Prescribing Dependency: The System Behind America's Opioid Crisis
- Tammy Adler Foeller
- 4 days ago
- 5 min read
May 18, 2026
Tammy Adler Foeller, Author, Founder & Executive Director, OpenDoor Women's Recovery
Tom O'Connor, Publisher
How Purdue Pharma and the institutions around it reshaped risk, pain, and trust in American healthcare.
Every week, I sit across from women who are rebuilding their lives. Many of them did not begin with illicit drugs. They began with a prescription—a surgery. An injury. A moment where they trusted the healthcare system to help them manage pain.
That trust matters. Because when we talk about the opioid epidemic, we often focus on where it ends. But if we are going to understand it and respond to it, we have to be honest about where it began.
Not in the streets. In our healthcare system. And at the center of that shift was Purdue Pharma.
A Narrative That Changed Medicine
In 1996, Purdue Pharma introduced OxyContin, a powerful opioid intended for long-term pain relief.
What made OxyContin different was not just the drug itself, but the story told about it.
Physicians were assured that the risk of addiction was low. However, that message did not come from rigorous, long-term clinical trials. Instead, it was rooted in a brief 1980 letter published in the New England Journal of Medicine, which observed that addiction appeared to be rare among hospitalized patients receiving short-term opioid treatment.
That limited finding was never meant to apply to long-term, outpatient use. Yet it didn't stay limited. It was repeated. Expanded. Misapplied. And over time, it became something far more powerful than data: belief.
Purdue Pharma reinforced that belief through aggressive marketing and physician education, assuring prescribers that opioids could be used safely and broadly.
This wasn't just misleading….it reshaped how medicine understood risk.
When Systems Reinforce the Wrong Message
That shift did not happen in isolation; it was reinforced by the systems surrounding it.
The role of the U.S. Food and Drug Administration helped solidify the perception that OxyContin was safe for broader use. When the drug was approved, its labeling suggested that its extended-release formulation might reduce abuse potential. While this may have been a theoretical assumption, it was not supported by long-term, real-world evidence, and it became a key part of how the drug was presented to physicians.
Cultural Shift
At the same time, healthcare itself was undergoing a cultural shift. Pain was increasingly treated as the "fifth vital sign," and patients were routinely asked to rate their pain on a 0–10 scale. Hospitals were evaluated, in part, on how well that pain was managed, and patient satisfaction became tied to outcomes.
While these tools were not created by Purdue Pharma, the company heavily promoted a culture of aggressive pain treatment. Through funded education and physician outreach, Purdue reinforced the idea that patients should expect to be pain-free and that opioids were an appropriate way to achieve that outcome.
Organizations like the American Pain Society and the Joint Commission also helped embed pain assessment into standard practice.
The result was alignment. Physicians were hearing the same message from multiple directions:
Pain should be eliminated
Opioids were a safe and effective solution
Patient satisfaction depended on it
This wasn't one bad decision; it was a system moving in the same direction, all at once.
Read More:
The Outcome Was Predictable: The Opioid Crisis
When you increase access to a highly addictive substance while minimizing its risks, the outcome is not surprising. Prescriptions rose—tolerance built. Dependency followed. And when prescriptions became harder to obtain, many turned to heroin. Later, fentanyl entered the picture, making an already devastating crisis even more deadly.
But statistics alone don't capture the full weight of this. Because behind every number is someone who trusted the system:
A person managing pain after trauma
A person recovering from surgery
A patient who followed medical advice—and found herself dependent
These are not exceptions. They are the result of a system that was misinformed at scale.
Accountability Came Too Late
As the consequences became impossible to ignore, accountability began to take shape, but long after the damage had taken hold. In 2007, Purdue Pharma and three top executives pleaded guilty to federal criminal charges of misbranding OxyContin, acknowledging they fraudulently marketed the drug as less addictive and less prone to abuse than other pain medications. The company agreed to pay over $600 million to settle the case.
Since 2007, Purdue Pharma has faced thousands of lawsuits over its aggressive marketing and deceptive claims regarding the addictive nature of OxyContin, resulting in two federal guilty pleas (2007, 2020), bankruptcy in 2019, and a 2024 Supreme Court ruling that blocked a settlement designed to shield the Sackler family from future liability. Years later, facing thousands of lawsuits, the company filed for bankruptcy. The Sackler family became a focal point of public scrutiny and agreed to contribute billions toward settlements. In April 2026, Purdue Pharma reached the final stages of its long-running bankruptcy and criminal proceedings, leading to its official dissolution.
But in 2007, the impact had already spread through communities, families, and entire systems of care. No settlement restores the years lost to addiction. No policy change rebuilds trust overnight.
What Changed—and What Still Hasn't
The influence of Purdue Pharma did not end with OxyContin; it continues to shape healthcare today. In response to the crisis, prescribing practices have changed dramatically. Physicians now operate under stricter guidelines, and monitoring systems track opioid use more closely than ever before. These changes have reduced overprescribing, but they have also introduced new challenges.
Patients with legitimate chronic pain can struggle to access appropriate care. Providers make decisions not only based on patient need, but within a system shaped by scrutiny and liability. At the same time, there has been meaningful progress in how addiction is understood. It is increasingly recognized as a chronic medical condition requiring long-term care rather than a moral failing.
And yet, one of the most significant impacts remains unresolved: TRUST. Patients question what they are prescribed. Providers question the information they are given.
Communities approach the healthcare system with caution. Rebuilding that trust will take far more than regulation.
What I See Every Day
At OpenDoor Women's Recovery Alliance, we walk alongside women doing the hard work of recovery. We are dedicated to empowering women in the early stages of recovery from substance use disorder, incarceration, and/or addiction treatment. Many did not set out to become addicted. They followed medical guidance. They trusted the system. And somewhere along the way, that trust led them into dependency.
Recovery, for them, is not just about sobriety. It is about rebuilding:
Stability
Relationships
A sense of safety in their own lives
And often, it is about learning to trust again. That kind of healing does not happen through policy alone. It happens through community, consistency, and people who show up.
Moving Forward Requires More Than Regulation
If we are going to respond to this crisis with integrity, we have to be honest about how it started. The opioid epidemic was not an accident. It was the result of messaging, incentives, and systems that moved in the wrong direction—together.
And while Purdue Pharma played a central role, the path forward requires more than accountability for the past. It requires a different approach to care.
One that:
● Balances responsible prescribing with compassionate pain management
● Expands access to long-term addiction treatment
● Strengthens oversight of pharmaceutical influence
● Invests in community-based recovery support
Because while systems can contribute to harm, they can also be redesigned to support healing. But only if we are willing to learn from what happened. And only if we center the people who are still living with its consequences.
History should remember the opioid epidemic not as an unavoidable tragedy, but as a preventable crisis fueled by deception, enabled by institutions, and paid for in human lives.
Read Tammy's bio by clicking her icon at the start of this article.
If you enjoyed this article,
Please forward it to a friend or colleague who might benefit from it.
Comments