Patrick Radden Keefe writes:

This past January, the Justice Department announced the results of investigations into Practice Fusion, a San Francisco-based company that maintains an online platform for health records. According to prosecutors, Practice Fusion had created a digital alert that prompted physicians to recommend strong opioid painkillers while meeting with patients. In return for adding the alert, Practice Fusion received a kickback from a pharmaceutical company, described in court papers as “Pharma Co. X.” A federal prosecutor, Christina Nolan, said that the alert “effectively placed the pharma company pushing opioids into the exam room.” Practice Fusion had suggested including a warning in the alert about how dangerous opioids can be, but, according to court filings, Pharma Co. X resisted the idea.

Practice Fusion agreed to pay a hundred and forty-five million dollars in fines and forfeiture. The settlement seemed to represent the first half of a two-act drama: if the company was now coöperating with authorities, then the Justice Department would surely turn next to Pharma Co. X—a prospect that became all the more intriguing when Reuters reported, the next day, that the drugmaker’s identity was Purdue Pharma, the maker of the blockbuster opioid OxyContin.

Many pharmaceutical companies had a hand in creating the opioid crisis, an ongoing public-health emergency in which as many as half a million Americans have lost their lives. But Purdue, which is owned by the Sackler family, played a special role because it was the first to set out, in the nineteen-nineties, to persuade the American medical establishment that strong opioids should be much more widely prescribed—and that physicians’ longstanding fears about the addictive nature of such drugs were overblown. With the launch of OxyContin, in 1995, Purdue unleashed an unprecedented marketing blitz, pushing the use of powerful opioids for a huge range of ailments and asserting that its product led to addiction in “fewer than one percent” of patients. This strategy was a spectacular commercial success: according to Purdue, OxyContin has since generated approximately thirty billion dollars in revenue, making the Sacklers (whom I wrote about for the magazine, in 2017, and about whom I will publish a book next year) one of America’s richest families. [Continue reading…]