In the midst of the 21st century and after decades of fighting the overdose epidemic, the United States continues to face an alarming scenario: opioids continue to be massively prescribed as painkillers, even when safe and effective alternatives exist.

The paradox is not minor. According to CDC figures, Arkansas leads the national ranking with more than 75 opioid prescriptions per 100 population, while Hawaii has the lowest figure, with less than 30.

The widespread use of opioids such as oxycodone, hydrocodone, morphine, fentanyl and codeine continues to dominate the treatment of acute and chronic pain, especially in patients with cancer, severe injuries or terminal illness. However, many physicians still prescribe them for less severe conditions such as low back pain or post-surgical recovery, despite the existence of alternatives such as acetaminophen, ibuprofen, gabapentin, or even physical and behavioral therapies.

Why is this practice perpetuated? A combination of pressures from the health system, lack of medical updating, and in some cases, economic interests. For years, campaigns such as the infamous "Pain as the Fifth Vital Sign" promoted a culture of immediate relief, where pain had to be treated quickly, and opioids were the answer.

Pharmaceuticals also played their part: companies like Purdue Pharma faced multi-million dollar lawsuits for hiding the addictive potential of their products like OxyContin.

A recent example was the closure of a pharmacy chain in Virginia for irregularly distributing more than 600,000 doses of opioids in a rural area. The federal investigation showed that pharmacists failed to report suspicious prescribing patterns, violating monitoring protocols.

Today, experts like Dr. Sarah Wakeman of Harvard Medical School insist on changing the paradigm: "Treat pain yes, but without perpetuating an epidemic of addiction." Some states already adopt stricter guidelines and electronic monitoring programs for prescriptions, but cultural change is still slow.

Meanwhile, the human toll remains high. In 2023 alone, more than 81,000 people died from opioid-related overdoses, a figure that reveals the crisis is far from history. Even in 2025, medications are still being prescribed to patients with easily treatable diagnoses and no drug addictions, but, as Edward M. Bednarczyk, PharmD, FCCP, FAPhA - Clinical Associate Professor, University at Buffalo told The Minessota Today, "some doctors are unethical enough and still continue to prescribe."

Perfect. Here is the full article with a journalistic approach and contextualized for a US Latino media, highlighting the implications for Hispanic communities and the political background of the case:

The Purdue Pharma Case and the Sackler Family

For more than two decades, millions of Americans have been direct or indirect victims of a silent epidemic: the opioid crisis. At the heart of this tragedy is one company: Purdue Pharma, responsible for aggressively manufacturing and marketing the potent painkiller OxyContin. Despite the havoc, it is still unclear who will pay for so much damage.

Purdue Pharma launched OxyContin in 1996 with a tantalizing promise: an effective chronic pain medication with low risk of addiction. That claim, with no real scientific backing, became the linchpin of a devastating business strategy. The company, owned by the influential Sackler family, financed campaigns aimed at doctors and hospitals to massively prescribe the opioid, even when there were already clear signs of its high addictive power.

According to federal government data, more than 500,000 people have died from opioid overdoses in the United States since then. After facing thousands of lawsuits from states, counties and cities, Purdue Pharma filed for bankruptcy in 2019. In a settlement with the Department of Justice, the company pleaded guilty to three criminal charges in 2020, including fraud and drug control law violations. The agreement provided for a fine of more than $8 billion, although much of that money remained on paper due to the bankruptcy process.

What about the Sacklers?

What was most controversial was not Purdue's downfall, but the shielding sought by its owners. The Sackler family agreed to pay $4.5 billion over several years, but in exchange they demanded immunity from future civil lawsuits, without filing for bankruptcy or admitting any fault, and that clause raised alarms.

Is it fair that one of the richest families in the country, a direct beneficiary of the opioid business, should be shielded from accountability? The case went all the way to the U.S. Supreme Court, which in August 2023 blocked the agreement and announced that it would review its legality.

Hearings were held in December, and a final decision is expected during 2025. The ruling will be historic: it will not only define whether the Sacklers can be sued, but whether the legal system allows the most powerful to evade liability through legal technicalities.

In the meantime, Purdue Pharma will be transformed - as approved by a bankruptcy court - into a non-profit public company, with its revenues going to addiction prevention and treatment programs. But many victims and experts consider that this measure is insufficient and came too late.

The Purdue case is more than a business story. It is a reflection of how economic interests, lax regulation and structural inequality can converge to generate human tragedies. And it is also a symbol of how the justice system - many times - acts more harshly on the weakest than on those actually responsible for the harm.