That July, Sister Beth stood in drizzling rain outside a federal courthouse in Abingdon, Va., disappointed about the outcome of the case. In the courtroom, a judge had approved a deal struck between the Justice Department and the three Purdue executives. Under it, the men were allowed to plead guilty to a single misdemeanor charge that did not accuse them of personal wrongdoing and for which they would not face jail.

Sister Beth said recently she was glad that some justice had been done, but that it was not enough.

“I think it would have made a considerable difference if these people had been arrested and done jail time,” she said.

Twenty years on

The problems of today’s opioid epidemic still plague this town. Drugs tainted by counterfeit fentanyl are now sold on the streets. The ravages of methamphetamine can be seen in the hollowed bodies of addicts who suddenly fly into psychotic rages.

The inpatient treatment facility was forced to close after several years for lack of funding. Sister Beth also said that government funding, both state and federal, was woefully short of what was necessary for people to get the help they needed.

“It has just started to get better,” she said.

Virginia’s decision last year to expand Medicaid, which has paid for treatment of many low-income people in other expansion states, may have helped, along with an injection of federal grant money to states for addiction treatment and prevention.

Sister Beth, Dr. Van Zee and Ms. Kobak , who is now retired, have been reading with fascination the new documents about Purdue Pharma and its owners, members of the wealthy Sackler family, that have recently emerged in lawsuits and elsewhere. As it turns out, it was in 2001, the year they and others in town confronted Purdue Pharma executives about the overzealous marketing of OxyContin, that a son of one of company’s founders, Dr. Richard Sackler, wrote a now infamous email about the need “to hammer on the abusers in every way possible” for the drug’s problem.