Keep calm, carry on, and maybe wash your hands a little more often. That’s the gist of the advice given to the general public in the event of a deadly epidemic: less panic, less pandemic. But behind the scenes, epidemiologists are in a frantic race against time to track the spread of disease back to its origins and, hopefully, find some answers on how to stop it.

Like an earthquake, every deadly epidemic has an epicenter, a central point where the disaster is set in motion. In the case of an epidemic, a central point is a person, and that person is known as patient zero. Here are 10 of the most famous patient zeros in history.

10 Typhoid Mary

We begin with the most famous patient zero of them all, “Typhoid Mary,” whose real name was Mary Mallon. Mary was just 15 when she emigrated from Ireland to the US in 1884 and found work as a maid.

By 1906, Mary had risen to the position of cook for the wealthy Warren family, who spent their summers at Oyster Bay, Long Island. None of Mary’s employers had had any problems with her culinary offerings, but it was a bit of a coincidence that the people Mary cooked for had a habit of becoming seriously ill.

Of the eight families Mary had worked for before the Warrens, seven of them had experienced cases of typhoid. Mary was found to be a carrier of typhoid fever, but as she was not sick herself, she refused to be quarantined. In 1907, New York was at the center of a typhoid epidemic that affected around 3,000 people, and Mary was thought to be its patient zero.

After two years of forced confinement on North Brother Island, Mary was finally released and took a job (under a false name) as a cook in a maternity hospital. Another typhoid outbreak ensued, at which point Mary was permanently incarcerated on Pest Island in the East River.^[1] She died in isolation on November 11, 1938. Her obituary officially named her as the cause of 51 cases of typhoid and three deaths.

9 Frances Lewis

Cholera was a serious threat to public health in Victorian London. In 1854, over the course of just 10 days, 500 people dropped dead within a few blocks of central London. Symptoms of cholera included vomiting, diarrhea, stomach cramps, and extreme thirst, and a patient who began feeling queasy could be dead that day.

By the end of the cholera epidemic, over 10,000 people were underground, and scientists were desperate to determine where this lethal epidemic originated. Ground zero, they found, was in the diaper of a tiny, five-month-old baby named Frances Lewis.

Local physician John Snow plotted on a map the exact locations where cholera victims had died. Known later as the ghost map, Snow’s map showed that most victims lived close to a water pump on Broad Street. It seems that Frances Lewis’s mother was washing her baby’s soiled diapers in pails of water that she then emptied into the cesspool in front of her house on Broad Street.^[2]

Victorian London was not known for its cleanliness, and the cesspool leaked directly into the local water source, poisoning thousands of the area’s residents. Soon after the pump was condemned, the cholera epidemic came to an end.

8 Mabalo Lokela

Ebola is considered one of the most alarming diseases of the 21st century. Ebola kills by causing its victims to suffer massive internal bleeding. It is a disease for which, even now, we have no cure, no vaccine, and no real idea why it keeps coming back.

The world’s first recorded victim of Ebola was a teacher named Mabalo Lokela. Mabalo lived in the town of Yambuku in the Democratic Republic of Congo and returned from a trip north in August 1976 with a high fever. Initially, medics diagnosed Mabalo with malaria. But after two weeks of dreadful symptoms—uncontrollable vomiting; trouble breathing; and bleeding eyes, nose, and mouth—he died.

Unfortunately, the Ebola virus did not die with him, and many of the people who came into contact with Mabalo during his sickness contracted the disease. As a result, around 90 percent of the people in Mabalo’s village died, and the world reeled as brave epidemiologists tried to work out how to stop this killer virus from spreading.^[3]

The most devastating outbreak of Ebola the world has ever seen happened in 2014 and claimed the lives of over 5,000 people in one year. As of the end of the outbreak in June 2016, more than 11,000 people had died from the disease, five times more than all other Ebola outbreaks combined. The West Africa Ebola outbreak of 2014 was traced to a two-year-old boy living in a remote village deep in the Guinean forest region.^[4] Emile Ouamouno’s death was quickly followed by his three-year-old sister, Philomene, their pregnant mother, their grandmother, and many other people from his village. But it would be months before Ebola got the worldwide attention it badly needed.

7 Dr. Liu Jianlin

Over the course of nine months, SARS (Severe Acute Respiratory Syndrome) crept steadily around the globe, taking a total of 774 lives across 37 countries and leaving many gravely ill. First diagnosed in the Guangdong province of China in November 2002, SARS was initially described as “atypical pneumonia.” Flu-like at first, the vicious virus quickly developed into full-on pneumonia and eventually respiratory failure.

As is often the case, we had no idea what we were dealing with until it was too late. By the time the world started to notice this contagious disease, a certain Dr. Liu Jianlin, a medical doctor from Guangdong province, had checked into Hong Kong’s Metropole Hotel.

Described later as hyper infectious, Dr. Liu is believed to have infected around 12 people at the Metropole before dying of respiratory failure. One of those 12 people was a lady named Sui-Chu Kwan, a resident of Scarborough, Ontario, who—feeling right as rain—boarded a plane for Canada two days after bumping into Dr. Liu.^[5]

6 Edgar Enrique Hernandez

“Kid Zero” may sound like the name of a superhero sidekick, but it was actually the nickname of the first human infected with swine flu. Four-year-old Edgar Enrique Hernandez from Mexico tested positive for H1N1 swine flu in March 2009. Soon, photos of his smiling face were on the front page of every newspaper.

In Edgar’s hometown, the rural town of La Gloria, several hundred people fell ill in a matter of weeks, and two children died. According to the World Health Organization, H1N1 has caused or contributed to the deaths of over 18,000 people as of January 2016. However, the CDC reports that the death count worldwide may actually be between 150,000 and 575,000.

Many residents of La Gloria blame nearby industrial hog farms for the outbreak, but the jury is still out on whether H1N1 originated in the pigpens. Also unconfirmed is whether little Edgar was actually the first human to contract the H1N1 swine flu.^[6] Regardless, the local authorities of La Gloria recently erected a bronze statue of Edgar in an interesting attempt to bring tourists to the town famous for swine flu.

5 Patient Zero MERS

The MERS (Middle East Respiratory Syndrome) epidemic in South Korea was officially declared over in July 2015. Also known as “camel flu,” this deadly respiratory disease was first detected in Saudi Arabia and is thought to be derived from bats. No one knows the identity of the first victim of MERS in Saudi Arabia. But when the virus hit South Korea, causing a serious epidemic that killed 36 people, it was easy to trace the source to one man.

Patient zero in the South Korean MERS outbreak first sought medical attention for a nasty cough and high fever on May 11, 2015. At a clinic in his hometown of Asan, south of Seoul, doctors examined the patient over the course of four days but were at a loss as to the cause of his ill health.

On May 20th, the patient sought help at the Samsung Medical Center in Seoul and revealed that he had recently returned from Saudi Arabia and the United Arab Emirates. Finally, he was correctly diagnosed with the highly contagious virus. By then, patient zero had infected the two men who shared his hospital room, his doctor, some people sharing his hospital ward, and their visiting relatives.^[7]

There were 186 confirmed cases of MERS in South Korea. Thousands of people were quarantined to stop the spread of the virus, a precaution that brought chaos to the city of Seoul.

4 Gaetan Dugas

The most infamous patient zero on our list is a man named Gaetan Dugas. He was an Air Canada flight attendant and was identified by scientists in the late 1970s as the first person to bring the HIV/AIDS epidemic to the US.

Journalist Randy Shilts publicly named Dugas in his 1987 book And The Band Played On. Upon the book’s release, the New York Post covered the story with the headline, “The Man Who Gave Us AIDS,” forever linking the name Gaetan Dugas with the devastation of the HIV/AIDs epidemic.^[8]

However, scientists have now learned that it is doubtful that patient zero in the HIV/AIDS epidemic was Gaetan Dugas. A recent genetic study using blood samples taken in the late 1970s has concluded that the virus probably came to New York City in 1970 and was linked to existing viruses then present in Haiti and other Caribbean countries.

AIDS is not the cause of death of those infected, but it plays a contributing factor. Most people die from another condition that becomes worse with their weakened immune systems. As of February 2020, about 30 million people worldwide have died from AIDS-related illnesses.

3 Patient Zero SARS-Cov-2

By December 2019, the first cases of SARS-Cov-2, or COVID-19, had appeared in China. The coronavirus, which caused the global pandemic, likely originated at a Chinese wet market. However, there is still so much to be discovered about the virus and its origins.

According to the Chinese government, patient zero may have been identified as a 55-year-old Chinese man from Hubei province. In late 2019, rumors about a strange new flu were beginning to circulate in Wuhan. On China’s social media platform WeChat, users had been discussing their coughs and colds for weeks with words like “SARS” and “shortness of breath” spiking from mid-November.

By early December, a so-called “pneumonia of unknown origin” had been identified, and patients—many of them workers or customers of a well-known market—were finding their way to the hospitals in Wuhan for treatment.^[9] While most people have no or few symptoms, some get very ill and can even die. What begins as a cough can lead to shortness of breath. In more severe cases, acute respiratory distress syndrome (ARDS) may occur after about 10 days after initial symptoms begin. At this point, hospitalization for breathing treatments and intubation may be required.

The physical and mental effects of the virus are still being studied, and it may be years before we truly understand the virus. As of May 2021, there have been more than 150 million confirmed cases and more than three million deaths worldwide due to COVID-19.

2 Private Albert Gitchell

Several nasty viruses spring to mind when pondering deadly pandemics—the bubonic plague, cholera, Ebola, and typhoid. But what about the benign-sounding Spanish flu? The Spanish flu is one of the most devastating pandemics the world has ever seen and is thought to have killed between 20 and 40 million people.

Yes, you read that right. Million. In the year 1918, with much of the world overwhelmed by World War I, the Spanish flu spread silently from person to person, eventually infecting up to one-third of the world’s population.

It all began on Monday, March 11, 1918, with a cough. A nasty cough coming from Private Albert Gitchell, a cook at the U.S. Army Base in Fort Riley, Kansas. Military medics knew how quickly a virus could spread in camp conditions and had Gitchell immediately quarantined. But it was too little too late.

Gitchell had cooked dinner for hundreds of soldiers stationed at the camp the night before, and by midday, over 100 soldiers were sick. Almost half of the soldiers died from their symptoms, and the flu spread like wildfire throughout the U.S. and Europe, across enemy lines, and into the rest of the world.^[10]

1 Goodwoman Phillips

Goodwoman Phillips was not the first person to die of the bubonic plague, and she certainly wasn’t the last. In fact, the bubonic plague8 Fascinating Facts About Plague Doctors is still present today. Annually, there are hundreds of cases and deaths, but it does not become the pandemic of previous centuries—like the Black Death in the 14th century—as it can be treated with modern antibiotics. Between 2000 and 2010, there were 21,725 people affected, with 1,612 deaths worldwide.

Goodwoman Phillips earned her inclusion on our list of patient zeros as she was the first person to officially die of “plague” during the Great Plague of London in 1665–66. Thanks to the work of John Graunt, a London draper with an eye for statistics, deaths from the bubonic plague were meticulously recorded. All told, more than 68,000 deaths from the plague were recorded in a city of around 450,000 people, over 15 percent of the population.^[11]

According to the people of London, the plague that befell the city was the result of two specific occurrences: the appearance of a comet in the skies over London and the coronation of King Charles II. The comet was seen as a bad omen that would bring about the end of days, while the plague was rumored to follow a coronation as a sign that the new king did not have God’s favor.

We know now that the Great Plague of London was actually the result of squalid living conditions that put people near plague-infected rats that were covered in plague-infected fleas.

Toni Marie Ford is a freelance writer, cinema lover, and slow travel enthusiast from the UK who has been enjoying a nomadic lifestyle since early 2014. Visit her blog, www.worldandshe.com, or follow her on Twitter or Instagram.

Sadly, opioids have ravaged some parts of the country, and several counties are worried that the drugs will wipe out an entire generation of people.

Some notable people who have lost their lives recently because of opioids are Prince, Whitney Houston, Phillip Seymour Hoffman, Amy Winehouse, Michael Jackson, and Heath Ledger.

But just before we start, often when reading or hearing about this heartbreaking topic, people often use the words opiate and opioids interchangeably; we certainly did before looking it up. Opiates are drugs that come from poppies, like heroin, and opioids used to mean just synthetic opiates, but now refer to the whole family of opioids and opiates.

10. Its Availability is Built on Faulty Science

One question surrounding the opioid epidemic is why the FDA allows doctors to sell a drug that is so dangerous and addictive?

Before the 1980s, opioids were used for short term pain, like for surgery and end of life care, but then in the January 10, 1980, issue of The New England Journal of Medicine a one paragraph letter to the editor was published that would change America. It was submitted by Dr. Herscel Jick and his graduate student, Jane Porter, who were from the Boston University Medical Center. The letter was entitled “Addiction Rare in Patients Treated with Narcotics.” It reads:

Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients’ who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients who had a history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.

What some people drew from this letter to the editor, which wasn’t peer-reviewed, was that less than one percent of people who use narcotics become addicted.

What wasn’t included with the letter were the actual results of their study. When people went back later to examine the results, they found out that his experiment was done over a short time and the subjects were given a small dose of narcotics in a controlled environment when they had acute pain. That is a whole lot different than giving someone narcotics they can take home and do whenever they want over a long period of time. In other words, Jick absolutely did not show that less than one percent of people get addicted to narcotics.

However, by the time people examined the results of his study, it was too late. In 1986, a paper citing it was published in Pain, which is a journal published by the International Association for the Study of Pain. In the paper, the authors, Dr. Russell Portnoy and Kathy Foley, said that their study found that opioids “…can be safely and effectively prescribed to selected patients with relatively little risk of producing the maladaptive behaviors which define opioid abuse.” In their study, out of 38 cancer patients with chronic pain who were given opioids over a short term, only two of them became addicted. The paper advises long term studies, which never happened.

Around the same time, several pharmaceutical companies, like Johnson & Johnson and Purdue Pharma, were developing their own opioid drugs. They started to market them to doctors in high end publications citing the Portnoy article and Jick’s letter to the editor. They even went as far to start non-profit groups to push the use of opioids for long term chronic pain, like back and neck pain, even though there were absolutely no studies that supported the idea that opioids should be used long term.

In 1996, the American Pain Society and the American Academy of Pain Management published a consensus, partially written by Portnoy, stating that opioids were addictive to less than 1% of users so doctors could prescribe opioids for chronic pain. Also in the consensus, they said that there was little risk that people will become addicted and/or overdose.

Of course, that consensus was dead wrong because it wasn’t based on facts, and opioids are addictive and do lead to overdoses.

In 2011, Portnoy spoke out against the idea that opioids for chronic pain don’t lead to addiction. He said: “None of [the papers] represented real evidence, and yet what I was trying to do was to create a narrative so that the primary care audience would look at this information.”

9. Can be a Gateway Drug to Heroin

According to several studies, about 80% of people who try heroin say that the first opioid they tried were prescription painkillers.

There are several reasons that people turn from prescriptions to heroin. One reason is that they start to build up a tolerance to the opioids so they start using more pills. However, doctors should only be doling out a certain amount of pain pills. So the person looks for ways to supplement their pills and sometimes they will turn to heroin because it has similar effects as prescription painkillers, but is much cheaper. Generally, for a 60 milligram painkiller pill, for an uninsured person, it is $60. For the same amount of heroin, it’s about one-tenth that price.

Another reason that people turn to heroin is because they get cut off from their painkillers for some reason and they no longer have access to them. This becomes a problem when the government cracks down on prescription drugs because people aren’t going to instantly stop doing opioids if they can’t get them. Opioids are so addictive that abusers will kill other people to get their next high and some abusers won’t even quit when they get their children taken away. So simply limiting access to painkillers isn’t the solution, because users will simply switch to a cheaper alternative that is provided by organized crime syndicates; usually the Mexican cartels and the Taliban in Afghanistan. Heroin is also much more dangerous because users can never be sure what is in it. For example, it could contain fentanyl.

8. What is Fentanyl?

Fentanyl is a synthetic opioid that was first developed in the 1960s. It is incredibly strong and it can be anywhere from 50 to 100 times more powerful than morphine or heroin. Two milligrams, which is two grains, are enough to cause an overdose.

It was originally developed in the 1960s to be given to patients for surgery and to people with severe pain from metastatic, colon, and pancreatic cancer. It first started being abused by people working at the hospital. It was then later made into take-home patches, which people quickly began to abuse. They would soak the patches in water and drink fentanyl like a tea.

In the 1980s, fentanyl was sold under the street name China White. Also around this time, heroin started to be laced with fentanyl, which made the heroin much more potent. Today, fentanyl can be found in cocaine, heroin, and in counterfeit painkiller tablets.

As for how it kills someone, the president of the American Society of Anesthesiologists, Dr. J.P. Abenstein, says, “What happens is that people stop breathing on it. The more narcotic you take, the less your body has an urge to breathe. And it makes sense that a lot of people are overdosing on it because they aren’t sure how much to take.” The most notable person who died from a fentanyl overdose was the musician Prince, who passed away in April 2016.

One reason that fentanyl is so dangerous is because illegal labs are making it from scratch using dangerous toxins. This makes the drug a lot more unpredictable, so it is much easier for people to overdose. It is also tasteless and odorless, so sometimes people using counterfeit painkillers or doing heroin don’t even realize they are taking fentanyl.

One place that is particularly hard hit with fentanyl overdoses is Canada. In British Columbia, half of all deaths in the province are from fentanyl overdoses. It has gotten so bad that funeral directors in British Columbia give naloxone nasal spray, which helps prevents opioid overdoses, to the friends and families of overdose victims, just in case they turn to opioids to deal with their grief. The funeral directors, who host about four funerals a month for people who overdose on fentanyl, said that they are tired of seeing so many families destroyed by the drug.

7. It Was Fueled In Part by the War on Drugs

The War on Drugs was launched in 1971 by President Richard Nixon and it’s been a losing battle ever since. Over a trillion dollars has been spent on it trying to go after manufacturers, traffickers, and distributors of narcotics, but as of 2016, over 20 million Americans have a substance abuse problem, there are a record number of drug overdoses, and the drug cartels are as powerful and as deadly as they have ever been.

There are some critics of the War on Drugs who think that it helped fuel the opioid epidemic because of its misguided policies. Specifically, it shouldn’t have targeted marijuana, which is relatively harmless compared to opioids. Notably, there are no confirmed records of anyone overdosing on marijuana and some experts think that it is impossible to overdose on marijuana. According to a DEA briefing, someone would have to smoke 1,500 pounds of weed in 15 minutes to overdose. Another benefit that marijuana has over opioids is that it’s not nearly as addictive.

Several medical marijuana studies have shown that marijuana is effective for the very thing that opioids are now prescribed to treat – chronic pain. In a study, 80 percent of people were able to substitute marijuana for painkillers. It can also be seen in the real world and not just in studies. In areas where medical marijuana is available, deaths from opioids drop anywhere from 15 to 35 percent.

However, because marijuana was vilified in the War on Drugs, it is still illegal in 40 states, but legal opioids continue to ravage the country.

6. Could Lead to Dozens or Even Hundreds of HIV Outbreaks

One of the biggest side-effects of the opioid epidemic is that it could lead to increased levels of HIV because of users sharing needles. Since 1993, HIV infections from sharing needles has dropped by 90 percent. However, that number is expected to increase, because while a lot of people take advantage of needle exchange programs, one study found that one-third of people who injected drugs intravenously admitted to sharing needles.

In 2016, 22 cities in America saw an increase in HIV infection rates from needle sharing and the Center for Disease Control says that there are 220 rural communities that are highly vulnerable to an outbreak of HIV and Hepatitis C.

One small town that has already experienced an HIV outbreak because of needle sharing is Austin, Indiana. Out of the town’s 5,000 residents, there are 190 diagnosed cases of HIV and more people have yet to be tested. The source of the HIV is a drug den, which is a single story brick house, and at any given time, half a dozen people live or squat there, and many of them are addicted to an opioid called Opana.

Needle exchanges were illegal in Indiana and the addicts’ needles were shared hundreds of times. When asked why they shared the needles at the risk of getting HIV, one user said they just didn’t think it would happen.

5. It’s Hard to Get Treatment

When someone stops taking an opioid that they’re addicted to, their body begins to go through withdrawal. They get tremors, a terrible fever, they vomit, have diarrhea, and experience other terrible flu-like symptoms. They also get very depressed and there is an intense feeling of hopelessness. Unfortunately, once someone is on the other side of their withdrawal, they aren’t instantly cured of their addiction and relapses are possible. So while some people can quit drugs on willpower alone, it’s not as easy for most. The problem is that the brain structure and function change in people who abuse opioids, so some people need professional help or they will not be able to get off the drug. Unfortunately, many people can’t get the help they desperately need.

Drug addiction treatment is expensive, and in some cases, drug users have sold everything they own and live on the streets to support their habits. How are they able to pay for treatment? Even for people who aren’t living on the streets, it’s hard to get treatment for addiction because most health insurance plans don’t cover addiction treatment.

While there are public treatment facilities, unfortunately, the beds are always full and there are waitlists to get help. This is one of the most heartbreaking aspects of the epidemic. People who may have hit rock bottom and are anxious to get help take a huge step by reaching out and asking for it, and they get told to “call back in two weeks.” Two weeks can be a long time to spend in a pit of despair that is created by addiction.

In 2013, 316,000 people with substance abuse problems tried to get treatment, but were turned away.

4. More People Die from Overdoses than Car Crashes and Gunshots

The death stats for opioids are as shocking as they are depressing. Between 2001 and 2014, the number of deaths from overdoses increased six fold. However, the deadliest year on record, so far, was 2016.

Deaths from heroin overdoses rose 23 percent from 2015 to 2016, totaling 12,989. Deaths from synthetic opioids, like fentanyl, spiked by 73 percent to 9,580. However, the most devastating drug of them all was prescription painkillers like OxyContin and Vicodin. 17,536 people died from overdosing on them in 2016.

That is a total of 52,404 opioid overdose deaths, which is an overall increase of 12 percent from 2015. Deaths from opioid overdoses dwarfed the fatalities from car accidents, which was 37,757, and gun deaths, including homicides and suicides, which was 36,252. It is also more deadly than the AIDS epidemic was when it was at its peak.

3. Enough Prescriptions for Opioid Painkillers Are Written Every American Adult to Have Their Own Bottle

One question that inevitably arises: why are there so many opioids available? Unfortunately, it’s because too many doctors prescribed too many of them. In 2012, physicians wrote 259 million prescriptions for opioid painkillers. That is enough for every adult in America to have their own bottle of pills. Of course, not all of these pills were used by the patients. Some of them made it to onto the black market, patients have them stolen, and some share them (or sell them) with friends and family.

Amazingly, in Canada, which is another country that is having an opioid epidemic (as we mentioned above), the rate of prescriptions for opioids increased from 2015 to 2016. In 2015, doctors gave out 19.9 million prescriptions, but that number increased to 20 million in 2016. Meaning despite knowing the dangers, physicians are still liberally prescribing opioids.

2. The Opioid Orphans

One major casualty of the opioid epidemic is the children who are affected by it. Horror stories in the news about young children finding their parents dead or dying from an overdose are becoming way too common.

However, many children of addicts do not happen upon their parents’ bodies or them dying because many times the children are taken away because one or both of their biological parents are too addicted to opioids to take care of them. That is how powerful the addiction to opioids is; people will continue to do drugs at the expense of losing their children.

The overall number of kids orphaned or put into foster care because of their parents’ addictions is hard to figure out; but what is known is utterly depressing. For example, Kentucky’s Appalachian ridge area is one of the hardest hit areas of the country for opioid addiction. According to the 2010 census, 86,000 children in Kentucky were being raised by someone who wasn’t their biological parents, usually their grandparents. While not all of the children that are living with someone that is a non-biological parent are the result of opioid addiction, it’s believed to be one of the biggest reasons.

In Vermont, one-third of the calls made to family services hotlines involve opioid addictions and between 2013 and 2016, the state saw a 40 percent increase in foster care cases. Meanwhile, West Virginia, another state ravaged by opioid addiction, saw an increase of 24 percent in foster care cases between 2012 and 2016.

1. Purdue Pharma

You may recognize Purdue Pharma from entry #10 as one of the companies that pushed for opioids to be used for long term pain by citing misleading studies and creating fake non-profits that pushed for opioids to be prescribed. Well, Purdue is also considered responsible for setting off the whole epidemic.

Purdue Pharma was purchased in 1952 by three brothers, who were all psychiatrists. One of the brothers, Arthur Sackler, was a pioneer in medical marketing. He was famous for finding enough uses for Valium that it became the first drug to make $100 million. Sackler was also one of the first medical advertisers to develop relationships with doctors where they would give the doctors free stuff (and/or money) in the hopes that the doctors would prescribe their products.

In 1996, Purdue introduce their new drug OxyContin. It was a time released oxycodone, which is a semi-synthetic opioid that is manufactured by modifying a chemical called thebaine, which is an organic chemical found in opium. It’s chemically similar to morphine and codeine.

Purdue spent $200 million marketing OxyContin and between 1996 and 2000, more than doubling their sales force. The average yearly bonus for salespeople was $70,000 and some were as high as $500,000.

In the first year, OxyContin made Purdue $45 million.

There is evidence that Purdue knew that hundreds of doctors were recklessly prescribing OxyContin as early as 2002. In 2016, Purdue was aware that at least 1.1 million OxyContin pills ended up being sold by organized crime syndicates like the Armenian mafia and the Crips. However, in all that time, Purdue has done very little to stop reckless prescribing or to curb OxyContin trafficking. They didn’t pass on their findings to law enforcement or even cut off the supplies to offending parties.

In 2016, the revenues from OxyContin were at $31 billion.