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Weighing in at a conservative $14 billion, the Sackler family entered Forbes’ Top-20 List of America’s Richest Families. How did this family generate such a lofty sum? In short, Raymond and Mortimer Sackler manufactured, aggressively marketed, and sold the most notorious painkiller ever created, OxyContin.

With access to America’s hospitals, Purdue then began funding more than 20,000 pain-related “educational programs” through financial grants and direct sponsorships. They used these grants to provide presentations and demonstrations to entire hospital staffs and present at state and local medical conferences, providing doctors with continuing medical education (CME) units.

The inmates weren’t running the asylum. The inmates had torn the asylum down, built a new one, and called it a hospital.

With pain management now mandated by the Joint Commission, Purdue began funding groups such as the American Chronic Pain Association (ACPA) and the American Pain Society (APS). These vocal groups began demanding doctors start taking pain management seriously, bringing their message everywhere from state legislatures to medical conferences.

Organizations funded by the pharmaceutical industry were created that rated doctors based on their willingness to treat pain and encouraged many family practitioners to begin prescribing outside of their normal scope of practice. The local family doctor suddenly felt pressure to prescribe powerful narcotics he or she might not have fully understood, or else risk a scathing review from a group like the American Pain Society that could irreparably harm his or her practice.

To ensure legal protection for prescribers, pharmaceutical companies began lobbying state legislatures who, with no medical background, began passing laws protecting doctors from malpractice claims for overprescribing.