Beth Macy is a former Roanoke Times reporter and the author of Factory Man. This article is an adaptation from her most recent book, Dopesick, to be published by Little Brown on August 7.

In February 2001, a 39-year-old IT worker named Ed Bisch was summoned home to his working-class enclave of Philadelphia after taking a frantic call from his daughter. She had found her 18-year-old brother incoherent in the bathroom the night before, and when she asked him what was wrong he said he’d had too much to drink. The next morning, she found him bluish and unresponsive.

Bisch arrived home to find a pair of emergency workers in front of his house. His son, Eddie, was a high school senior, a soccer player with decent grades and plans to attend a local culinary school. Eddie had complained of feeling sick recently, but it had not crossed his father’s mind that he was in opioid withdrawal. Bisch had suspected Eddie was drinking and maybe smoking pot but hadn’t considered pills. They had plans to fly to Florida for a father-son fishing vacation in just six days.


“I’m sorry,” one of the paramedics told Bisch. Eddie was dead.

As friends gathered, Bisch was still in shock and searching for answers when he asked Eddie’s friends what his son had taken.

“Oxy,” one said.

“What the hell’s an Oxy?” Bisch wanted to know.

The first time Ed Bisch heard the word “OxyContin,” his son was dead from it.

Within months, Bisch would find himself at the forefront of a parent-led nationwide pushback against Purdue Pharma, the maker of the powerful opioid OxyContin, organizing other parents of the overdosed dead and soon funneling their stories to a nascent federal investigation centered in western Virginia. Oxy overdoses had already swept through Appalachia and other distressed rural areas in the nation, reaching epidemic proportions in the Northeast and West and, eventually, in most corners of America. In 2012, the highest rates of opioid prescriptions per person in the country were in mostly Appalachian states.

The Virginia-led federal investigation culminated in a plea agreement in 2007 and a $634.5 million fine against Purdue’s parent company and its top executives for criminally misbranding the drug. Since then, more than 20 states have sued Purdue Pharma, and recently, the company dismissed most of its sales staff in response to mounting allegations over its marketing tactics. A federal judge in Cleveland is now presiding over massive multijurisdictional litigation against opioid distributors, retailers and manufacturers, including Purdue.

But the story of this first federal investigation illuminates how holding Purdue Pharma accountable was so hard in the first place, and why it took so long to rein in the marketing practices that led to widespread addiction and saddled local communities with costs that have overwhelmed law enforcement, hospitals and even indigent burial funds.

It also looks different 10 years on: We now know, in a document only recently made public, that federal prosecutors had originally recommended felony charges that could have sent top Purdue execs to prison if they were convicted. In that report, the prosecutors said the company had knowingly concealed OxyContin abuse shortly after the drug’s 1996 release. We also know that top Justice Department officials in the George W. Bush administration did not follow the Virginia prosecutors’ recommendations—and refused to indict the executives on felony charges, instead pursuing lesser misdemeanor charges for them and no jail time.

Ten years on, we know, too, that the key figures on Purdue’s side—ex-New York City Mayor Rudy Giuliani, who was consulting for the company and leveraging the height of his post-9/11 popularity on its behalf, and Mary Jo White, the chief counsel for Purdue’s top lawyer, Howard Udell—went on to even more high-profile careers.

What we don’t know so much about is the improbable cast of grieving parents and western Virginia characters who worked to bring the case to court, and how their struggle to be heard over Purdue Pharma and Giuliani foretold the coming opioid epidemic.

***

The burgeoning OxyContin epidemic didn’t hit the national media until the same month Bisch came home to find his dead son, when New York Times reporters Barry Meier and Francis X. Clines swooped in to central Appalachia to deliver a front-page story on Operation OxyFest, a nine-month federal investigation that produced the biggest drug-abuse raid in Kentucky history. “We caught 207” user-dealers, a federal prosecutor told the reporters. Most of those arrested were Oxy-addicted patients who had coaxed pills out of doctors who were either busy, slipshod or quietly cooperative in overprescribing the drug. “We didn’t catch half of them; that’s how pervasive this thing is.”

From his home in Philly, Bisch retreated to his computer, where he was shocked to learn that his son’s death had been the region’s 30th opioid overdose in the past three months. How was that possible when he’d only just learned the word? “The internet was still new, and back then it was mostly message boards as opposed to websites,” he told me.

Bisch channeled his grief into computer code, forming a national coalition of parents of the dead, called Relatives Against Purdue Pharma, or RAPP. Hoping to warn other families, he created his own message board, giving it the bluntest moniker he could think of—OxyKills.com. Within weeks it had morphed into a scrolling database of grief, warnings and statistics. The website became a clearinghouse for the latest Oxy-related overdose numbers reported by local medical examiners and the Drug Enforcement Administration, along with heart-wrenching stories of high-school wrestlers and cheerleaders who had succumbed to OxyContin overdose. Bisch promoted news stories about OxyContin, such as when the New York Times noted that the drug’s sales in 2001 hit $1 billion, outselling even Viagra.

Bisch and the other parents made an informal alliance with a pair of people who were doing more than anyone in Appalachia to sound the alarm on OxyContin overprescription: Dr. Art Van Zee and Sister Beth Davies, an activist nun. Bisch had read about Van Zee and Davies in newspaper articles, and he knew about their unsuccessful David vs. Goliath fight to persuade Purdue to take OxyContin off the market in the early 2000s until it could be reformulated to be abuse-resistant. Then, as now, Davies counseled patients with Van Zee at her Addiction Education Center in Pennington Gap, Virginia. “Not a week goes by that I’m not talking with parents about their young adult children that are losing their jobs, spouses, children, and homes to this addiction,” Van Zee wrote in a 2000 letter to Purdue executives, noting that 20 percent of local high-school seniors had reported trying Oxy. And in another letter that year: “My fear is that these [addiction-hit rural communities] are sentinel areas, just as San Francisco and New York were in the early years of HIV.”

Dr. Art Van Zee and Sister Beth Davies. | Photos courtesy of Beth Macy and Beth Davies

If OxyContin seeded the opioid deluge in communities across the nation, Bisch and his fellow activists nationalized the opposition to it. Relatives Against Purdue Pharma became his message board sprung to life, a nonvirtual resistance party that would assert itself politically and in person over the next decade.

Together the parents-turned-activists would lobby for the creation of statewide prescription monitoring programs, or PMPs, so doctors could check a patient’s prescription records and prevent themselves from being shopped. They would battle—online and at times in person—with chronic-pain patients who praised the drug for allowing them to function and to sleep through the night. They would march and hold up pictures of their dead children outside Purdue-sponsored pain management seminars.

Among RAPP’s first courtroom targets was the 2003 civil lawsuit against Purdue brought by former Florida Purdue sales rep Karen White. She’d been fired in 2002 for allegedly having paperwork irregularities, poor communication skills and declining sales, the company said. But White claimed in her legal filing that she was actually fired for refusing to sell to doctors who were illegally overprescribing OxyContin to their patients. “We had such high hopes that she would be one of our saviors,” said Barbara Van Rooyan, a RAPP parent in California who unsuccessfully petitioned the Food and Drug Administration to recall OxyContin until it could be made abuse-resistant, and to restrict its use to cases of cancer and severe pain.

At the time, Purdue’s legal bills were mounting—to the tune of an estimated $3 million a month—and the company still had 285 lawsuits pending against it. To help burnish its image in the face of mounting legal, financial and public-relations problems, Purdue had hired Republican insider Rudy Giuliani and his consulting firm, Giuliani Partners, in 2002. Just a few months after his lauded response to the 9/11 terrorist attacks, Giuliani’s job was to convince “public officials they could trust Purdue because they could trust him,” as the New York Times put it.

Purdue Pharma heaped praise on its American hero and new political star: “We believe that government officials are more comfortable knowing that Giuliani is advising Purdue Pharma,” Udell gushed in a promotional brochure. “It is clear to us, and we hope it is clear to the government, that Giuliani would not take an assignment with a company that he felt was acting in an improper way.”

After all, Giuliani also had just been named Time magazine’s Person of the Year 2001.

But RAPP hoped that Giuliani’s magic would not save Purdue from White’s wrongful-termination case. The parents believed the lawsuit would prove that Purdue’s marketing practices had crossed a legal line. In 2005, Bisch drove 12 hours from Philadelphia to White’s trial so he could sit in a federal courtroom in Tampa, Florida, beside Lee Nuss, who’d also lost an 18-year-old son to OxyContin overdose. It was the first case against Purdue to progress beyond summary judgment, and White was asking the jury to award her $138,000 in lost wages plus $690,000 for emotional pain. Depressed and anxious since her dismissal, she had never before been fired from a job.

“They were counting on us to run out of steam,” Bisch recalled. “They were all lawyered up and Rudy Giuliani’d up.” He counted 10 lawyers on Purdue’s side, not including staff, quarterbacked by the formidable Atlanta-based firm of King and Spalding, whose clients ranged from cigarette makers to Coca-Cola. White’s attorney estimated Purdue spent $500,000 defending the case, an amount a Purdue spokesman declined to confirm.

White had a single lawyer and no staff.

The jury ruled in favor of Purdue, whose lawyer called the case a “personal disagreement with promoting the drug in an entirely legal way.” While White believed calling on sleazy pill prescribers was illegal, her lawyer had not proved the illegality of the company’s sales strategies.

“The court basically said, ‘Don’t tell us what you believe. Tell us what you know,’” explained University of Kentucky legal scholar Richard Ausness, who has written about the difficulty of winning civil cases against Purdue, citing among other reasons the company’s hefty defense chest.

With that loss behind them, Bisch and the rest of RAPP geared up for another fight.

***

Back in western Virginia, a young U.S. attorney with political aspirations had been secretly working on his own attempt to defeat Purdue in court since 2002, when he started investigating the company’s marketing practices. In his mid-30s, John L. Brownlee was brash and a little bit of a cowboy. With a ruddy complexion and a mop of reddish-brown hair, he had a boyish appearance that belied his hard-charging demeanor. As a former paratrooper and Army Reserve JAG Corps captain, he was not afraid of high-stakes drama.

Or the press. He was married to a local news anchor, Lee Ann Necessary, whom he’d met on the job a decade earlier. He was so fond of calling news conferences that he traveled with a portable podium with fold-out legs.

When a New York Post reporter broke the news in 2005 that the Virginia-based federal grand jury had been investigating Purdue, Van Rooyan told Bisch and the other RAPP parents, “They think they’re going to run roughshod over a bunch of hillbilly lawyers.” She recalled how Udell, the company’s general counsel, had gloated over the scores of legal wins, and his pledge that the company would never settle such “absurd lawsuits.”

But the company and its executives underestimated Brownlee. The Roanoke-based U.S. attorney was smarting from recent high-profile losses in two unrelated cases, and, many political spectators thought, looking to build up his reputation before an entrée into politics. (He ran for Virginia attorney general in 2008 but yielded the Republican nomination to future gubernatorial nominee Ken Cuccinelli.)

RAPP banner that was used at rallies in early to mid-2000s of kids who had overdosed on OxyContin. | Courtesy of Ed Bisch

He might have had self-serving motivations. “But on the other hand, [OxyContin abuse] was happening everywhere in the country, and no one else took them on,” said Laurence Hammack, the Roanoke Times reporter who first chronicled OxyContin abuse in Virginia’s coalfields.

Brownlee’s team compiled a growing trove of ammo against Purdue. After one 71-year-old man, a coal miner, tried unsuccessfully to sue the company in nearby Abingdon, Virginia, in 2004, the plaintiff’s attorney, Emmitt Yeary, sent many of those documents to Brownlee. They included juicy sales-rep calls and depositions, all of it cataloged on spreadsheets by an eager federal fraud investigator who was tracking all the civil lawsuits and Oxy-related crime. These documents helped buttress Brownlee’s argument that Purdue had knowingly concealed the drug’s addictiveness.

Brownlee brought in prosecutors from neighboring jurisdictions and deputized them as special assistants to pick up the non-Purdue-case slack. To lead the Purdue investigation, he appointed Assistant U.S. Attorneys Randy Ramseyer and Rick Mountcastle, career government lawyers who were not given to drama and worked three hours west of Brownlee in the district’s satellite office in Abingdon, closer to the coalfields.

By the time their investigation was over in 2007, nine state and federal agencies had spent five years helping the stone-faced prosecutors build the case.

Unlike in the civil lawsuits that preceded them, Brownlee’s team had to prove only that the company had “misbranded” the drug, a broad and somewhat technical charge that makes it a crime to mislabel a drug or fraudulently promote it, or market it for an unapproved use. The federal prosecutors didn’t have to prove the misbranding was actually responsible for the overdoses and the addiction and misuse, according to Hammack. “So it was a very murky legal line, but Randy and Rick figured it out. But there was definitely this feeling by Purdue that this was a little bit of a backwoods, small-town outfit. I think they underestimated them to some degree,” Hammack said.

The almost five-year run-up to what would eventually result in the company’s plea agreement involved Purdue Pharma struggling to understand that the backwoods lawyers had in fact sussed out a crime inside their mound of documents. The company put a full-court press on Brownlee, first with multiple phone calls from Giuliani, who attempted to unnerve the much younger man during settlement negotiations on Purdue’s behalf.

Brownlee had read Giuliani’s book, Leadership, to get ready for his first meeting with him. “I wanted to be prepared,” he said.

An assistant prosecutor in the case recalled that Giuliani put on a folksy front but was not intimately involved in the negotiation’s details, possibly because he was pursuing what would prove to be a failed bid for the Republican presidential nomination. “His role was that his star power alone was supposed to intimidate us,” said the assistant federal prosecutor, who was not authorized to speak publicly about the case. “People say ‘the government and all its resources,’ but when you’re in the middle of a case like this, you don’t feel that sense because they always have way more people working on the case than you have.”

In the fall of 2006, Purdue’s lawyers began to sense that this case against them was different; that a full-court press meant nothing when the opposing counsel was the United States of America. Was it really possible the small-town lawyers had compiled enough evidence to indict both the company and its top executives on a host of felony charges, not just for misbranding the drug but also for mail fraud, wire fraud and money laundering? It seemed so, according to a memo written by the federal prosecutors to Brownlee at the time.

“But it got watered down, as it went through the Department of Justice headquarters, and the folks working for Purdue, including Giuliani, lobbied hard for the executives not to be indicted on felony charges,” said an observer connected to the case. The fines would get batted around, too, with Purdue initially offering to pay $10 million compared with the government’s initial proposal of $1 billion.

The winnowing down of a settlement is a common part of plea agreements. Prosecutors typically threaten more serious charges while defense lawyers counter that they’ll go to trial to prove their client’s innocence.

Meanwhile, Giuliani and crew continued trying to influence the case when and where they could. In 2005, Purdue lawyers called then-Deputy Attorney General James Comey to question Brownlee’s investigatory tactics, and Comey called Brownlee with concerns. The young attorney responded by personally driving four hours to Washington to lay out his strategies. “Brownlee, you are fine. Go back to Virginia and do your case,” Brownlee said Comey told him.

But Purdue’s boldest move came later, in October 2006, the night before the plea agreement was set to expire—after which the company would face charges—when a senior Justice Department officer phoned Brownlee at home (at a Purdue lawyer’s request), urging him to extend the deadline to give Purdue more time. Brownlee was through being pressured. The lobbying and negotiations had gone on long enough.

Rather than risk more serious charges or a jury trial in western Virginia, where drug crime had skyrocketed and where the painkiller was now known as “OxyCoffin,” the company accepted the plea agreement later that night. But Purdue wasn’t quite finished negotiating. Eight days after it accepted the deal, Brownlee was stunned to see his name on a firing list circulated within the DOJ, along with four other U.S. attorneys. Though he wasn’t ultimately fired, the incident provided fresh criticism of then-Attorney General Alberto Gonzales, accused of trying to sway the work of U.S. attorneys’ offices.

And it only underscored the long reach of Purdue: Udell’s defense lawyer Mary Jo White, a former Manhattan U.S. attorney, had been the one to press for more time in a call to a Department of Justice official. (Brownlee would break down how Purdue’s attempted influence peddling worked—or didn’t—in a later Senate hearing about the case.)

Brownlee weathered the heat—sort of. By the time the negotiations were complete, Purdue’s holding company, Purdue Frederick, would plead guilty to a single misbranding felony and the company’s executives to misdemeanor charges of misbranding the drug. Ultimately, though, it was the holding company, not Purdue Pharma, that was banned from doing business with public health programs, a Giuliani-arranged deal that allowed OxyContin sales to continue growing—and the epidemic to continue festering, largely unchecked.

While the RAPP parents argued repeatedly on the witness stand at the sentencing hearing and in the media for executive jail time to deter or at least slow the rapacious marketing of painkillers, the men were permitted to stipulate in the agreement that they’d had no direct knowledge of the misbranding, only that “the court may accept these facts in support of their guilty pleas.” In other words, their only crime was that they headed up a firm wherein other people committed crimes.

Compared with the charges Ramseyer and Mountcastle had originally threatened, the final agreement was a mixed bag. Prosecutors initially wanted to impose the $1 billion corporate fine as well as multiple felony charges against both the company and the executives. “But we got what we could get,” said a prosecutor involved in the case.

Purdue, for its part, had initially proposed paying $10 million and incurring no felony charges—“an insult,” according to a government source involved in the negotiations. “It was clear they thought we’d take a very small sum of money and go away—because it would be a lot of money for a district of our size,” the source said. “I will tell you, what we ended up with was far closer to where we started than where they started.”

“Their lawyers were shocked,” the negotiator added. “They did not expect the firmness with which we approached this. … Had they not agreed, we were fully prepared to take them to trial.” The Sacklers, the family that owned Purdue, were convinced. Midway through the negotiations, following a Washington meeting of both sides, word filtered down from the Sackler family: “We can’t buy our way out of this one. Make this case go away,” the government negotiator recalled. If that meant throwing three executives under the bus, well, then, the men had been loyal employees for many years. But the Sacklers had to do what the Sacklers had to do.

On a clear day in May 2007, in the atrium of a downtown Roanoke office building, Brownlee unveiled the news of the settlement: The company and its top executives would plead guilty to their role in a marketing blitz that hyped OxyContin’s strengths while downplaying its propensity for addiction and abuse. To resolve the federal criminal and civil misbranding charges, Purdue Frederick would pay $600 million in fines and admit that for six years it had fraudulently marketed OxyContin as being less prone to abuse and having fewer narcotic side effects than instant-release painkillers—a felony misbranding charge. Top executives Paul Goldenheim, Michael Friedman and Udell would pony up $34.5 million and plead guilty to misdemeanor versions of the crime. The fines against Purdue and its executives accounted for about 90 percent of the company’s OxyContin profits from the time the drug went on the market, in 1996, until 2001, when Purdue dropped the insert language about the timed-lapse mechanism’s ability to “reduce the abuse liability of a drug,” Brownlee explained. It was the 11th-largest fine paid by a pharmaceutical firm in the Justice Department’s history.

Brownlee enjoyed presenting his evidence at the news conference.

For added visual effect, he displayed falsified charts created by Purdue that had claimed “smooth and sustained blood levels” and “fewer peaks and valleys” for patients on OxyContin. The ginned-up graphs were meant to buttress the drugmaker’s claim that OxyContin had less potential for abuse. An adjacent easel featured actual clinical data that the prosecutors had culled from Purdue’s own studies. The real data looked like a map of steep mountains, the faked data like a single gentle slope.

In the end, the settlement made little difference in the actual sales practices of OxyContin, with the company’s reps largely continuing to downplay the dangers of opioids while focusing on the prevalence of chronic pain. Between 2006 and 2015, Purdue and other opioid-makers spent $900 million on lobbyists and political contributions—eight times more than what the gun lobby spent, according to a recent series by the Associated Press and the Center for Public Integrity. The company didn’t reformulate the drug to be abuse-resistant until 2010—and, many believe, only because the original OxyContin patent was about to expire, in an end run designed to block competition from generic drugs. By then, it was too late. OxyContin’s chemical cousin, heroin, and, later, fentanyl fueled epidemics of their own the moment OxyContin became harder to get and to abuse. Today, Americans, who make up just over 4 percent of the world’s population, consume almost a third of its opioids.

Two months after the news conference announcing the terms of the settlement, the Purdue executives flew to Abingdon for their sentencing hearing. The RAPP parents congregated there, too, marching outside the federal courthouse in the rain and clutching posters of their dead children. They took turns on the witness stand, trying to convey to the judge the depth of their losses and their ongoing grief, as well as their concern for an epidemic unleashed.

Lee Nuss, who’d even brought along a mini-urn containing some of her son’s ashes, shook it at the executives as she stepped down from the stand. “Illegal drug pushers get jail time, and so should you,” she told them. Years later she would end up becoming a foster mom, largely to the children of opioid-addicted parents, and even adopting one as her son.

She wanted the men to apologize, to admit that they had understood all along that OxyContin wasn’t a novel way of fighting pain but simply a different and more potent way of dispensing nature’s oldest drug. If the Sacklers’ lieutenants had legitimately not known about the flood of pills unleashed by sales reps toting around bad data and OxyContin beach hats 25 rungs down the corporate ladder from them, maybe it was because they had not cared to look.

Following the 2007 settlement, most of the parents were too worn out to fight Purdue any longer. “After Abingdon, most of us thought it was a moral victory, but the money [Purdue had to pay] was a joke,” Ed Bisch told me last year. “After so many years, I had to back off because it was destroying me. You get beaten down, and for your own health, you have to let it go.”

Bisch believes today, he wrote in an email, that if the Purdue executives had gotten jail time as part of the 2007 settlement, it would have “changed history and saved thousand[s] of lives.”