Nearly 100 deaths a day.

The leading cause of death for under 50s.

Over two million problem users.

Responsible for more deaths a year than guns or cars.

2017 was the year that America’s opioid epidemic made the headlines. With story after devastating story of families and communities ravaged by lives lost to addiction. It was also the year that big pharma came under the spotlight for their role in fuelling this “public health emergency”, having flooded states with millions upon millions of pills. (More than forty states are suing the pharmaceutical companies, reminiscent of the mass litigation against tobacco (some background)).

Mainstream media has barely touched on the broken ethics of doctors taking $46 million in opioid-promoting payments from pharma companies (over just 29 months).

Amid this notable coverage, the murky relationship between big pharma and the health professionals who prescribe their drugs has been under-reported. Mainstream media has barely touched on the broken ethics of doctors taking payments from pharma companies. Yet research shows that even a $20 lunch can influence prescribing habits, and the higher the payments doctors receive, the higher the rate at which they prescribe the promoted drugs. Research published this summer revealed drug companies made 375,000 opioid-related payments to doctors in just 29 months. One in five family doctors – health professionals implicitly trusted to do the best thing for patients – have received payments relating to these highly addictive narcotics.

The role of big pharma is half the story, the willingness of doctors to cosy up to them – facilitated by millions of dollars in payments and gifts – is the other half. But that isn’t making front-page news.


  1. Ian Birrell describes what he saw on a trip to Dayton, Ohio, in ‘The even more deadly hurricane surging across America’
  2. Charlotte Pickles examines the role of doctors in enabling the spread of opioid addiction in ‘The cosy relationship between big pharma and doctors is killing people’
  3. Peter Franklin writes about how legally prescribed opioids have developed the criminal market for such narcotics in ‘How to create a drug epidemic’


Introduction to this Under-reported series.

Summary guide to all under-reported articles in this series.