Homeless drug-addicts on a sidewalk in Philadelphia, USA. Photo: Reporte Asia.
By Misión Verdad – Sep 16, 2025
The official US narrative on the opioid epidemic, now experiencing a new wave with fentanyl, has been diligently built on the search for external scapegoats.
However, the seeds of its worst public health crisis in decades were planted, cultivated, and harvested within the United States itself by domestic actors who operated under the cover of corporate greed and the negligent—or complicit—gaze of institutions.
The society that medicalized pain now criminalizes its relief
It is estimated that 80,391 people in the US died from drug overdoses in 2024, a 27% drop from the 110,035 deaths recorded the previous year and the lowest level since 2019. Fentanyl deaths fell from approximately 76,000 in 2023 to 48,422 last year, still accounting for more than half of all cases.
Fentanyl—synthetic, cheap, easy to produce, and 50 times more potent than heroin—appeared in six out of ten cases, but its origin lies within the medical system itself. Between 1999 and 2030, approximately one million people will have died from opioid overdoses in the US. This includes both prescription and illegal opioids.
But the origin of these opioid “waves” lies in a phenomenon dubbed the “medicalization of life and society,” which transformed everyday ailments into profitable diagnoses. Sociologist Susana Rodríguez Díaz sums it up as follows:
“Making people believe they are sick can be a substantial source of income. One way to achieve this is to broaden the boundaries of treatable illnesses … for example, by turning ordinary ailments into medical conditions, mild symptoms into serious ones, personal problems into medical issues, or risks into diseases.”
Common life processes, including anxiety, certain moods, menstruation, birth control, infertility, childbirth, menopause, aging, and death, have been medicalized. They were redefined as clinical conditions requiring pharmacological intervention.
This narrative promoted by the medical-pharmaceutical complex—or Big Pharma—opened the door to a flood of opioid prescriptions such as OxyContin, produced by Purdue Pharma. The plot begins with a letter published in the New England Journal of Medicine in 1980—cited 600 times since—that claimed opioids were “rarely addictive” when used for chronic pain. Purdue Pharma, owned by the Sackler family, translated that phrase in 1996 for its OxyContin campaign: “Reduce pain, not quality of life.” This analgesic, like fentanyl, is chemically related to heroin.
In 2001, the company paid leading pain specialists to assure patients that the substance was effective. It also funded groups like the American Pain Foundation that styled themselves as advocates for pain patients. Several of these entities downplayed the risk of addiction and fought against efforts to reduce opioid use in patients with chronic pain.
As early as 2012, doctors in the United States were prescribing 259 million opioid prescriptions per year, enough for every American adult to have their own bottle of pills. When authorities began restricting access to legal pills, millions of dependent patients migrated to the black market.
Fentanyl, previously reserved for chemotherapy regimens, filled the void. The first wave of overdoses—during 2009–2014—was due to painkillers, the second—during 2015–2019—was due to heroin, and the third, which is ongoing, is driven by fentanyl and stimulants. This opioid surpassed firearms as the leading cause of death among adults aged 18-49 and has redefined the United States’ relationship with death, pain, and social control.
Fentanyl benefits the same old rich people
Behind every fentanyl death lies a chain of profits. The Sackler family, owners of Purdue Pharma, amassed a fortune from the sale of OxyContin, knowing since the 1990s that the product was highly addictive. Despite multiple class-action lawsuits, this family managed to protect billions of dollars in a settlement that many described as “structural impunity.” The empire of pain, as journalist Patrick Radden Keefe called it, remains in place as families bury their loved ones.
In March, a bankruptcy court approved Purdue Pharma’s plan under which the Sackler family will contribute $7 billion—approximately 63% of its fortune—in exchange for full civil immunity. The agreement shields about 40 members of the clan, who had already transferred $10.8 billion to Delaware, the United States’ internal tax haven, between 2008 and 2018. Another $1.5 billion ended up in entities registered in the British Virgin Islands and Luxembourg. The Court of Appeals granted the family immunity in 2023, against which the Biden administration took action. However, the pain business remains profitable, even in the supposed bankruptcy.
Last year, Endo Health Solutions pled guilty to a corporate criminal charge 10 years after the allegations against it began, and it was announced that it would face 1.5 billion in fines and forfeitures. Federal agencies, which had claimed the company owed as much as $7 billion in criminal fines, back taxes, and other charges, reached a settlement for just $200 million, only 2.8% of the debt.
The lawyers earned $350 million, some executives split $95 million in bonuses, and thousands of opioid victims will divide $40 million—about $1,000 each.
Other Big Pharma companies, such as Teva, Pfizer, and Johnson & Johnson, have also been implicated in flooding the market with opioids. Between 1995 and 2022, their stock prices rose by 900% to 1,000%. Although they denied any direct responsibility, internal documents suggest that some executives ignored warning signs about the misuse of their chemical products.
Less than a year ago, the DEA accused executives of three pharmaceutical distributors of illegally shipping nearly 70 million opioid pills and more than 30 million doses of other commonly prescribed medications to alleged over-the-counter pharmacies in the Houston, Texas.
According to researcher Helena Glass, 40% of the fentanyl seized on the street comes from “diverted” batches from plants in New Jersey and North Carolina. The chain is circular: the same Food and Drug Administration (FDA), which restricted opioids in 2016, approved 50 new licenses for “transmucosal” fentanyl for cancer patients in 2022. The surplus—billions of doses—feeds the black market without any need for imports.
Although various authorities and media outlets claim that most fentanyl is produced abroad, they omit the uncomfortable fact that much of the synthetic opioid circulating in the United States is no longer manufactured solely in China but is synthesized in clandestine laboratories in the US territory itself, using precursors that often go undetected.
These clandestine laboratories have grown exponentially. According to the Narconon program’s website, “fentanyl is no longer just a transnational trafficking problem: it is produced locally, in garages and rural homes, from imported precursors.” It is estimated that there are 3,500 fentanyl kitchen labs in 48 US states, most of them in middle-class suburban garages. The production cost is 30 cents per pill. But the media narrative claims that the precursors arrive in the United States, are shipped by parcel to Mexico, and then return north transformed into millions of pills.
The synthetic opioid crisis in the United States is an epitome of the decline of a model based on structural impunity, whose vehicle is a market that is only free for those who can get everything they want through lobbying. While Washington judges alleged corruption in other countries and shifts blame on external actors, these drugs demonstrate the corrosion lurking in the fine print of the law of supply and demand.
Translation: Orinoco Tribune
OT/SC/SH
Misión Verdad
Misión Verdad is a Venezuelan investigative journalism website with a socialist perspective in defense of the Bolivarian Revolution
