The Opioid Crisis in 2021: Benchmark Legal Decisions & Deaths

Flags on the Newton-Wellesley Hospital lawn on Oct. 8, 2021, honor the 2,104 lives lost to opioid addiction in 2020 in Massachusetts. The 2020 documentary ‘Opioids, Inc.’ examined the role of Insys Therapeutics in the opioid crisis.

Flags on the Newton-Wellesley Hospital lawn on Oct. 8, 2021, honor the 2,104 lives lost to opioid addiction in 2020 in Massachusetts. The 2020 documentary ‘Opioids, Inc.’ examined the role of Insys Therapeutics in the opioid crisis. (Suzanne Kreiter/The Boston Globe via Getty Images)

December 27, 2021

It has been a landmark year for the opioid crisis, in court and in the toll on human lives.

In August 2021, a federal judge dismissed an appeal by John Kapoor, the founder of the pharmaceutical manufacturer Insys Therapeutics, upholding Kapoor’s 2019 conviction for his role in bribing doctors to prescribe opioid pain medication and defrauding insurers. Kapoor began serving his sentence in April at a federal prison camp in Duluth, Minnesota, according to Bloomberg Law.

Then, in November, Insys executives were ordered to pay $48.3 million — most of which Kapoor is responsible for — in restitution to insurance agencies and individual victims.

Insys and Kapoor, who was sentenced to five-and-a-half years in prison in January 2020, were the subjects of an investigation by FRONTLINE and the Financial Times that included the June 2020 documentary Opioids, Inc. Six other Insys executives have also been sentenced to prison, among them Alec Burlakoff, the company’s former vice president of sales, and former CEO Michael Babich, both of whom pled guilty in federal court and served as witnesses for the prosecution in the case against Kapoor.

Read more: Insys Executives Are Sentenced to Prison Time, Putting Opioid Makers on Notice

The denial of Kapoor’s appeal preceded word in November that the U.S. Supreme Court would hear two cases concerning doctors charged with illegally distributing prescription drugs, including one previously convicted of accepting kickbacks from Insys.

Insys represented just one set of landmark cases that made headlines in 2021, as multiple lawsuits against pharmaceutical companies progressed through the courts. Experts say the drug manufacturers’ tactics and misconduct created an active marketplace for prescription opioids, leading to a continuing opioid crisis.

In September, Purdue Pharma, the company behind the prescription opioid OxyContin, was dissolved in a bankruptcy settlement ordering the company’s owners, the Sackler family, to pay $4.5 billion toward addiction treatment and prevention in return for shielding them from future opioid litigation.

That settlement was overturned on Dec. 16, 2021, by a federal judge who said the bankruptcy court could not grant the Sacklers legal protection from civil opioid-related cases.

Also in 2021, the Centers for Disease Control and Prevention estimated in November that more than 100,000 people died of drug overdoses in the first year of the COVID-19 pandemic, May 2020 to April 2021, with about three-quarters of those deaths involving opioids — a national record.

Read more: Opioids, Bribery and Wall Street: The Inside Story of a Disgraced Drugmaker

Kapoor’s attorneys and representatives of Purdue Pharma did not respond to interview requests.

The regulations and culture around prescribing opioids have changed since the 1990s and early 2000s, when pharmaceutical manufacturers realized “they could market opioids as an effective treatment for pain at all times,” according to Michael Barnett, an assistant professor of health policy management at the Harvard T.H. Chan School of Public Health and an expert witness for plaintiffs in lawsuits against opioid manufacturers.

Today, physicians are far less likely to prescribe opioid pain medication due to regulatory red tape, Barnett said. Instead, street opioids, such as heroin and some forms of fentanyl, are considered the main drivers of the current wave of the opioid crisis.

“Prescription marketing created fertile ground during the first wave of what we think of as a three- or four-wave crisis,” Barnett said. “And we were in wave three before the [COVID-19] pandemic.”

Listen: Bribing Doctors, Making Millions from The FRONTLINE Dispatch podcast

Barnett and others said the pandemic has only made it harder to address the opioid crisis. People need access to treatment and safe injection sites, as well as avenues of social support that many were cut off from by COVID-19, said Silvia Martins, associate professor of epidemiology at the Columbia University Mailman School of Public Health.  

Beyond pandemic-induced hardship, Martins said there are “structural changes that need to happen,” like stable housing and access to employment for those with substance-use problems.

With the opioid crisis ongoing, some experts said pharmaceutical manufacturers have not done enough.

“I hold significant doubt about this,” Thuy Nguyen, research assistant professor of health management and policy at the University of Michigan School of Public Health, responded when asked whether the industry has been held accountable.

“For instance, facing thousands of lawsuits, Purdue Pharma filed for bankruptcy in 2019 to protect itself and its owners from these lawsuits,” Nguyen wrote to FRONTLINE in an email. “Many opioid victims are still left out in the ongoing legal battles, and millions of patients are still suffering from opioid use disorder.”

Watch Opioids, Inc. in its entirety below.

Aasma Mojiz

Aasma Mojiz, Former Abrams Journalism Fellow, FRONTLINE/Columbia Journalism School Fellowships

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