Which drug started the opioid crisis? Unpacking the origins with OxyContin

October 11, 2025 •

4 min read

First marketed in 1996, the prescription painkiller OxyContin is widely considered the medication that ignited the opioid crisis in the United States, triggering a widespread wave of addiction due to its deceptive marketing and powerful nature. The story of this drug, its manufacturer Purdue Pharma, and the consequences of its widespread use provides a critical understanding of the public health emergency still unfolding today.

Quick Summary

The modern opioid crisis was ignited by the prescription painkiller OxyContin, aggressively marketed by Purdue Pharma. Misleading claims of low addiction risk led to widespread over-prescription, fueling the epidemic's first wave before evolving to include illicit street drugs.

Key Points

The Triggering Drug: The powerful prescription painkiller OxyContin, developed and marketed by Purdue Pharma, is widely credited with initiating the opioid crisis in the mid-1990s.
Deceptive Marketing: Purdue Pharma aggressively promoted OxyContin to doctors and the public with false claims that its controlled-release formula made it less addictive than other opioids.
Market Expansion: The company's marketing efforts successfully expanded the use of opioids from severe cancer pain to a wider range of chronic pain, dramatically increasing the number of prescriptions and users.
Pathway to Illicit Drugs: As addiction and tolerance grew, many individuals dependent on prescription opioids turned to cheaper and more potent illegal substances like heroin, fueling the crisis's next phase.
Legal Consequences: Purdue Pharma and the Sackler family faced billions of dollars in fines and settlements after pleading guilty to criminal charges related to their deceptive marketing practices.
The Continuing Crisis: Although the initial wave was driven by prescription opioids, the crisis has since evolved, with powerful synthetic opioids like fentanyl now driving the deadliest phase.

The Introduction of a Game-Changing Painkiller

In 1995, the Food and Drug Administration (FDA) approved OxyContin, a new long-acting opioid pain medication developed by Purdue Pharma. While oxycodone, the drug's active ingredient, was not new, its controlled-release formulation was seen as revolutionary. It was designed to provide 12 hours of pain relief, a significant improvement over traditional opioids that required more frequent dosing. At the time, the FDA and others believed this slow-release mechanism would result in a lower risk of abuse and addiction, a claim that would later be proven tragically false.

Deceptive Marketing and the Expansion of the Opioid Market

Purdue Pharma launched a highly aggressive and fraudulent marketing campaign for OxyContin, targeting doctors and positioning the drug as a safe and effective treatment for a broad range of chronic pain conditions. Previously, strong opioids were reserved mostly for severe pain, like that associated with cancer. Purdue's strategy was to expand the market to patients with less severe, long-term pain.

The Misleading Message

Purdue sales representatives were instructed to downplay the risks of addiction associated with the drug. The company funded supposedly independent pain advocacy groups and paid physicians to promote the safety of opioids. This was despite internal company knowledge of high addiction risks. For example, the company targeted high-volume opioid prescribers, incentivizing sales representatives with lucrative bonuses for increasing sales and dosages. In a 2007 plea deal, Purdue admitted its sales personnel had falsely claimed OxyContin was less addictive than other opioids.

Bypassing the Controlled-Release Mechanism

Despite the drug's intended 12-hour duration, many patients and illicit users discovered that the controlled-release formula could be defeated by simply crushing, snorting, or injecting the pills. This delivered a high concentration of the drug at once, producing an intense and immediate high that promoted abuse. As patients developed tolerance, they needed higher doses or more pills, and when prescriptions became unavailable or too expensive, many turned to cheaper alternatives.

The Evolution of the Opioid Crisis: From Pills to Street Drugs

The crisis's origin with prescription opioids like OxyContin set off a chain of events that has evolved over several distinct phases, as recognized by the Centers for Disease Control and Prevention (CDC).

Wave 1: Prescription Opioid Overdoses (1990s)

Beginning in the 1990s, prescription opioid overdose deaths surged due to the over-prescription and widespread availability of drugs like OxyContin. Increased prescribing for chronic pain led to a dramatic rise in opioid use, misuse, and dependence.

Wave 2: Heroin Overdoses (c. 2010)

As the availability of prescription opioids was curtailed through regulatory crackdowns and formulation changes (Purdue introduced an abuse-deterrent version of OxyContin in 2010), a population dependent on opioids sought cheaper and more potent alternatives. This fueled a rapid increase in heroin overdose deaths. Many individuals dependent on prescription pills switched to heroin as it became more readily available and affordable on the illicit market.

Wave 3: Synthetic Opioid Overdoses (c. 2013–present)

The third and current wave is characterized by a dramatic and devastating rise in overdose deaths involving illicitly manufactured synthetic opioids, particularly fentanyl. Fentanyl is 50 to 100 times more potent than morphine, and its presence in the illegal drug supply has led to a new level of overdose risk.

Legal Accountability and the Continuing Crisis

Purdue Pharma and its owners, the Sackler family, faced immense legal and public scrutiny for their role in the crisis.


Timeline of Legal Action Against Purdue Pharma	Year	Event	Details	Outcome
2007	Federal Criminal Charges	Purdue executives plead guilty to misleading the public about OxyContin's addiction risk.	$635 million in fines and penalties paid.
2019	Bankruptcy Filing	Purdue Pharma files for Chapter 11 bankruptcy amidst thousands of lawsuits.	Restructuring process and ongoing settlements.
2020	DOJ Resolution	The Department of Justice announces a multi-billion dollar resolution to criminal and civil investigations.	Largest penalties ever levied against a pharmaceutical manufacturer.
2025	Global Settlement	All 50 states and U.S. territories sign onto a new $7.4 billion settlement with Purdue and the Sackler family.	Funds allocated for addiction treatment and recovery.

Conclusion

While a single drug cannot be blamed for the entirety of a complex crisis, the evidence overwhelmingly points to OxyContin and the deceptive practices of Purdue Pharma as the primary trigger for the modern opioid epidemic. Its aggressive and misleading marketing flooded the medical community and the public with a highly addictive substance, expanding the market for opioids far beyond their traditional, restrictive use. This initial wave of addiction to prescription painkillers created the conditions that led to the subsequent surges in heroin and synthetic opioid overdoses. The crisis continues today, serving as a stark reminder of the devastating consequences when corporate profit is prioritized over public health. The widespread harm caused by this one drug highlights the need for stronger regulation and accountability in the pharmaceutical industry.

Comparative Opioid Characteristics


Feature	OxyContin (Prescription)	Heroin (Illicit)	Fentanyl (Illicit)
Main Use	Chronic pain relief	No medical use	Extremely potent synthetic, often mixed with other drugs
Chemical Type	Semi-synthetic opioid	Semi-synthetic opioid (derived from morphine)	Synthetic opioid
Potency	High, especially when misused	Highly addictive	50-100 times stronger than morphine
Abuse Potential	High, controlled-release formula can be bypassed	Extremely high, illegal and unregulated market	Extremely high, often involves hidden presence in other drugs
Role in Crisis	Triggered initial wave due to over-prescription	Surged in Wave 2 as a cheaper alternative	Driving the current, deadliest wave (Wave 3)

Frequently Asked Questions

No, this was a fraudulent marketing claim by Purdue Pharma. Despite its controlled-release formula, the potential for abuse and addiction was high, and the drug could be easily manipulated to deliver a powerful, immediate high.

Purdue Pharma faced thousands of lawsuits from states, local governments, and individuals. The company filed for bankruptcy in 2019 and eventually reached multi-billion dollar settlements with victims, though its owners, the Sackler family, retained much of their fortune.

As individuals became dependent on OxyContin and its supply was restricted or became too expensive, many turned to cheaper and more accessible street drugs, such as heroin, to prevent withdrawal symptoms.

The Sackler family owned Purdue Pharma. They directed the deceptive marketing campaign for OxyContin and profited significantly from its sales, despite being aware of the drug's high addiction potential.

The crisis has progressed in waves. The initial wave involved prescription opioids like OxyContin, followed by a second wave driven by heroin, and a third, ongoing wave dominated by powerful synthetic opioids, most notably fentanyl.

The term 'opioid' is a broader category that includes all substances that interact with opioid receptors, both natural and synthetic. 'Opiate' refers specifically to naturally derived opioids, like morphine and heroin.

While regulations have tightened and Purdue Pharma ceased marketing opioids to doctors, some smaller companies and competitors increased their marketing efforts following the initial lawsuits against Purdue. However, public awareness and stricter prescribing guidelines have changed the landscape significantly.