Since 1999, more than 800,000 Americans have died from opioid overdoses. The latest headlines focus on fentanyl, yet the staggering toll can be traced to the widespread availability of opioid pills made possible by decades of overprescribing. Few users start with fentanyl. Experts date the start of the opioid epidemic to within three years of the approval of OxyContin in 1995. Reports from emergency departments across the US showed Purdue's pills were being crushed and injected or snorted as early as 1997. "My eyes popped open," recalls one FDA medical officer of seeing the reports. "Nobody wanted to see it for what it was. You would've had to have your head in the sand not to know that there was something wrong." By 2000, Purdue was selling $1.1 billion annually in OxyContin. Higher doses led to higher profit. Sales reps were coached accordingly. In five years, oxycodone prescribing had surged 402%, and hospital emergency room mentions of oxycodone were up 346%. By 2012, OxyContin sales were almost $3 billion annually. And many other companies were cashing in. In the preceding six years, 76 billion opioid pills had been produced and shipped across the US, as the FDA faced a national crisis of epic proportions. In the 2010s, the US, with less than 5% of the global population, was consuming 80% of the world's oxycodone. And with coordinated pharmaceutical campaigns to destigmatize opioids, brands other than Purdue's and Roxane's benefited.