The current opioid epidemic started slowly  in the mid 1990s, leading to millions becoming addicted to prescription opioids and later to any opioid substance available. This was not an accident. American doctors were aware, at least by the 1920s, of the addictive properties of opioids. Nearly seventy years later, in 1996, a marketing campaign by Purdue Pharma (the creator of Oxycontin) changed the (correct) perception that opioids are highly addictive.

This campaign focused on changing the medical communities’ attitudes, and created the idea that opioid use for pain often created “pseudo-addiction.” The pitch was that  people who had been prescribed opioids, that began showing signs of addiction, were not in fact addicted—the addiction symptoms were signs that their prescription pain management was inadequate.

In short, the best way to treat pain with opioids was to continue to prescribe opioids and increase the dosages until patients’ pseudo-addiction symptoms went away.

As the New Yorker recently reported (October 30, 2017: The Family That Built an Empire of Pain), Purdue described that  pseudo-addiction “seems similar to addiction, but is due to unrelieved pain.” The pamphlet continued, “Misunderstanding of this phenomenon may lead the clinician to inappropriately stigmatize the patient as an ‘addict.’”

Purdue explained that pseudo-addiction generally stopped once the pain was relieved—“often through an increase in opioid dose.” A large part of the medical community bought the idea that opioids were not addictive. The floodgates were opened and opioids were prescribed in an unprecedented fashion. Surprisingly, the opioid manufacturers and their distributors started bringing in billions and billions in dollars.

In hindsight, we can see now how insane this was. It is not a secret that opioids are highly addictive. Wars have been fought over opium because it was very profitable to sell it to addicts. But the manufacturers created a new narrative to contradict the fact that opioids are highly addictive. Purdue invested heavily in marketing opioids as non-addictive, and created customers who would want to purchase their additive until they died.

When I first heard the story of how the current opioid epidemic began, I thought of Big Tobacco’s lies about cancer and addiction. That addiction was a part of Tobacco’s business model. Likewise, I believe we will find that addiction was a part of the opioid manufacturers’ business model. Over the next few years, we will see the reckoning of what the manufacturers’ purposeful decisions have done to addict Americans.

However, this is the first part of the story—and critical to understanding why these manufacturers need to be held responsible for the costs of the epidemic. For the millions of people who have been affected by this criminal behavior, the costs are anything but pseudo.


— Stephen represents Jefferson and Berkeley Counties in the national opioid litigation.

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