When OxyContin hit the market in the United States in 1996, it filled a distinct need. An extended-release version of oxycodone, the shiny pink pills from Purdue Pharmaceuticals allow patients to take pain pills less often—every 12 hours, down from every four to six.** But the same trait that makes OxyContin a more manageable treatment for patients also renders it highly addictive: Because each tablets contains a concentrated dose, the pill mimics the powerful euphoria of heroin when it’s crushed and snorted, or mixed with water and injected, or simply swallowed by the handful. As an opioid, OxyContin shares a similar structure with heroin—both drugs are derived from the opium poppy, a brightly colored flower that has been used for millennia to relieve pain.

In fact, heroin itself was once used as a medication for both adults and children. In 1898, the German pharmaceutical-company Bayer introduced the drug as a cough medicine to ease the pain of the growing number of patients with tuberculosis. At the time, heroin was touted as an effective, non-addictive painkiller and cough suppressant for all ages; one advertisement of the time featured the words “The cough disappears” beneath an image of a mother feeding the “heroin medicine” to her little girl. But less than three decades later, addiction, abuse, and heroin-related crime had become so rampant that the U.S. outlawed the manufacturing of the drug with the Heroin Act of 1924.

A century later, its descendant, OxyContin, similarly benefited from an initial aggressive marketing campaign. From 1997 to 2005, the marketing budget for prescription drugs rose from $11 to $30 billion. As part of OxyContin’s aggressive publicity, Purdue boasted that its extended-release formula made the drug less addictive than other painkillers—a claim that eased the mind of general practitioners, many of whom practiced in rural areas and had little prior experience in prescribing pain medication. (In 2007, that blatant lie would lead to criminal charges against the company and three of its executives, along with $600 million in fines.)

Thanks to relentless promotion, the name OxyContin became more than simply a drug: It was now a brand, meaning physicians were more likely to prescribe it and patients were more inclined to ask for it. The strategy paid off; Purdue Pharmaceuticals has seen sales of more than $35 billion from OxyContin.

After its wide distribution, oxycodone, like heroin, soon found a place on the black market, especially in the Appalachian communities of Kentucky, Ohio, and West Virginia, before spreading across the country; today, it’s one of the most widely abused types of prescription medication in the U.S. In 2010, to combat the surge of abuse, Purdue Pharma came out with a reformulated drug, OxyContin OP, which turns to mush when it’s crushed. But this formula, widely described as “tamper-proof,” didn’t completely live up to that reputation. The rise of oxycodone has led to what the Centers for Disease Control calls an opioid-addiction epidemic: Of the nearly 23,000 Americans who die from prescription-drug overdoses each year, more than 16,000 died from opioid painkillers, either on their own or in conjunction with other drugs.***