Since 2016, The Washington Post has been investigating the opioid epidemic that has ravaged communities and claimed the lives of more than 500,000 people nationwide. The series of investigations is collectively known as The Opioid Files.
The Post’s efforts culminated on July 16, 2019, with the disclosure of a previously unreleased Drug Enforcement Administration database that tracks the path of every pain pill sold in the United States. The confidential database was obtained by lawyers representing 3,000 cities, towns, counties and tribal nations in a civil action alleging that nearly two dozen drug companies conspired to saturate the nation with opioids. The database and additional court exhibits were made public after a legal challenge by The Post and the owner of the Charleston Gazette-Mail in West Virginia.
In 2021, HBO presented “The Crime of the Century,” a two-part, four-hour documentary tracing the arc of the opioid epidemic in America, focusing on the roles of the drug companies that initiated and fueled it. The documentary, by acclaimed filmmaker Alex Gibney, was based in part on The Post’s work.
In 2022, The Post published an adaptation from Scott Higham and Sari Horwitz’s book, “American Cartel: Inside the Battle to Bring Down the Opioid Industry.” In the story, Post reporters detailed how lobbyists, lawmakers and K Street attorneys thwarted efforts to stop the deadly flow of pain pills.
Here are the major findings from the reporting:
• In 2016, The Post’s first investigation documented how major drug companies had fought back against an aggressive decade-long DEA campaign to target wholesale companies that distributed huge volumes of opioid pills to corrupt pharmacies and pill mills. The Post’s investigation also showed that 13 drug distributors knew or should have known that hundreds of millions of pills were ending up on the black market, and some distributors ignored DEA or external warnings of drug diversion.
• In 2017, The Post launched a second investigation, in collaboration with “60 Minutes,” to reveal the pressure exerted by drug industry lobbyists and members of Congress to restrain the DEA. At the height of the epidemic, Congress effectively stripped the DEA of its most potent weapon against large drug companies and personally attacked the leader of the agency anti-opioid campaign, who was forced into retirement. Days after the investigation appeared, President Donald Trump’s selection to be the nation’s new drug czar, who had led the efforts backed by the drug industry in Congress, removed his name from consideration.
• In 2018 and in early 2019, as drug abusers who had been addicted to opioids increasingly turned to heroin and the synthetic painkiller fentanyl, Post reporters documented how the Obama administration failed to grasp fentanyl’s threat or to organize an effective strategy as deaths soared.
• In mid-2019, The Post obtained and published the DEA’s ARCOS database, tracing the distribution of billions of oxycodone and hydrocodone pain pills across the country. The Post initially learned 76 billion pills saturated the country between 2006 and 2012. Additional reporting revealed the breadth of distribution between 2006 and 2014: more than 100 billion pills. Just six companies distributed 76 percent of the pills during this period. The Post made the database public so it could be available to other researchers and media organizations, and more than 100 newspapers across the nation used the data to publish stories of their own.
• In 2022, a cache of more than 1.4 million records revealed the inner workings of Mallinckrodt Pharmaceuticals, the largest manufacturer of opioids in the United States. The documents, made public after years of litigation and bankruptcy proceedings, shed new light on how aggressively Mallinckrodt sought to increase its market share as the epidemic was raging.
• In late 2022, The Post published a seven-part investigation into fentanyl’s deadly surge. In 2021, 107,622 died of drug overdoses in the United States. Fentanyl was responsible for two-thirds of those deaths. The epidemic has hit the young with alarming speed and disproportionately killed Blacks and Native Americans in recent years. The amount of fentanyl seized along the U.S. southern border — the most reliable gauge of supply — has jumped ninefold during the past five years. Despite record numbers of American deaths, federal officials have been slow to react and the surge has been exacerbated by a breakdown in U.S.-Mexico counternarcotics cooperation.
Norton, Va., was flooded with 306 pain pills per person per year from 2006 to 2012. Now, those devastated by the opioid crisis are demanding accountability.
Here are some other stories that tell the struggles of those affected by the crisis:
The fight over who is accountable for the epidemic has led to the largest civil case in U.S. history and involves nearly two dozen major drug companies. The 2,500 cases from around the nation have been consolidated in U.S. District Court in Cleveland. In October, several drug companies reached a $260 million settlement with two counties in Ohio. Johnson & Johnson, which owned two companies that processed and imported raw material to manufacture oxycodone, reached its own settlement. The remaining cases are pending.
Purdue Pharma, the drug manufacturer accused of triggering the nation’s epidemic through its sale of OxyContin, filed for bankruptcy in September 2019.
Throughout its reporting, The Post learned how drug company lobbyists allied with members of Congress to derail the DEA’s efforts to go after distributors. The Post further helped shed light on the drug industry’s efforts to lobby for a law that weakened one of the government’s most powerful drug enforcement tools.
In the middle of the epidemic, the drug industry used aggressive marketing practices to ramp up the sale of opioids. Watch how they made it happen in our documentary below.
Explore two other companies involved in the distribution and sale of pain pills: McKesson Corp., the nation’s largest drug company, and Mallinckrodt Pharmaceuticals, one of the nation’s largest manufacturers of oxycodone.
In early 2016, The Post began investigating how hundreds of millions of highly addictive pain pills that are sent along a tightly regulated pharmaceutical supply chain were fueling a growing, deadly epidemic.
• Starting in 2006, the DEA launched an aggressive campaign to curb the rising opioid epidemic, targeting wholesale companies that distributed hundreds of millions of highly addictive pills and to the corrupt pharmacies and pill mills that illegally diverted the drugs to the black market. But the industry fought back, and soon officials at DEA headquarters were delaying and blocking enforcement actions.
• Thirteen drug distributors knew or should have known that hundreds of millions of pills were ending up on the black market, according to court records, DEA documents and legal settlements in administrative cases reviewed by The Post. Even when the companies were alerted to suspicious pain clinics or pharmacies by the DEA and their own employees, some distributors ignored the warnings and continued to send drugs.
• Pharmaceutical companies have hired dozens of officials from the top levels of the DEA during the past decade. The hires came after the DEA launched an aggressive campaign to curb the rising opioid epidemic.
In 2017, reporters dug deeper into the issue, working with “60 Minutes” to explore in greater depth the pressure that had been exerted on Congress by the drug industry and its lobbyists and its impact on some key DEA investigations into large drug companies.
• At the height of the deadliest drug epidemic in U.S. history, Congress effectively stripped the DEA of its most potent weapon against large drug companies suspected of spilling prescription narcotics onto the nation’s streets. The law was the crowning achievement of a multifaceted campaign by the drug industry to weaken DEA enforcement efforts by working behind the scenes with lobbyists and key members of Congress.
• After two years of painstaking investigation, a DEA team was ready to move on the biggest opioid distribution case in U.S. history. Instead, top attorneys at the DEA and the Justice Department struck a deal that was far more lenient than the field agents wanted, according to interviews and internal government documents.
• In 2012, distributor Cardinal Health got word that the DEA was about to take action against a Florida warehouse that supplied millions of painkillers to customers every month. Cardinal retained one of Washington’s best-connected power lawyers, Jamie Gorelick, who had served as deputy U.S. attorney general from 1994 to 1997. She reached out to her old agency on the company’s behalf, and the impact was immediate.
In 2018 and 2019, The Post turned its focus to the synthetic painkiller fentanyl, the latest wave of the opioid crisis, which claimed the lives of about 30,000 that year. Pain pill addiction had given rise to heroin use, which in turn created a soaring demand for fentanyl, which is 50 times as powerful as heroin.
• Federal officials failed to grasp how quickly fentanyl was creating another — and far more fatal — wave of the epidemic. In the span of a few short years, fentanyl became the drug scourge of our time. If current trends continue, the annual death toll from fentanyl will soon approach the yearly toll from guns or traffic accidents.
• The depth of the fentanyl problem continues to overwhelm the government’s response, and the administration has yet to produce a comprehensive strategy that is legally required by Congress. Health policy experts say treatment funding is not nearly enough, and the Trump administration’s response was hobbled by the failure to appoint a drug czar in its chaotic first year and confusion over who was in charge of drug policy.
• The flow of fentanyl into the United States from China was facilitated for years by the illicit use of the U.S. Postal Service and other persistent vulnerabilities at the nation’s ports of entry.
• As deaths mounted from fentanyl overdoses, Congress took little action to address the epidemic or stop the flow of the deadly drug into the United States.
In July 2019, The Post obtained the DEA database of opioid distribution. Among the findings:
• America’s largest drug companies distributed billions of oxycodone and hydrocodone pain pills across the country. The Post initially learned 76 billion pills saturated the country between 2006 and 2012. Additional reporting revealed the breadth of distribution between 2006 and 2014: more than 100 billion pills. Just six companies distributed 76 percent of the pills during this period.
• The volume of pills handled by the companies climbed as the epidemic surged, increasing 51 percent during a seven-year time frame. An interactive database of pain pill shipments shows the locations that were inundated with opioids.
• Deaths from opioids soared in the communities that were flooded with pain pills. The highest per capita death rates nationwide were in rural West Virginia, Kentucky and Virginia.
• Internal documents showed the pressure within drug companies to sell opioids in the face of numerous red flags. The exhibits reveal concerns by some drug company employees about the huge number of pain pills being distributed.
• Records show that by 2006, as the number of overdose deaths grew, a handful of obscure generic-drug manufacturers were selling the bulk of opioid pills flooding the country.
• Walgreens dominated the nation’s retail opioid market. The company handled nearly 1 in 5 of the most addictive opioids and acted as its own distributor.
Post reporters continued delving into the aspects of the opioid epidemic and related developments for a fifth year, even as the covid-19 pandemic overtook the country.
• One story documented how Johnson & Johnson companies had used a ‘super poppy’ developed in Australian to make narcotics for America’s most-abused opioid pills.
• Another investigation revealed that Native American tribal lands were flooded with opioids and especially hard hit with skyrocketing deaths as the epidemic progressed. A plan by a Native American tribe to build an opioid treatment center was blocked by neighbors.
• During the course of 2020, efforts to hold the drug companies accountable bore fruit. In October, Purdue Pharma agreed to plead guilty to federal criminal charges in a historic $8.3 billion settlement with the Justice Department over the opioid crisis. In November, Johnson & Johnson and the “Big Three” wholesale drug distributors, McKesson, Cardinal Health and AmerisourceBergen, reached a tentative settlement of $26 billion deal on the opioid litigation. However, the companies were also seeking $4.5 billion in tax deductions for those costs.
• More than a quarter of the doctors ranked by Mallinckrodt Pharmaceuticals as its top prescribers of opioids during the height of the pain pill epidemic, in 2013, were later convicted of crimes related to their medical practices, had their medical licenses suspended or revoked, or paid state and federal fines after being accused of wrongdoing, according to a Washington Post analysis of the Mallinckrodt documents. The documents are part of a cache of 1.4 million records, emails, audio recordings, videotaped depositions and other materials the company turned over as part of its $1.7 billion bankruptcy settlement in 2020.
• A federal judge rejected claims that the nation’s three major drug distributors bore responsibility for the opioid crisis in a West Virginia community that was among the hardest hit.
• The Post published an adaptation from Scott Higham and Sari Horwitz’s book, “American Cartel: Inside the Battle to Bring Down the Opioid Industry.” The Post reporters detailed how lobbyists, lawmakers and K Street attorneys thwarted efforts to stop the deadly flow of pain pills.
• A 17-year-old’s death in California shows how fentanyl-laced pain pills, often sold on social media, are killing record numbers of unsuspecting Americans. Anne Milgram, head of the Drug Enforcement Administration, said Snapchat and other social media firms should do more to protect their users.
• In November 2022, Customs and Border Protection seized 2,900 pounds of fentanyl at ports of entry along the southern border, the highest monthly total ever, an amount that easily eclipses what the agency confiscated during the entirety of 2018. The Cartel RX series traced the fentanyl epidemic from the back alleys of Tijuana to official Washington and from warehouses in northern Mexico to neighborhoods in Utah, Colorado and San Diego. Despite record numbers of American deaths, federal officials have been slow to react and the surge has been exacerbated by a breakdown in U.S.-Mexico counternarcotics cooperation.