The FDA approval and subsequent launch of OxyContin transformed a family-owned pharmaceutical company’s morphine-based pain business into a much broader commercial venture. In the book’s account, the drug’s significance lies not only in its formulation and promotion, but also in the assurances about addiction that accompanied it—and in the widening distance between those assurances and the harms later experienced by patients, families, and communities.

Corporate Origins and a New Product

OxyContin was approved by the U.S. Food and Drug Administration in late 1995. Its developer, Purdue Frederick, had been bought in 1952 by three brothers who were research psychiatrists. The company then had only a few employees and annual sales of $20,000. Before entering pain medicine, the Sackler family built its business around over-the-counter products, including laxatives, earwax remover, and Betadine, an antiseptic used to wash down the Apollo 11 spacecraft after its mission.

The company’s entry into pain relief came with MS Contin, a morphine-derived medication for end-of-life care developed in 1984. By the mid-1990s, the product had annual sales of $170 million, but its patent was nearing expiration. OxyContin was introduced to fill the commercial gap. It reformulated oxycodone, a painkiller based on a compound first developed in 1917 from thebaine, an ingredient in the Persian poppy. Unlike MS Contin’s hospice and end-of-life focus, the new product was intended for marketing beyond those settings.

The Sackler brothers were publicly better known for philanthropy than for drug development, and their family name appeared on art wings at institutions including the Smithsonian and the Metropolitan Museum of Art. Promotion and sales of OxyContin were handled by Purdue Pharma, the company’s marketing arm, launched in Delaware. The shift thus joined a new product and a wider intended market to a dedicated sales operation.

Approval and the Safety Promise

Purdue Pharma promoted its opioid-delivery system by emphasizing that patients who followed directions faced a very low risk of addiction. Dr. J. David Haddox, a pain specialist who became the company’s principal spokesperson for OxyContin, publicly put that risk at one-half of one percent. A 1996 company training session for doctors characterized doctor-caused addiction as exceptionally rare. These were not peripheral claims: they helped frame how prescribers were asked to understand the medication and its risks.

The book places that confidence against a longer history of opioid use and harm. It recalls that opium had served both medical and intoxicating purposes, and that commerce in it had also driven conflict. That history makes the central tension of OxyContin’s arrival especially sharp: a familiar pain-relieving drug family was presented through a new delivery system and a reassuring account of addiction risk, even as earlier experience offered reasons for caution.

Early Warnings and the Growing Crisis

Signs of misuse appeared soon after the drug’s release. A local detective contacted a pharmacist a couple of months after OxyContin became available, and the pharmacist already doubted the company’s delayed-absorption claims. The detective’s report, together with neighbors seen wearing shirts stained orange and green, led the pharmacist to conclude that the product was being abused. The episode offers an early contrast between the public safety promise and observations on the ground.

The book later follows the opioid crisis into communities where people who began with prescriptions turned to heroin and sold part of what they bought to finance their next purchase. That cycle could draw in further customers and grow through successive transactions; withdrawal avoidance became an immediate pressure shaping decisions. In Roanoke, heroin had once been widely treated as an inner-city drug and was understood by many users and dealers as largely separate from white suburban life. By 2006, however, a dealer operating there had connected with both Black and white users, and two suburban teenagers caught selling heroin to friends led investigators to evidence implicating dozens more, many from Hidden Valley High School.

The later pattern does not reduce the crisis to one product or one event. Rather, the book links prescription exposure and shifting drug supply to a wider cycle of dependence, resale, and heroin use. In Woodstock, users described in the narrative moved from prescriptions to heroin through the same basic economic and physical pressure: obtaining more drugs to avoid withdrawal.

Unequal Responses and Public Recognition

The consequences unfolded through institutions that did not act as one system. Families often hid addiction out of shame; in 2012, parents in different parts of the state lacked the online groups that later helped them share treatment information and practical support. The book also describes a gulf between criminal justice and health care, with addicted people trying to survive withdrawal while relatives and volunteers struggled to keep them alive. For people taking buprenorphine, stigma could persist inside recovery meetings even where formal policy accepted medication-assisted treatment.

The treatment and enforcement landscape was also shaped by race. The book reports that doctors prescribed painkillers to people of color at lower rates than to white patients, reflecting distrust that they would misuse opioids. At the same time, Black and Hispanic people were disproportionately represented among federal drug offenders, while public calls to avoid arrest as the solution to opioid addiction did not apply evenly to people prosecuted for heroin distribution. The launch of OxyContin therefore sits within a history in which access to pain treatment, exposure to addiction, and punishment for drug activity were distributed unequally.

The author began reporting on heroin in the suburbs of Roanoke in 2012, after two decades covering marginalized families for the Roanoke Times. At first, many families were too ashamed to speak publicly; five years later, nearly all agreed to be named. That change does not erase the cost of the epidemic, but it marks a movement from private silence toward public testimony. In the book’s wider account, OxyContin’s approval and launch belong to the beginning of a chain whose consequences were borne not only in prescribing and sales, but also in family life, treatment access, community response, and criminal punishment.