three waves of deaths. Prescribed opioids drove the first from the 1990s, heroin the second from 2010, and illegally made fentanyl the third from 2013.
  • The Sacklers took about $11 billion out of the company between 2008 and 2016, and it went bankrupt in 2019. In June 2024 the US Supreme Court ruled by 5 to 4 that a bankruptcy deal could not protect the family from victims' lawsuits without the victims' consent.
  • A new $7.4 billion settlement took effect on 1 May 2026, and Purdue Pharma was dissolved. US opioid deaths have fallen from about 85,700 a year at their peak in mid 2023 to about 41,000 in the year to May 2026.
An OxyContin tablet

Dig deeper

  • Opioid prescribing in England grew for years and has fallen slightly since 2016.
    • In 2017 to 2018, 5.6 million adults, 13%, were prescribed an opioid painkiller, and about 540,000 had been on one continuously for three years.
    • Public Health England, then in charge of public health, found long term opioids for chronic non cancer pain not effective for most patients.
    • The MHRA, which regulates medicines, asks doctors to agree a plan for ending treatment before they start it.
  • In England and Wales, 2,621 drug poisoning deaths registered in 2024 involved an opiate or opioid, 47.1% of the total. Deaths involving nitazenes, a newer group of synthetic opioids, rose from 52 to 195 in a year.
  • The CDC's 2022 guidance said some policies drawn from its 2016 advice had led to rapid tapering, meaning cutting the dose quickly, and abrupt stopping without working with patients. Patients were left with untreated pain and serious withdrawal.
  • Brett Kavanaugh, one of the four Supreme Court justices who dissented in 2024, wrote that the rejected plan would have given substantial and equitable compensation to more than 100,000 individual victims. The majority held that bankruptcy law does not allow such a release without consent.
  • Under the 2026 settlement the Sacklers pay up to $7 billion over 15 years, and individual victims could receive about $8,000 or $16,000 each. Family members were not charged in the 2020 criminal case.
  • Hershel Jick, who wrote the 1980 letter, said in 2017 that he would not publish it again: "It wasn't worth it." Smoking and lung cancer raised the same problem, with an industry's safety claims set against the evidence.

Ethical issues

PrincipleHow it applies here
AutonomyConsent to a strong painkiller is informed only if the patient knows the risk of addiction, and in 2007 a Purdue Pharma affiliate admitted selling OxyContin as less addictive than other opioids. UK packs now carry an addiction warning. Patients already on long term opioids also have a say in how their dose is cut, which the CDC's 2022 guidance supports.
BeneficenceOpioids relieve severe short term pain and cancer pain well. Public Health England found long term opioids for chronic non cancer pain not effective for most patients, so the good a doctor can do with them depends on the kind of pain and how long it lasts.
Non maleficenceAddiction and overdose are the harms, and Purdue Pharma admitted paying doctors fees to bring in more prescriptions. Stopping carries harm too, since the CDC found rapid tapers left patients in pain and withdrawal.
JusticeIn England, prescribing of opioids and gabapentinoids, another group of painkillers, is 1.6 times higher in the most deprived areas than the least, so the risk falls unevenly. Accountability is part of justice too. The Sacklers kept billions taken from the company, and the Supreme Court refused to let a bankruptcy deal end victims' claims against them without consent.

Interview questions

  • What do you know about the opioid crisis in the United States?
  • A drug company offers to pay you to give talks about its painkiller. What do you do?
  • A patient who has taken opioids for back pain for two years asks you to increase the dose. What do you do?
  • What are the arguments for and against protecting the Sackler family from lawsuits in return for paying billions to victims?
  • What responsibility do doctors carry when a drug company's safety claims turn out to be false?
  • Why might opioid prescribing be higher in poorer areas?
  • How should a doctor balance treating pain against the risk of addiction?
  • What does the opioid crisis have in common with the history of smoking and lung cancer?

Sources

  1. GOV.UKgov.uk/…/opioids-risk-of-dependence-and-addiction
  2. wgbh.orgwgbh.org/…/doctor-who-wrote-1980-letter-on-painkillers-regrets-that-it-
  3. supremecourt.govsupremecourt.gov/…/23-124_8nk0.pdf
  4. abc7ny.comabc7ny.com/…/8224043
  5. cdc.govcdc.gov/…/understanding-the-opioid-overdose-epidemic.html
  6. portal.ct.govportal.ct.gov/…/attorney-general-tong-announces-purdue-pharma-to-dissolve-to
  7. cdc.govcdc.gov/…/drug-overdose-data.htm
  8. GOV.UKgov.uk/…/prescribed-medicines-review-summary
  9. ons.gov.ukons.gov.uk/…/2024registrations
  10. cdc.govcdc.gov/…/rr7103a1.htm
  11. pbs.orgpbs.org/…/judge-formally-approves-opioid-settlement-for-purdue-pharma-
  12. GOV.UKgov.uk/…/dependence-on-prescription-medicines-linked-to-deprivation

Photo: Psiĥedelisto, CC0, via Wikimedia Commons, colour altered.

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