And, as Lembke points out, doctors are a group chosen for more or less exactly the opposite characteristics. We are habitual pleasers, accustomed — even addicted — to patients’ admiration and gratitude. We like to do what we do well, and most of us don’t do pain well. So it’s no big surprise that when we find ourselves in a pain-filled room we just want to escape fast, and prescribing another round of pills lets us do just that.

What about the part played by pharmaceutical companies in this crisis? Was Purdue Pharma, manufacturer of OxyContin, an aberration in its misleading promotion of the drug, with assertions that ultimately resulted in $600 million in fines and penalties? Or is this just how Big Pharma always operates, dodging the law and relevant moral principles in single-minded pursuit of Big Profit?

Back in 2004, Dr. Marcia Angell, a former editor of The New England Journal of Medicine, wrote in “The Truth About Drug Companies” that the pharmaceutical industry “has moved very far from its original high purpose of discovering and producing useful new drugs.” Her book presents instead a vision of an industry motivated largely by greed. Pretty much every specific outrage critics have identified in Purdue’s behavior appears in Angell’s analysis, including the “jaw-dropping” gifts doctors may receive for prescribing a company’s drugs, the subtle advertisement masquerading as education and the lukewarm, often ineffective protestations by regulatory agencies.

Writing from Britain, Dr. Ben Goldacre echoes Angell’s concerns, charging in “Bad Pharma” that the worst misbehavior in the pharmaceutical industry actually occurs not when prescription drugs are being burnished for market, but far earlier in their development. Lackluster compounds are evaluated in ways guaranteed to make them look good, Goldacre writes, then prettied up even further with distorted claims of efficacy. While “bad behavior in marketing departments is unpleasant,” he concludes, the real scientific outrage and the big public danger lie in uniformly dubious practices of drug development.

The immersion journalist Barry Werth provided a more sympathetic view of the pharmaceutical industry after taking two deep dives into the workings of a young biotech company. In exchange for many years of fly-on-the-wall privileges at Vertex Pharmaceuticals, Werth allowed his manuscripts to be vetted by corporate executives, and presumably some of their sharper edges were sanded down. What remains, though, is an impressively detailed, dense epic in two volumes, “The Billion-Dollar Molecule” and “The Antidote,” describing the truly herculean labors needed to birth a panel of marketable drugs.

Vertex developed early H.I.V. and hepatitis C drugs, and many of the executives Werth trails are clearly committed to the humanitarian aspects of their work. But they are also committed to their own proprietary molecules, sometimes with a passion bordering on worship. As the head of Vertex once announced at an industry conference, “It’s a tremendous responsibility to live up to a molecule like VX-950.” A regulator for the F.D.A. put it a little more bluntly, screaming over the phone to another Vertex executive, “You guys believe in your drug too much.”

Opioid-dependent patients may be trapped in a web of pain and addiction for months, years or a lifetime. One of the most eloquent descriptions of that hard fate comes to us from more than 200 years ago, back in the days when opium and laudanum (a solution of opium in alcohol) were perfectly legal in England, and as widely available as, yes, aspirin is today. It was in the fall of 1804 that Thomas De Quincey, a 19-year-old wannabe intellectual, decided to try a little opium for a bad toothache.