In America, when you attempt to buy government favors, it’s called lobbying.

When it came to the pharmaceutical industry, it worked like this: newly approved FDA drugs were over here. Potential users of the drug were over there. In between? Bureaucrats, medical boards, and elected officials whose votes could potentially be swayed — for a substantial donation, of course — if you knew people who knew people.

In the early 90s, the painkiller industry was stagnant, as it had been in the 80s, as it had been in the 70s. There wasn’t a whole lot of money to be made producing opioid painkillers since they were primarily used to treat cancer patients and people just out of surgery. And, well, to be frank, only so many people get cancer, and only so many people have surgery.

Sure, opioids made a profit for the pharmaceutical industry, but in limited quantities due to a limited demand.

The solution? Simple. Manufacture a demand. Establish not only a new system that gives doctors more freedom to prescribe narcotics for non-postoperative and non-malignant pain, but create an environment that actually demands it. Instead of fighting a losing battle against the existing medical framework, create an entirely new one — one that promotes opioid and opiate painkillers for everyday aches and pains — and work from within it.

To understand just how the American medical system became corrupted in the 2000s, you have to understand the role of Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the most powerful accreditation institution in the world.

The Joint Commission is the gatekeeper. They’re the last line of defense between the patients over here and the drugs over there. The Joint Commission is a nonprofit organization based out of a Chicago suburb, charged with setting the standards of care for hospitals in this country and accrediting more than 20,000 facilities in all but four states. They’re the ones tasked with inspecting hospitals and ensuring adequate care is being given and standards are being met. They also issue directives in care.

In 2001, the pharmaceutical lobby spent just under $100 million in lobbying efforts. It paid off. The Joint Commission promptly issued a new directive to its 20,000+ hospitals across the country:

It was time to start treating pain.

And who did the Joint Commission bring in to teach the hospitals how to treat the pain?

Purdue Pharma.

According to the United States General Accounting Office’s report to Congressional Request in December, 2003, the Joint Commission allowed Purdue Pharma to fund the “pain management educational courses” that taught the new standard of care for treating pain to JCAHO hospitals and facilities. And despite being cited twice by FDA for OxyContin advertisements in medical journals that violated the federal Food, Drug and Cosmetic (FD&C) Act, Purdue was allowed to disperse materials to educate doctors on pain management.

With access to America’s hospitals, Purdue then began funding more than 20,000 pain-related “educational programs” through financial grants and direct sponsorships. They used these grants to provide presentations and demonstrations to entire hospital staffs and present at state and local medical conferences, providing doctors with continuing medical education (CME) units.

With pain management now mandated by the Joint Commission, Purdue began funding groups such as the American Chronic Pain Association (ACPA) and the American Pain Society (APS). These vocal groups began demanding doctors start taking pain management seriously, bringing their message everywhere from state legislatures to medical conferences.

Organizations funded by the pharmaceutical industry were created that rated doctors based on their willingness to treat pain and encouraged many family practitioners to begin prescribing outside of their normal scope of practice. The local family doctor suddenly felt pressure to prescribe powerful narcotics he or she might not have fully understood, or else risk a scathing review from a group like the American Pain Society that could irreparably harm his or her practice.

To ensure legal protection for prescribers, pharmaceutical companies began lobbying state legislatures who, with no medical background, began passing laws protecting doctors from malpractice claims for overprescribing.

With the Joint Commission and state legislatures having opened their doors, Purdue Pharma set its sights on the Federation of State Medical Boards (FSMB). According to an investigation by John Fauber of The Milwaukee Journal Sentinel, the FSMB accepted a $100,000 donation from Purdue for “printing and distribution” of pamphlets explaining safe use and prescribing of opioid medications. Presumably, in color.

Coincidentally, while it accepted $100,000 from Purdue, the FSMB began calling for doctors to be punished for not adequately treating pain.

The system was collapsed and the floodgates were opened. With the channels flowing so freely, Purdue began focusing on the last line of defense for the American public: the doctors.

If Americans were going to demand opioid painkillers, Purdue was going to be the one to supply it.