After prescribing opioids to a West Virginia woman who subsequently died, a Virginia doctor has been sentenced to 40 years in prison. A district court ruled that Joel Smithers was guilty of over 800 federal drug charges, including illegally distributing controlled substances without a legitimate medical purpose.

The prosecution claimed that essentially, Smithers’ practice existed primarily to prescribe opioids to his clients. In total, Smithers prescribed over 500,000 doses of oxycodone, hydromorphone, and fentanyl, among other substances. Authorities from the U.S. Justice Department said that his Martinsville office prescribed controlled substances to “every patient in his practice, resulting in over 500,000 Schedule II controlled substances being distributed.”

That’s a lot of people getting opioids in a relatively short amount of time. Smithers opened the office in 2015, and it was raided by the feds only two years later.

Over prescription and abuse of opioids is a grave problem in the U.S. The Centers of Disease Control and Prevention has announced that of the 700,000 residents who died of drug overdoses between 1999 and 2017, 68 percent of the fatalities included the use of a prescription drug or illegal opioid.

Smithers’ case was a harbinger of a shift that has occurred with United States law enforcement when it comes to dealing with the issue. In September, federal officials announced the arrest of 11 doctors in the Appalachia region who are charged with the illegal prescription of opioids. The policy direction makes use of algorithms that identify suspicious behavior among prescribing doctors and patients, such as high death rates, long travel times to visit doctors, and dosage amounts.

But that’s not the only way that authorities are tackling the crisis. Drug companies are beginning to find themselves held responsible for the many people who have abused their products. Just this week, Johnson & Johnson settled for $20.4 million rather than go to court over charges. And that’s small change compared to a Oklahoma judge’s ruling in August that the company must pay $572 million in a civil suit.

Among the charges for which Smithers was convicted were possession with the intent to distribute controlled substances and maintaining a place for the purposed of unlawfully distributing said substances.

His sentence was not even as heavy as it could have been. The maximum punishment for the myriad of crimes of which Smithers was accused is a life sentence and a fine of over $200 million.

Patients would visit the doctor’s office from all corners of Virginia, and as far away as Ohio, Tennessee, Kentucky, and West Virginia. He did not take payment via health insurance.

One man who testified on behalf of the defense drove all the way from Kentucky to see Smithers. “There wasn’t no doctors in my area like that to see,” he told the court.

Another high profile case of a doctor who has been accused of neglect and over prescription of opioids is Michigan’s David Neff, whose patients say he failed to monitor tendencies towards opioid abuse among the individuals for whom he wrote opioid prescriptions. Ironically, Neff has been the recipient of awards for his work on providers’ roles within the opioid epidemic.