An extravagant liar has occupied the White House since Jan. 20, 2017, and he seems bent on shredding the truth right up until he leaves it Jan. 20, 2021, assuming that his wildest claim yet — that fraud cost him reelection — does not achieve its dangerous purpose.

Yet newly released government data reminds us that Donald Trump might not have become president if powerful people before him had not spread their own brand of misinformation, at an awful human cost.

Last Thursday, the Centers for Disease Control and Prevention reported that 81,000 people died from drug overdoses in the 12 months ending in May, the highest 12-month number ever recorded. Opioids were the main culprit: The addiction crisis was the top public health issue before the coronavirus, and probably will be again after the virus is contained.

Though synthetic opioids such as fentanyl are responsible for a rising share of the deaths, the CDC has described their surging use as a follow-on phenomenon to the wave of prescription opioid addiction, which began in the late 1990s and continues to claim thousands of lives today.

And the cause of the initial prescription opioid addiction wave was an untruth: that doctors could and should prescribe powerful opioid pain medications liberally for non-cancer pain, with little or no risk of addiction.

That terribly mistaken sea change in U.S. medical practice — begun about a quarter-century ago, at the prompting of a profit-minded pharmaceutical industry, and with the active and passive support of federal regulators, drug wholesalers, pharmacies, hospitals and doctors — contributed to nearly half a million deaths due to opioid overdose since 1999.

Heavily concentrated in Appalachia and other bastions of the “White working class,” this massive trauma both reflected and worsened the destabilization of communities already reeling from the loss of manufacturing and mining industries.

Counties hardest hit by the opioid epidemic also voted overwhelmingly for Trump in 2016.

The fact that Trump broke his promise to solve the problem is predictable and ironic, but does not render his support among the victims incomprehensible. Nor does the fact that culpability varies among business, government and medical authorities. Some acted in bad faith for profit; others thought they were following valid science.

All that matters to the victims — or anyone else, really — is that the authorities who were supposed to protect the public did not.

Even now, the list of implicated establishmentarians grows. Documents released as part of a lawsuit against Purdue Pharma have shown that in 2009 McKinsey & Co., the world’s leading business consulting firm, strategized with Purdue about its opioid OxyContin, including discussion of a plan to “counter the emotional messages from mothers with teenagers that overdosed.”

OxyContin by that time was notorious as the cause of much addiction and death across Appalachia; in 2007, Purdue had pleaded guilty, as a corporation, to marketing it in violation of federal law.

In 2017, McKinsey senior partners suggested Purdue could shore up its position in the market by paying distributors $14,810 whenever one of their customers overdosed on OxyContin, according to newly released bankruptcy court documents. The proposal was never implemented; McKinsey has apologized for its Purdue work.

The U.S. political and legal systems have delivered limited and scattershot accountability for all of this. Former pharmaceutical executive John Kapoor got 5½ years in prison for federal crimes related to boosting his company’s sales of prescription fentanyl.

State, municipal and tribal lawsuits have forced Purdue into bankruptcy; the Trump administration has extracted more guilty pleas and fines from the company, as well as, for the first time, $225 million from members of the Sackler family, which owned Purdue.

The Sacklers — including Richard Sackler, the executive most responsible for promoting OxyContin — have escaped any personal criminal liability and stand to retain the bulk of their wealth, which Forbes estimates at a collective $10.8 billion.

The worst consequence they’ve had to face so far may have been a tongue-lashing from members of Congress at a hearing on Thursday.

Responding to questions publicly for the first time in decades, former Purdue board member David Sackler, Richard’s son, and his cousin Kathe Sackler, who also sat on the board, expressed carefully worded regret that the product that made them fantastically rich has been “associated with” so much devastation.

They denied personal mistakes or wrongdoing, however, and gave every indication of believing it. Given what she was told in her 28 years on Purdue’s board, Kathe Sackler said, “There is nothing I can find that I would have done differently.”

In the United States, it seems, hundreds of thousands can suffer avoidable deaths, but if the chain of decisions, actions and events leading to that catastrophe is sufficiently complex, no one in particular — or almost no one — must face serious consequences for it. Is it any wonder people get angry?

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