not ever know. are you going to be okay with that? >> we have to live with it. i mean it's sad, and it's disappointing that we will never know or we may never know. but we have to be okay with it. >> that's all for this edition of "dateline." i'm natalie morales. thank you for watching. >> announcer: this is an msnbc special presentation. >> 36-year-old male unconscious. >> i said, tell me. eddie's dead. what did he do? he did an oxy, an oxycontin. what the hell's an oxycontin? >> before covid-19 changed everything, america was grappling with a different kind of epidemic. >> the president declared a public health emergency.

>> the opioid crisis. >> it came with little warning, killing without regard to g geograph geographic, economic, or racial lines. unlike the coronavirus, this epidemic was manmade, driven by relentless pursuit of profits. >> when you see huge amounts going to specific pharmacies, doesn't that raise a red flag? they had to know of all the bad things that were going on with it, and yet they didn't care. >> the opioid epidemic has claimed more american lives than all the wars since world war ii combined. and since the covid pandemic hit, it's only gotten worse. it's made a few people rich. >> there's your money. >> aaron shamo -- >> at 26 years of age, almost overnight, he's able to spawn this incredible empire. >> and it's devastated families

from coast to coast. >> it's pretty gut-wrenching when you go out to the cemetery and there's a headstone with your kid's name on it. >> how did it start, and how did it spread? with the health care system stretched to its limits -- >> cases are on the rise in 43 states. >> -- how will families cope, and how will communities survive a scourge that shows few signs of relenting? >> all epidemics have a point of origin. the opioid epidemic probably started in one of the coal mining towns in rural appalachia. a place like tiny pennington gap in lee county, virginia.

>> a lot of very good folks live around here. there's a lot of wonderful folks. people know each other, and there's a lot of, you know, extends families. >> art van zee is a soft-spoken family doctor who moved to pennington gap more than 40 years ago. >> in its heyday, it was the biggest town in the county. 14,000 men working up here in the coal field. >> beginning in the late 1990s, dr. van zee started to see a troubling number of people visiting his clinic seemingly addicted to a prescription painkiller called oxycontin. >> a lot of these young people were people i'd seen -- you know, i'd seen them grow up from babies. some of them were very good kids with bright, promising futures. it completely kind of caught me off guard about the extent of the problem.

>> we had a young woman overdose and her friends dropped her off at the emergency room and drove away, which in lee county was very unusual. and i just remember talking to her, and she was describing oxycontin, and i was like, where did this come from? that's the first time i had heard about it. naively i thought that might be the last time i hear about it. >> we were getting people walking into our facilities, and they were talking about oxys and ocs, which didn't mean a thing to either one of the counselors there. so i called the local pharmacist and i said, greg, what is this? and all he said to me, beth, this is going to be the worst disaster that has ever hit lee county. mark my words. >> patients quickly understood that if they put the pill in their mouth and let the coating melt off, they could then wipe it off on their shirts and then they could snort it, or inject

it and get that full nuclear bomb of oxycontin. once that time-release mechanism is gone, it's basically taking heroin in a pill. and that, of course, leads to addiction. >> there were more and more people coming in, and more and more desperate people. and a lot of desperate families, because they didn't know what happened. they didn't recognize their loved one, you know. and they were desperate. you know, what is happening to my husband, to my wife, to my son, daughter? >> every night, if you drove down into pennington or saint charles or anywhere around, you could see kids out on the street selling drugs, using drugs, high. how hard it would be trying to get them sober and i would be trying to get them out of jail. >> the things i saw were family members who loved their family. loved their grandson, son, daughter. and they were stealing them blind. they were robbing them, taking

everything they had. >> people were stealing lawnmowers in broad daylight. they were stealing wide screen tvs from walmart. a night manager of a grocery store was making a night deposit. somebody killed him to get his money to go buy more oxycontin. so it was crime on a level that they had never seen before. >> and then came the deaths. so many overdoses that the local funeral parlor was quickly overwhelmed. >> there were times we attended funerals twice a day and missed some. all of a sudden, there was a balloon of all these children put into foster care, and their parents were in the hospital or on the street or dead from this drug. >> this was the most devastating thing to not only our community but our region that i've seen in 43 years of medical practice here.

>> what happened in pennington gap and towns like it looked a lot like an infectious disease spreading rapidly through the population like a virus. but this epidemic differed in a crucial respect. it was manmade, in large part a product of the hunt for profits by american drug manufacturers, including one called purdue pharma. in the mid-1990s, purdue already had a painkiller called ms contin. it contained morphine and was mostly reserved for very sick patients. with its patent about to expire, purdue devised a new drug based on the more powerful opioid oxycodo oxycodone. this new pill would release its medicine gradually into patients' bloodstreams. >> they see the possibility of marketing a high-strength opioid and creating a market for it amongst people who are living

with everyday chronic pain. purdue pharma worked out that they could market a pill that they would claim would last all night. and the way that they would do that was that they would pack this pill with very high levels of opioid, and they would coat it in what they said was a slow-release protection, and that essentially this pill would drip the painkiller into your system over 12 hours. >> in 1995, purdue asked the food and drug administration to approve its new painkiller called oxycontin. they claimed that because of its slow release, it was perfectly safe and of great benefit to patients with chronic pain. >> they realized that this was key, not only was the drug more effective, but they needed to market it as safer. and essentially what you see is that they go to the fda and they persuade them of this. and the fda allows them to put it on the label. >> literally the words were "it is believed that the

time-release mechanism reduces the risk of addiction." now, the guy at the fda who approved this was a fellow by the name of curtis wright, who left the fda shortly thereafter and took up a six-figure position at purdue. >> even with fda approval, there was still a big hurdle in the way of purdue's plans for oxycontin -- skeptical doctors. >> the marketing department went to the management and said, even if you get this drug approved, these doctors are not going to prescribe. they're not convinced it's safer. in fact, they're convinced it's more dangerous. >> what most doctors understood was that prescription painkillers like oxy are almost identical chemically to street drugs like opium and heroin. are all derived from a milky fluid produced by the poppy plant and all are classified as opioids. doctors' reluctance to prescribe opioids stretched back to the civil war, when the use of

morphine, a chemical cousin of oxycontin, reached epidemic levels. >> the civil war contributed to the medical demand for morphine because there were a lot of debilitating injuries, particularly in the south where a lot of the fighting took place and a lot of the greatest devastation happened. you had increases in opium use after the civil war. >> in the chaos of rebuilding the country, few noticed the army of addicted veterans. morphine was seen as a quick and easy way to address a host of ailments. >> there certainly was no sanction against using morphine itself as a medicine. physicians prescribed it at the drop of a hat for all kinds of things. >> in 1895, a new product called heroin was introduced by the bayer pharmaceutical company as an over-the-counter cuff suppressant. it was thought to be so safe that it was routinely used for teething infants. >> there was on the part of

large numbers of people a lack of awareness of the dangers of these drugs. essentially the state of addiction that grew up then created this backlash in the early 20th century. it's become a crisis in america. >> the crisis of addiction led to a crackdown. no longer would doctors prescribe them or pharmacies stock them, pushing opioids into an illicit black market. >> from the 1920s through really the early 1990s, there is a strong restrictive consensus about opioid use among physicians, among pharmacists, and the federal government really enforces it among pharmaceutical companies. >> so how does it come to pass that purdue comes out with an opioid in the 1990s, and suddenly it's a great time to be selling opioids? >> how did opioids go from the black market to behind the pharmacy counter? although it's a complex story, it has come to be told through a

single family, the sacklers. their genius for marketing drugs would earn them billions and help precipitate the opioid epidemic. eze) skip to cold relief fast. alka-seltzer plus power max gels. with 25% more concentrated power. oh, what a relief it is! so fast! our most advanced formularonamel repair. helps you brush in vital minerals to actively repair and strengthen enamel. so you don't just brush to clean, you brush to build. pronamel intensive enamel repair.

over decades, the sackler family built a pharmaceutical giant by means of skilled mav marketing kpamarke marketing skpans. the family dynasty began with arthur sackler, a brooklyn born psychiatrist. >> he was a good doctor at that, but more than anything he was a

salesman of drugs to americans and particularly of drugs that americans didn't really need. >> in the early 1940s, sackler joined a sleepy ad agency called william doug allas mcadams and quickly turned it into a pharmaceutical juggernaut using sales techniques that had never before been used to market drugs. >> doctors are now prescribing an ataraxic medicine. >> a key factor, a stroke of genius in a way, was to realize the public probably wasn't going to listen to him. but the public would list ton their doctors, and he sent out doctors to tell people that this was the drug that they needed to solve their problems. >> sackler had his greatest success with a drug called valium, turning it from an obscure remedy for frayed nerves into an international

blockbuster. >> valium was the best-selling drug in the united states and on the whole planet. >> valium, for the response you know, want, and trust. >> over 100 million prescriptions a year written by 1973, and so as this fantastic success except it could also be adicktive. so even as it was climbing the sales charts, it was also climbing the charts of overdose, fatal and otherwise. >> sackler and his brothers bought the purdue frederick pharmaceutical in 1952. at first, the company limped along with a roster of unexciting products. then they spotted a golden opportunity in the field of pain management. if purdue could overcome doctors' fears of opioid addiction, they could greatly expand the market for their prescription painkillers along with addressing the unmet needs of millions of chronic pain sufferers. >> purdue pharma begin by taking

control of the narrative, and that narrative is that there's a pain epidemic in this country, and the way to deal with that is through prescription of opioids. >> pain had long been accepted by doctors as inevitable in the treatment of disease and injury. because of the risk of addict n addiction, opioids were prescribed only for the most severe cases such as terminal cancer. however, some doctors disagreed. >> in the 1970s, you see elements of the medical profession start to question why these drugs, which are very effective painkillers, even if dangerous, aren't be more widely used when they see so many patients in pain. and they create the idea that there's a stigma against opioids in the routine treatment of pain. >> the message that there might be a way of treating chronic pain without causing addiction

quickly gained traction. >> and what you see is these radical pain reformers, they just start to climb and climb and climb. they're the head of professional societies. they are giving talks all across the country. >> one of the chief evangelists for this new pain management revolution was a specialist at sloan kettering named russell portnoy. >> the possibility that a patient becomes like a street addict when given narcotic drugs for pain -- and i'm talking about a patient with no prior history of substance abuse -- is so unlikely that we don't even discuss it. we don't view it as a credible risk. >> as evidence for the safety of opioids, dr. portnoy and others cited a five-sentence letter to the editor published by two boston researchers, her shell gymnastic and jane porter, in 1980. >> the letter was about 100 words to the new england journal of medicine, and essentially it was a study of a small group of patients in a hospital setting, which suggested that if you were

given opioids for the treatment of pain, there was a less than 1% chance of addiction. >> but the letter was never intended as a study. it applied only to patients in hospitals. nevertheless, some took the letter and ran with it. >> once that interpretation had been given, it then gets repeated without anybody really going back and looking at the original claim in the letter. and it gets cited time and time again in paper after paper. less than 100 words becomes the whole basis for claiming that opioids are safe for long-term treatment of chronic pain. >> purdue used the claim in its own public relations materials. >> the rate of addiction amongst pain patients who are treated by doctors is much less than 1%. they don't wear out. they go on working. they do not have serious medical side effects. and so these drugs, which i repeat are our best, strongest pain medications, should be used much more than than they are for

patients in pain. >> to purdue pharma, the new relief movement lent valuable sport to their plans to expand the market for oxycontin beyond end of life care. purdue hired key reformers as spokesperson, funded their research, and championed their ideas. >> we can manage better than 90% of the pain problems that present to us with relatively simple medications, lifestyle changes, exercises. >> 34 million adults suffer from chronic pain. >> they start to put their lobbying money and their political muscle and marketing money behind the idea that there's an epidemic of untreated pain in america and that opioids is the solution to that. and that's when you begin to see the door crack open to their use. >> purdue created videos directed specifically at doctors. >> we doctors were wrong in thinking that opioids can't be used long-term. they can be, and they should be. >> there was just one problem with the message that oxycontin

would be less addictive. it was wrong. >> i believe that there were messages that purdue pharma promoted that they knew were false, that they didn't accidentally teach the wrong thing, that they intentionally lied to the medical community. and if you look at the litigation that's been filed today, much of that litigation really is focused on this brilliant multifaceted campaign that downplayed opioid risks, exaggerated benefits, and falsely marketed opioids. >> over time, purdue's marketing campaign began to work, lowering the resistance of mainstream doctors to prescribe opioids. >> the standard of care is now to treat pain as ener jetically, as vigorously as we treat any other serious medical derangement like diabetes or asthma. >> pain management became so

routine that patients visiting doctors' offices were asked to point to smiley faces to indicate their level of discomfort. >> you call it measured pain. you can measure your blood pressure. you can measure your heart rate. what you can't do is measure pain, so patients had to be asked about their pain. if they said it was five or higher on a scale of one to ten, then they had to be referred for pain treatment. that pain treatment frequently ended in the use of opioids. >> to minimize any concern over oxycontin's addictive potential, purdue sales reps peddled a dubious theory called pseudoaddiction pioneered by purdue's own medical director. the idea of pseudoaddiction was that what looked like addiction in a patient was really just more pain, requiring larger doses of opioids. >> the doctor expressed a concern about a patient who he thought might becoming addicted,

we were trained to say to them, okay, doctor. you need to consider that this might be pseudoaddiction. the way that you manage pseudoaddiction is the behaviors seem the same as an addict, but perhaps it's only because that patient's pain is not adequately managed. and maybe, doctor, the simple solution is you just need to take them to a slightly higher dosing strength. there were no studies. there was nothing to back that up. >> purdue and other pharmaceutical companies had flipped the script on opioid use. doctors who previously had been reluctant to prescribe opioids were now afraid not to. >> some doctors were reported to ethics boards for not giving enough drugs. and what happens is opioids become the default. and even doctors who are cautious about using these drugs find themselves under incredible pressure. >> purdue never had more than a 4% share of the prescription opioid market. companies leek specgx and

activist pharma ended up selling many more pills. but experts say oxycontin played an outsized role in the epidemic, especially at the beginning because it was so powerful yet easy to grind up, snort, and inject. armed with a product and a pitch, purdue set its sights on easing america's pain. tired of clean clothes that just don't smell clean? what if your clothes could stay fresh for weeks?

now they can! this towel has already been used and it still smells fresh. pour a cap of downy unstopables into your washing machine before each load and enjoy fresher smelling laundry for up to 12-weeks.

when you drink or eat something that's acidic everyone is at risk for enamel loss. it sucks the minerals out of the tooth's surface. pronamel is formulated to help deliver minerals to the tooth's surface to help reharden and strengthen your enamel. to save time and stay ahead of the messn dishes as you cook, but scrubbing still takes time. now there's dawn powerwash dish spray. the faster, easier way to clean as you go. it cleans grease five times faster on easy messes, just spray, wipe, and rinse. on tough messes, the spray-activated suds cut through grease on contact, without water. just wipe, and rinse. get dishes done faster dawn powerwash dish spray. spray. wipe. rinse.

by the mid-1990s, purdue pharma had convinced the medical community that oxycontin was safe. to drive their message further into america's heartland, they hired an army of pharmaceutical reps, taught them a sales pitch, and directed them to doctors most likely to prescribe. >> they had data that they had purchased, and they gave them to their reps, and they sent them everywhere in the country. but they paid particular attention to places like pennington gap, where there were already larger than average percentages of people on opioids because there were lots of workplace injuries because of coal mining and factory work. so they targeted those doctors, and they went to them with the message that this drug is safer. look, the fda allows us to say it. >> in pennington gap, dr. art

vanzee was on the receiving end of purdue's sales pitch. >> this was kind of in the early days of the campaign that they had these kind of things. one of them was this oxycontin beach hat that physicians could get. and then they had this cd with "swing is alive." swing in the right direction with oxycontin. a lot of the old great swing tunes on here. it's a distraction. it's a way of taririvializing w you're doing. i mean you wouldn't give hats that have heroin on it. but it has the same addiction potential. >> i have one of the early mugs. it has a oxycontin on one side. on the other side, it says "the one to start with, the one to stay with." i find that really clarifying. they wanted you on that drug. they made more money when you were on that drug. and of course they knew most people, once they were on that drug for any amount of time, were going to have to stay on

that drug. it was a great business model. >> it's a very practice, date-driven marketing decision to go in and hit those places. now, as it turned out, when things started to go wrong, when addiction rose, those were also the places that were most marginalized. they were easiest to stigmatize, and they were easiest in many ways to hide a drug academic in. >> there were huge amounts of oxycontin being shipped out of purdue's warehouse to pharmacies in kentucky and tennessee and different places they sent it to. there were towns in west virginia where they had more medication than the number of residents in the whole town could have taken. every single man, woman, and child was on oxycontin, they couldn't have taken the amount that was going through a couple of pharmacies there. when you see huge amounts going to specific pharmacies, doesn't that raise a red flag?

>> by the fall of 2000, vanzee and a few colleagues had seen enough crime, misery, and death in their small community, they decided it was time to act. >> i was very concerned that we were the only ones that knew about this. in my naivete, i said, we have to let purdue pharma know. and i thought they're going to be just absolutely thankful that we contacted them and told them about the problems we're seeing because i thought they didn't know. >> dear dr. haddox, i am writing you as medical director at purdue pharmaceuticals to give you further information on the growing abuse of oxycontin in a number of areas in the country. i'm sure that you are already -- >> they just didn't move. they didn't respond. and because of that, we just knew we were going nowhere with purdue. we're on our own, and we have to do what we can to stop them.

>> vanzee and his colleagues decided to call an emergency meeting at the local high school. more than 800 people showed up. >> people wanted something done. they wanted a resolution to what they were seeing with their children, what they were seeing with their parents, what they were seeing with their neighbors, the crime, the addiction, the suffering that they were going through, the neglect of children. >> at the meeting, a petition was circulated demanding that purdue recall oxycontin until it could be made in a less abusable form. within weeks, the petition had thousands of signatures. >> that really got the attention. that's really when purdue kind of woke up to what was happening. this community's not keeping quiet. >> the company reached out to request a meeting. three high-level executives traveled from purdue headquarters in stamford, connecticut, to meet with health

officials at a local motel. the group from pennington gap included a businessman who had lost his son to an overdose. >> they wanted to put a face on the suffering. so we thought if we brought this father -- and this father was in desperate pain. i mean it was awful to listen to him. we thought maybe putting a face on it might, you know, grab them a little bit. >> but purdue executives refused to recall oxy, instead offering to cut a check to the community for $100,000. >> i felt so helpless. i felt that all my skills were useless. and to have someone come to you and say, oh, it's not our problem, it's your problem, you know, and we'll help you out by giving you $100,000. and we were supposed to be impressed by that. i kept thinking, how can they expect us to be that dumb? but they did. >> soon stories about the

addictive potential of oxycodone, the active ingredient in oxycontin, would spread from towns like pennington gap to the rest of the country. to cold ret with alka seltzer plus severe power fast fizz. dissolves quickly, instantly ready to start working. ♪ oh, what a relief it is so fast.

alice loves the scent of gain so much, she wished there was a way to make it last longer. say hello to your fairy godmother alice. and long-lasting gain scent beads. part of the irresistible scent collection from gain! to your friends... your family... to your teachers. in that spirit of giving, chevy's proud to give our employee discount to everyone. the chevy price you pay, ...is what we pay. not a cent more. because giving, ...and giving back, is what the holidays are all about. use the chevy employee discount for everyone to get a total value of over eight thousand

four hundred dollars on this silverado. get the chevy employee discount for everyone today. good evening. i'm dara brown. president trump, president-elect bind, and vice president-elect harris will travel to georgia before tuesday's critical runoff elections that will decide control of the senate on tuesday. the republican incumbent david perdue is quarantining after exposure to covid-19. he has tested negative.

back in washington, mitch mcconnell again blocked a senate vote on $2,000 stimulus checks, perhaps a final blow to any chance of a payment increase. now back to "forgotten epidemic." by the early 2000s, purdue knew about the addictive properties of oxycontin, but they and other companies in the opioid business had a few billion reasons to keep aggressively marketing their drugs. >> we're talking about huge, huge amounts of money. so every year that they can prevent regulations from cracking down on this market, that's a major victory for them. >> the vast supply and illegal diversion of opioids made them increasingly available to millions of americans suffering from the disease of addiction. >> once the people become hooked on these drugs, they need more

and more. you build up a tolerance. you need ever-increasing doses to either offset the pain or to get high. once it got big enough, once you then start to see is the black market becomes an important part of this whole economy of dealing in opioids. >> clinics and pharmacies turned themselves into pill mills, distributing objectiing oxys an opioids as fast as they could get them. >> in little more than a decade, more than 20 million prescription pills were sold here, an average of 6,500 per person. >> in a town of williamson, west virginia, the police described to me how you would have mini bus loads of people who would arrive brought by one dealer. he would simply sign people up to come, get spripprescriptions. he would pay them, get their prescriptions, get the pills, sell them on the black market. so everybody starts to benefit a bit by this, except of course

those being dragged down by it. >> it's the fastest growing drug in america. >> the tide of opioid addiction spread out from appalachia like a stain across the country. >> the centers for disease control has this map, and it flipped through the years beginning in the late '90s. there's a little red spot that rises in southern west virginia. and as the years tick by, you see that spot spread through southern west virginia, east into kentucky. it pops up in southern ohio and up in parts of new england, and that red dot gets wider and d k darker, and then eventually dots spread out across the country. >> the wildfire of opioid addiction had so far burned virtually unchecked, but all that was about to change. by february 2001, the opioid epidemic had spread from small rural towns to the streets of

big eastern cities like philadelphia, where 18-year-old eddie bish was a high school senior. >> presidents' day, february 19th, 2001. i was at work. i got a call from my daughter. dad, eddie's not breathing, and he's turning blue. as i ran up the block, i noticed two guys were sitting in the ambulance, and they looked at me, and i looked at them. and they said, sorry, sir. and i was like, please don't tell me he's dead. and they said, sorry, sir. nothing we could do. i was like, why? >> unbeknownst to his father, eddie had begun experimenting with a little blue pill that was appearing at neighborhood parties. >> my son's friends were gathering outside. i walked outside.

i said, tell me what did he do? eddie's dead. what did he do? he did an oxy, an oxycontin. what the hell is an oxycontin? i was reading these stories about how bad this drug was. i had no clue painkillers were related to heroin. they were almost the exact same as heroin. ever since that day, it was my personal mission. i dedicated in the name of my son, eddie, to warn as many people as i could. never letting anything get in my way. not the doubts, distractions, or voice in my head. and certainly not arthritis. voltaren provides powerful arthritis pain relief to help me keep moving. and it can help you too.

feel the joy of movement with voltaren.

my hygienist cleans with a round head, so does my oral-b. my hygienist personalizes my cleaning, so does my oral-b. my hygienist uses just the right pressure, and so does my oral-b. oral-b combines a dentist-inspired brush head with the gentle energy of micro-vibrations for the wow of a professional clean feel every day. my mouth says wow and so does my oral-b. after losing his son to an oxycontin overdose, philadelphia's ed bisch devoted his life to stopping the spread of the drug. a professional i.t. specialist,

bisch created a simple website called oxyabusekills.com. >> the website started one page, just one page, and it told eddie's story. my 18-year-old son died 2/19/01 after chewing a powerful drug painkiller called oxycontin. and the site developed from there and eventually that one page website had 40 or 50 pages. >> the website became a kind of virtual memorial, its pages filled with the stories of young people dead from oxy overdoses. these were some of the first casualties in an epidemic that was still mostly under the radar. >> to my surprise, over half the emails i got were from people who were prescribed oxycontin, people who took it as prescribed and became addicted. as i learned more and more

stories came out, it was, you know, plain and clear that the company was lying about this drug. >> bisch wanted to turn his grief into action. he put out the word to the parents who visited his website to join him in an effort to rein in purdue pharma. >> we got together, and we came up with a name for our little group -- rapp. relatives against purdue pharma. as i got emails, ai would let them know, look, we're trying to do something. >> rapp parents fanned out at public protests, in front of congress, and on television news, letting the country know of the dangers of oxycontin and other opioids. >> it has now been over ten years since oxycontin first came on the market. the deaths and addiction continue unabated.

>> my 19-year-old son, bobby, died from an overdose of oxycontin. >> my wife mary jo died from oxycontin. >> my 18-year-old son matthew died of an overdose of oxycontin. >> bisch sent articles to every reporter and prosecutor he could find. one of the offices he contacted was the u.s. attorney in the western district of virginia. that u.s. attorney, john bro brownlee soon launched the first criminal probe of purdue for fraud and mislabeling of the drug. >> he sees these overdose figures and deaths, and he says to himself, what's going on here? when he looks at it, he sees one drug, oxycontin. so he starts to digs into what's going on. he essentially leaves open the door to all of the internal information about purdue pharma, actually how they have marketed this drug, the lies that are being told, the misinformation about its safety. and above all, what the company

knew and what it was telling its salespeople to say wasn't, as far as he was concerned, an accidental epidemic. it was something that they consciously pursued. >> ultimately, brownley indicted the company and three of its top executives on criminal charges. >> the genesis of oxycontin was not the result of good science or laboratory experiment. oxycontin was a child of marketeers and bottom-line financial decision-making. >> purdue fought back, hiring one of the most famous lawyers in the country, former new york mayor rudolph giuliani. >> rudolph giuliani was there to show that purdue pharma had political pull. he was still a big name in washington. and so the pressure starts to ratchet up. >> brownley wanted to indict purdue executives on felony criminal charges, but his

higher-ups in the justice department ordered him to settle for miami-dade charsdemeanor ch misbranding and no jail time. ed bisch and the other members of rapp felt betrayed. at the executives' sentencing hearing, they were invited by the judge to give a statement. >> we pleaded that they get jail time. the judge was apologetic, saying that if it was up to him, they would have got jail time, but he had to go by the recommended plea agreement. >> purdue pharma must pay a $600 million fine, one of the biggest ever against a drug company. and company executives individually were fined $34 million. >> in the end, purdue pleaded guilty to felony misbranding for actions that occurred before 2001. but for purdue, the $600 million fine was affordable when

compared to billions in profits from the sale of oxycontin. >> there are various watershed moments, i think, when you say that the opioid epidemic could have been, at the very least, reined in if not prevented. and that was one moment. because the way the case turned out, it discouraged others from going after purdue pharma, and it would take many more years before other federal agencies decided to look more closely at what the company was doing. >> reached for comment, purdue says in part that it has accepted responsibility for specified misconduct before 2017 and has made changes including ending promotion of opioid products. it says it has eliminated its sales force and appointed new executives. the sackler family members have resigned from the board. it would take until 2010 for purdue pharma to release a tamper-resistant version of the

oxy pill. >> oxycontin finally reformulated so you can't just crush it and inject it or snort it anymore. and you see something else going on at the same time, which is the medical profession starts to get a bit more hesitant about prescribing. and the third element is you se element is you see a big crackdown on the pill mills. >> news off the arrests and prosecutions of suspected pill mill operators filled local news casts. >> more than 20 people arrested two weeks ago, accused of stockpiling oxycontin by getting prescriptions from different doctors. >> richard pay earned the nickname dr. ocracy one prescription at a time according to prosecutors. >> the tighter controls on oxydid little to slow the spread of the opioid epidemic. in many ways, it was too late. those addicted to opioids were already looking for new ways to get high. before long, drug cartels rushed in to meet the demand with an even cheaper drug, heroin. cranky-pated: a bad mood related to a sluggish gut.

miralax is different. it works naturally with the water in your body to unblock your gut. free your gut, and your mood will follow. our most advanced formularonamel repair. helps you brush in vital minerals to actively repair and strengthen enamel. so you don't just brush to clean, you brush to build. pronamel intensive enamel repair. gillette proglide and proglide gel.

five blades and a pivoting flexball designed to get virtually every hair on the first stroke, while washing away dirt and oil. so you're ready for the day with a clean shave and a clean face. you downloaded the td ameritrade oh yeah,mobile app?ake off. yeah, actually i'm taking one last look at my dashboard before we board... and you have thinkorswim mobile- -so i can finish analyzing the risk on this position. you two are all set. choose the app that fits your investing style. ♪

virginia, in 2008 was in many ways a microcosm of the opioid epidemic sweeping through appalachia and beginning to leak out to the rest of the country. 30-year-old mark trent grew up

there. he left to go to college to study photography. when he returned and saw what was happening to his community, he picked up his camera and started to shoot. >> i started trying to document it around 2008, 2009. i was an outsider at that point, so it took me time to come back and be accepted again, especially for what i was asking. i was asking a lot. >> when trent began taking pictures, oxycontin was still the main problem in reconnaissance vert. >> this is an x-ray of barbie's knee. >> one of our close friends had a knee injury playing soccer, and that turned into a prescription for painkillers. that prescription for painkillers turned into an diction. from there she turned her friends on it, and it wasn't just her, it was everywhere. >> in 2009 mark connected with an old friend named ali.

ali introduced him to her 17-year-old girlfriend, piqué, and another friend named barbie. these three women became mark's three main subjects over the next few years. >> that was the first day i met piqué, so young. piqué at the time was a young, young girl that had no experience with this stuff. everyone was watchful at first too. no one wanted her to get involved but it was one of those things that got her. >> for years ali tried to keep piqué off opioids, but heroin proved too enticing. >> she begged me not to do it and i wouldn't elizabeth. i went ahead and done it. i remember it going up through my arm and, like, my whole body just got really warm and, like, my eyes got really heavy. and i remember looking up and at her and smiling because i never felt that my entire life and it was the most peaceful thing i had felt in my life.

>> with ali, piqué, and barbie as his guides, mark began taking his camera where her. >> this is one of the houses i always shot in. there was always, like, a hunt railro for drugs, seeing who's getting high, seeing who's getting their scripts. i knew it was inevitable that i was going to see my friend shoot up. i knew there was evidence. i saw the arms. i knew they were doing it. but i never seen it in person. when they drew back on the syringe, it was just black. it was like injecting death. that was the second time i was ever shocked. it was the first time i ever saw someone shoot up in their neck. this is such a heartbreaking moment because ali was high and she was talking about it, everyone was turning against her and her own family didn't want her around and they treated her like she was trash and, like, there was something wrong with

her. >> isn't this crazy, dude? >> the center of reconnaissance vert's drug scene was an old abandoned house since burned to the ground. >> this is the living room where everyone would gather up right here. we would always sit in here and if you cut back through there, there's a bathroom and stuff. that's where everyone would do drugs and stuff like that. it got to the point where nobody cared where you did it at. there were needles laying around everywhere and everyone would be piled up in this house, elbow to elbow in here, hanging out doing trades and deals. we traded a vehicle one time for some stuff. >> once she got into heroin, piqué became addicted quickly. >> at times i remember being so messed up stumbling out of this door and swaying and stuff and everything was, like, spinning around. but i thought i had it under control. i thought i could quit and i

thought that for a long time. >> piqué couldn't quit, nor could her girlfriend, ali, or their close friend, barbie. mark watched helplessly as the three women spiraled deeper and deeper into addiction. >> three and a half years in, i started seeing the struggles of what being dope sick would look like and shivering and being cold and the people that i knew and loved changing completely and being irrational with each other, angry with each other. like, relationships just turning really, really sour because one person had gotten just a little more high than the other. it wasn't let's go out and party and have fun anymore. it was let's survive and what do we got to do to survive. >> mark's photographs became one of the first and most complete visual records of the opioid epidemic. >> i never thought about not shooting this or making this work because i knew that it came to a point where they wanted me to.

>> in 2016, the inevitable happened. ali and piqué's friend, barbie, succumbed to a fatal overdose of heroin. >> i had just gotten back from new york and i had gotten two calls from a west virginia number. my heart sank because it was one of the girls, one of the girls, one of the girls. i called and it was piqué. she was crying and she's like, barbie and her girlfriend are dead. they died. they overdosed. they're dead. >> i thought things would change at that point in time. i was, like, wow, these girls are going to see. >> yeah, you think so, but that's the thing. >> because barbie was pretty invincible. i never seen anybody like that. >> it hit reality but we didn't care. we just wanted to keep getting high, kind of numb the pain. >> ali survived, pulling herself

through sheer force of will out of addiction. as part of her recovery, she decided not to talk to us on camera. >> ali found sobriety through a court-ordered program. and that came about when she got into a bit of trouble and finally just came clean and said if you guys don't get me out of here, i'm going to die. and they pulled some strings, got her a bed, and she found sobriety that way. and that's what really turned things around for her. this is the first time she saw her family after being clean for, like, a year. >> piqué was on and off heroin for years, shooting up so much that her arms were kris crossed with needle marks. finally in 2018, she quit too. >> it wasn't until i got pregnant with my son this past year that i didn't want to put him through what i put my

daughter through, like, even though i didn't use while i was pregnant with her, she still had to grow up not without me but without me, like, in a sense. and, like, i didn't want to make them go through withdrawals. and so that's when i finally was just like i have to be done with it this time. >> piqué and her boyfriend are now on a maintenance drug called intox zone, but they want to quit that too. >> i want to quit so i can be normal, but i don't think i'm ready. i'm stressed out about it. >> i guess now it's the last thing, you know. all the other stuff's done, so it's hard to quit the very last thing you have. >> we still have hard cravings about wanting to do it and we almost break. so, like, if she would cut me down, then what if the cravings are overcome, like, you know, me not having that, you know what i mean? then it's going to jeopardize my whole sobriety. >> in december 2018, mark

published some of his photos in "the new york times," bringing much-needed national attention to the opioid crisis. >> i figured if i could reach one person and show them how horrible that life was, this one person could show 20 other people and i could save 20 people. you lose so many people. my sister just died last month of it. i mean, i'm not trying to lose any more friends from it. >> though the story mark chronicled brought hope, it was too late for many in reconnaissance vert and many other towns like it. >> these communities are still under water with it. it hasn't went away. as crazy as that sounds, like, an overdose death is not shocking at all and it's normal now. you can meet entire generations that have been wiped out by this. the damage is done.

there's no undoing any of this. nicorette knows, quitting smoking is freaking hard. you get advice like: try hypnosis... or... quit cold turkey. kidding me?! instead, start small. with nicorette. which can lead to something big. start stopping with nicorette

and ask your doctor about biktarvy. biktarvy is a complete, one-pill, once-a-day treatment used for h-i-v in certain adults. it's not a cure, but with one small pill, biktarvy fights h-i-v to help you get to and stay undetectable. that's when the amount of virus is so low it cannot be measured by a lab test. research shows people who take h-i-v treatment every day and get to and stay undetectable can no longer transmit h-i-v through sex. serious side effects can occur, including kidney problems and kidney failure. rare, life-threatening side effects include a buildup of lactic acid and liver problems. do not take biktarvy if you take dofetilide or rifampin. tell your doctor about all the medicines and supplements you take, if you are pregnant or breastfeeding,

or if you have kidney or liver problems, including hepatitis. if you have hepatitis b, do not stop taking biktarvy without talking to your doctor. common side effects were diarrhea, nausea, and headache. if you're living with hiv, keep loving who you are. and ask your doctor if biktarvy is right for you. if you're living with hiv, keep loving who you are. to customizes yourcan gocar insurancetual.com so you only pay for what you need? really? i didn't-- aah! ok. i'm on vibrate. aaah! only pay for what you need. ♪ liberty. liberty. liberty. liberty. ♪

an epidemic hitting rural america hard. oxycontin. heroin overdose deaths have doubled in the last two years. >> public health crisis. >> the opioid epidemic in the united states has come in three waves. prescription painkiller phase crested around the same time as cheap heroin began to flood the market. >> about 28,000 people die each year from heroin overdoses. >> the leading killer of people under 50 in the united states. >> heroin overdose deaths quintupled between 2010 and 2016. before that drug too reached saturation. but the deadliest period of the epidemic was still to come. >> this is fentanyl. an opiate up to 50 times more powerful than heroin.

>> so powerful, you could die just touching it. >> taking 18,000 lives in 2016. african-americans suffering the most dramatic increase. >> fentanyl was first synthesized in a european lab in the 1950s as a powerful answer thettic. >> schedule 2 medicine. used in invasive surgery and patches to treat cancer pain. end of life pain. today the problem is it's being manufactured abroad and imported into the united states. >> it is estimated that fentanyl overdoses have cost the lives of 150,000 people in the last eight years. most fentanyl comes into the united states from china. where it can be purchased online. >> we do think the dealers are the ones driving the transition toward fentanyl. in part because it makes economic sense. the profit margins are much larger. you can conceal it easily. you can ship it easily through

the mail. it just makes economic sense. >> open the door! >> this is challenge for law enforcement because now this stuff is showing up in places where there was no prior contact or proximity to organized crime. >> fentanyl represented a frightening new front in the war on drugs. no longer would traffickers require sophisticated distribution networks. ties to mexican cartels or guns. now they needed only an internet connection and mailing address. they could operate from anywhere. even a middle class suburb in the heart of mormon country in utah. >> in 2016 we heard that they -- there were shipments of fentanyl making their way into utah and it instantly became a top priority for our office. >> on november 8, 2016, postal inspectors seized a box on route from a port city in china. it was a addressed to a man in salt lake named sean gigi.

>> we received intelligence from customs and border protection. there was an inbound package. of pejoratives headed to our area of responsibility. we began to investigate the package. our sense of urgency went off the charts and it led to further intercepts of packages intended for delivery. >> investigators quickly determine that gigi was a low-level courier, probably unaware of the contents of the packages he was handling. >> he went home that night and thought about things. he thought long and hard and the next morning he called back and said there's more to the story i need to tell you. most nights of the week i get in my car and i go to a port. and from that port i pick up 40, 50, packages and then i take them to the blue post office collection boxes throughout the valley. and i mail those out every night. >> gigi agreed to cooperate with

authorities. instead of dropping his pickups in the mail, he delivered them to police. inside a single day's packages were nearly 35,000 counterfeit oxycontin pills. each lace td with a few grains of fentanyl. he began to give up the names of others in the large fentanyl trafficking ring. at the head of which was a 26 -year-old former eagle scout named aaron sha mow. he grew up in fedex, arizona, but moved with his family to salt lake city in 1996. in high school, he began smoking pot and skipping school. he dreamed of the using the internet to become wealthy like his idols, steve jobs and bill gates. he went to work at e bay after college. the tedious life of entry life employee was not for him.

sha mow and crandall con cocted a plan to sell prescription drugs on the dark web, a part of the internet accessible only with a special browser. there he set up a store modeled on amazon where he bought and sold drugs using untraceable digital currency. he called his company pharma-master. >> they quickly overwhelmed them and they needed help. they approached associates and friends from work or previous life. and they recruited them. not out of the goodness of their heart, but with cash to help them run this operation. it was almost like an internet startup. >> he acquired a pill press. with which he made fake oxycontin pills in his basement. to give them the same narcotic effect as real oxy, he laced them with inexpensive fentanyl he had shipped from china. >> in most of our organized crime cases, we're dealing with models that we know.

and that have been around for a long time, mexico-based drug trafficking organizations linked to cartels, for example. we more or less understand their way of doing business. but this was a new learning curve. this was the first experience with someone who was so prolific at selling drugs on the dark net. >> it's almost surreal to read customer reviews from his operation. the glowing reviews from customers of how good the product is. how wonderful the customers service is. that they always send center -- extra to what you ordered. it's a reasonable price and it has quite a powerful hit. and this mushroomed on the dark net. by word of mouth or otherwise, tens of thousands of customers came to buy his product. >> obviously they got good at it, in one year pharma master was the largest retailer of counterfeit oxycontin pills in the nation. >> in november 2018, sean agreed

>> the conversations revealed crucial details of the operations, including the involvement of two female associates, alexandria tong and katy bustin. >> he is pressing and manufacturing the pills at his home. and then the pills that he

pressed he would take them to the ladies' home. and they would organize the pills according to the dark net orders and package them and get them ready for shipping. and place those on the doorstep. for him to come and pick up each night and deliver to different mail facilities throughout the valley. >> his packages found their way to customers in all 50 states. including one to a 29 year-old man in utah. named devin. >> when devin was a teenager, he began to have these things that are called cluster headaches. it's kind of like a migraine on steroids. it's like sticking a hot knife in your eyeball and rolling it around in your brain. >> it was every day. he could almost time it. he knew it would be between 3:00, 4:00 in the morning. he would have his oxycontin to help him survive. it would carry him usually through the next day.

until the next one hit again. when you are in pain all the time, depression is a problem. because you don't see any hope or any point. we tried everything we could find just to try to find him an alternative. but the opioids, it's the only thing that deadened the pain. >> by the time he was in his mid-20s, devin was taking two oxycontins a day. >> he said the doctors just felt so bad that he couldn't do anything more than he was doing. when devin explained he was having two day and can i get more -- i can't. i legally can't give you more. >> didn't have knew >> he knew he was becoming addicted and struggled against it. >> he actually would go on week long detox. which was a nightmare. to get it out of the system. but he didn't want to be addicted to it, but ultimately he goes right back on them because it's the only thing he

could find that would help. he was stuck. he was very much trapped. >> didn't have took to hoarding pills. his fear is he would get caught without his oxys. >> there was a period he did ask myself and some family members if they had any left over pain meds that they wouldn't need. so held have a backup to get him through those days. >> we had to tell him, you can't go asking people for prescription meds. i'll never forget he said, what am i supposed to do? >> devin found a way to make sure he always had enough oxy. he ordered a small number of backups through internet from a company called pharma-master. >> the day that didn't have passed away, he was supposed to meet me to get his suit fitted for his brother's wedding that was coming up. and he had a headache and didn't feel good, so he was just going to come home and rest. that night, i told him good night and went to bed. and it was a couple hours later.

i was sound asleep and kate came in and knocked on the door and woke us up. and told us that didn't have wasn't breathing. so we went downstairs and he was on the floor. and i called 911 and started doing cpr and the rest is just kind of a blur. when it comes to laundry,

everyone thinks their way is the right way. i wash on delicate. i just stuff everything in. you have to wash on cold, because it saves energy. the secret is, tide pods work no matter how you wash. so, everyone is right. it's got to be tide. these days you need more than an education. so that's what we give you. introducing career services for life. learn more at phoenix.edu tonight, try pure zzzs all night.

unlike other sleep aids, our extended release melatonin helps you sleep longer. and longer. zzzquil pure zzzs all night. fall asleep. stay asleep. see every yikes...... and even every awwwwwwww... wait, where was i? introducing self protection from xfinity. designed to put you in control. with real-time notifications and a week of uninterrupted recording. all powered by reliable, secure wifi from xfinity.

gotta respect his determination. it's easy and affordable to get started. get self protection for $10 a month. >> by early 2016, the drug enforcement administration and local authorities were ready to move on aaron's operation which was producing millions of fake pills laced with deadly fentanyl. >> the date is november 22, 2016. the time is 9:23 a.m. this is initial walk through.

>> at the house of the women, they found a room dedicated to packing pills into boxes and shipping them out. they found postage, priority mail envelopes, mylar bags, lists and lists of customers, and what they had ordered. in one tote alone they found 74,000 of the fentanyl pills. pills everywhere. these women were having to work so quickly to keep up with the orders that, when pills would spill on the ground, they would vacuum them up. there were several thousand dollars of pills just inside the vacuum. >> i was surprised it was taking place less than a mile from my own home. we live in a quiet middle class neighborhood where nothing particularly exciting goes on. it's clean. it's like americana. >> police next turn to aaron shamo. specially trained agents in

hazmat suits descended on his nearby home. ♪ >> it's a crazy scene. and then to see what the agents pull out of this nondescript home that could be in any neighborhood in the united states. >> bags of cash. have i ever seen $1 million cash in person? no. >> $1 million in cash was hoisted out of shamo's home in garbage bags. $1.2 million.

>> you go in the door, there was a pill press they were using to create the xanax tablets. mr. shamo was running that pill press. the second pill press was dedicated to the fake oxycodone tablets. >> you can see where powder has been wiped off the wall. powder everywhere. it was quite a scary scene for everybody knowing the dangers of fentanyl. >> dea agents have taken down what could be the biggest pill bust in utah's history. >> among the bags of cash, agents found countless pills laced with fentanyl. >> several hundred thousand pills and a pill press capable of making up to 7,000 pills an hour. >> perhaps the most alarming

thing about shamo's operation was just how quickly and easily he had put it together. >> at 26 years of age almost overnight here's able to spawn this incredible empire and it's not like he had an elaborate network. it's small and it's off the internet and it's this young kid. that's a very different profile than what we had seen emerging. and what we see in other types of drug cases. >> most of these individuals had good parents, good families, good upbringings. and what happened was greed. there were over 8,300 orders placed on pharma-master. we were able to look at those customers on the list and figure out where all the drugs were going to. >> these orders touched every part of the united states.

every major metropolitan area, every small city. >> we received a call from the derksa's -- dea office. and the office said we understand your son passed away. we'd like to see if we can get his computer. because when we got aaron shamo and his computer, your son's name came up on the list of people who purchased from him. sure enough, there was the order that he had made i think it was for two pills, if i remember right, they were supposed to be two oxycontin pills. what they were is fentanyl laced. pills. >> the trial of the former eagle scout. >> aaron shamo went on trial in salt lake for 13 counts, including criminal conspiracy and murder. >> there were cardboard boxes and plastic bins full of evidence in the courtroom. as u.s. government prosecutors

lay out their case against 29-year-old aaron shamo. >> the trial lasted 18 days. among the witnesses to take the stand for the prosecution, were members of shamo's organization, sean gigi, katy, and alexandria tong. >> the jury found him guilty on two counts including one that carries a mandatory life sentence. prosecutors say his actions directly resulted in death. the jury couldn't reach a verdict on a specific count involving death. >> shamo was convicted of continuing a criminal enterprise and sentenced to life without the possibility of parole. >> i have heard criticism about the sentence and how fair is that for a young man in his 20s. how fair is that? we know there's more than one death. there's tens of deaths and customers who are on his list. how much more serious does it get than that?

>> i hope that while he's in prison he recognizes and realizes and has a long time to think about all the hurt and pain and carnage that he has unleashed upon people's lives. >> devin! >> that's pretty gut wrenching when you go to the cemetery and there's a headstone. with your kids name on it. my na. i'm 70 and i live inmill . my biggest passion is gardening. i love to be outdoors. i have jaybirds that come when i call. i know how important it is to feed your body good nutrition. i heard about prevagen and i heard about the research behind it. taking prevagen, i have noticed that i can think clearly. my memory is better. i can say that prevagen is one of the most outstanding supplements i've ever taken.

prevagen. healthier brain. better life. i felt gross. it was kind of a shock after i started cosentyx. four years clear. real people with psoriasis look and feel better with cosentyx. don't use if you're allergic to cosentyx. before starting, get checked for tuberculosis. an increased risk of infections and lowered ability to fight them may occur. tell your doctor about an infection or symptoms, if your inflammatory bowel disease symptoms develop or worsen, or if you've had a vaccine or plan to. serious allergic reactions may occur.

learn more at cosentyx.com. (announcer) do you washed pounds? stress? do you want to flatten your stomach? do all that in just 10 minutes a day with aerotrainer, the total body fitness solution that uses its revolutionary ergonomic design to help you maintain comfortable, correct form. that means better results in less time. and there are over 20 exercises to choose from. get gym results at home. no expensive machines, no expensive memberships. go to aerotrainer.com to get yours now. ♪ ♪ ♪ ♪ for every trip you've been dreaming of, expedia has millions of flexible booking options. because the best trip is wherever we go together.

♪ good evening. i'm dara brown. one day into the new year and more than 2,100 more americans have tied of covid-19. more than 148,000 have tested positive. republican senator mitt romney says the trump administration's vaccine distribution plan is incomprehensible and inexcusable. and the u.s. is facing a growing threat from the new strain. five cases have been identified in this country in colorado, california, and florida. now back to "forgotten epidemic." >> by the mid-2010s, fentanyl became the first dangerous drug to hit america's streets. authorities in places like buffalo, new york, found

themselves totally unprepared for on opioid that was both so powerful and so difficult to interdict. >> it was in 2015 when i got a call from people at the central police services lab when they were telling me about the substance that they've been detecting in the heroin. that's when the overdose deaths started to really spike. >> drug dealers and users lacing heroin with a narcotic painkiller fentanyl. >> we've already had more than six times the number of overdose deaths from opiates and opioids than we had for homicides in all of last year. >> it was unbelievably dangerous. we were seeing in some cases two or three overdose deaths a day. it was that overwhelming. it suddenly was the wake-up call that this is not going away and it's getting worse. >> our country was involved in the vietnam war for about 12

years in that entire conflict we lost 58,000 u.s. service personnel. in one year of overdose deaths, we lost 72,000 people. it's a national emergency. >> i love this one. it's my favorite. >> sheryl moore of the erie county health department is in charge of the city's response to the opioid epidemic. like many others in buffalo, she has been directly impacted, losing a sister to an overdose in 2011. >> i like this one. all the halloween costumes. >> what i learned from dealing with this in my family is there's a lot of anger and frustration, there's a lot of misunderstanding. >> this one she was definitely a mess. you can even see it in her eyes in the picture. >> she's trying to hide behind them. >> people are doing anything that they can to feel okay. whether it's selling their children's toys, whether it is stealing your mortgage money. these are not bad people. they don't need to be locked up

somewhere. i think a lot of the things we did in the past, we just didn't know. this is not a moral failing. in my family's journey, we learned this. it's a chronic disease. >> when it came time to formulate buffalo's strategy to fight the opioid epidemic, moore sought greater compassion and less punishment. >> okay, folks, if everyone wants to get a seat, get settled, i'm sheryl moore from the erie county health department. i have the privilege of running this task force. >> together with her boss, erie county health commissioner gail bureau stein, moore began meeting in november 2016. >> first i'm going to talk about our overdose trends. >> since then, nearly every government agency touched by the epidemic has signed on. >> we have all the stakeholders. if you have anything, any vested interest that's affected by an opioid, you're in the room. and i think that each agency in that room learning what the

challenges are of the other agencies was paramount. >> we're going to do a presentation today about gathering overdose data. >> perhaps the most difficult challenge was to convince law enforcement that they could arrest their way out of the epidemic. >> they had to trust the health folks to understand that if people were in good treatment, law enforcement wasn't going to have to live with them anymore. >> we just got called for an overdose. we'll see what's happening there. [ siren ] hopefully we can wake him up before ems gets there. >> so far john simoneian has seen his skrob from arresting officer to something like wartime medic trying to keep casualties arrive. >> the officers on scene are trained to recognize overdose

and utilize mnarcan. >> narcan is the brand name for a drug called no lock zone which quickly reverses the effects of an opioid overdose. >> the human brain will last four minutes without oxygen, so we need to get this narcan into them asap, get some oxygen into them. we can deal with everything else later. every single police department carries narcan. every fire department carries narcan. family members carry narcan. we aggressively train the community. if you're not alive, you don't get treatment. >> come on, let's go. >> am i detained? >> you're going to the hospital. >> what exactly did you take? just the pills? >> yeah, just the pills. >> don't close your eyes. >> look at my nose.

>> the cultural shift is you wake up there's drugs or heroin there, you're going to jail. we don't do that anymore. >> getting the overdose victim to the hospital is the first step. to prevent future overdoses, there must be a massive follow-up effort, and it has to happen right away. >> we knew that there was a short window after overdose where somebody would be necessarily receptive to stopping the cycle. and that if it took too long, or you had to wait too many days or possibly weeks. in some cases a month for a bed to open up, the cycle starts up again. >> responding officers are now required to make a report of the incident. key details about where and when the overdose occurred.

these reports become points on an electronic map showing in real time how the epidemic is unfolding. >> each dot alludes to a specific incident. diamonds are deaths. dots are resolutions of overdoses. a red diamond what it shows me it was a fatal. so that person probably was dead. when i look at a kind of a orange colored diamond, it was a fatal single dose. green, fatal multiple doses. >> it's not uncommon i'll get a phone call from sheryl moore because she'll look at the map first thing in the morning and say we had a number of overdoses in this neighborhood. what do we have to do? it allows a quick immediate response to the problem. >> if a victim survives, moore is able to quickly assign former addicts trained as counsellors to reach out to them. >> they reach out to these individuals, not at the time of overdose, 24 to 72 hours later and they offer them help, if

they need a ride, they will offer transportation. the biggest key they do is get them linked to medication assisted treatment. >> medication-assisted treatment is the use of less addictive drugs to wean the body from its dependence on opioids. >> the way the disease works the more you take the more you need. when your body needs opioids, you have to replace it with opioid. get people on the right medications so that they're not craving. get them on the right medications so they're not hurting. >> we wouldn't take a high-risk chest pain patient and discharge them with no plan. but for some reason we did this with patients that were using opioids for years. patients that have opioid use disorder need to be on medication for a while. it's not a substitution for drugs. we look at it as a treatment, and it's a treatment that works. >> will people addicted to opioids in buffalo get treatment

in time to save their lives? (sneeze) skip to cold relief fast. alka-seltzer plus power max gels. with 25% more concentrated power. oh, what a relief it is! so fast!

if your child doesn't seem themself at times, they may not be hydrated enough. ♪ ♪ plant-powered creative roots gives kids the hydration they need, with the fruit flavors they love. and one gram of sugar. find creative roots in the kids' juice while. ♪ birds flyin' high, you know how i feel. ♪ ♪ breeze drifting on by you know how i feel. ♪ ♪ it's a new dawn... if you've been taking copd sitting down, it's time to make a stand. start a new day with trelegy. no once-daily copd medicine has the power to treat copd in as many ways as trelegy. with three medicines in one inhaler,

trelegy helps people breathe easier and improves lung function. it also helps prevent future flare-ups. trelegy won't replace a rescue inhaler for sudden breathing problems. tell your doctor if you have a heart condition or high blood pressure before taking it. do not take trelegy more than prescribed. trelegy may increase your risk of thrush, pneumonia, and osteoporosis. call your doctor if worsened breathing, chest pain, mouth or tongue swelling, problems urinating, vision changes, or eye pain occur. take a stand and start a new day with trelegy. ask your doctor about once-daily trelegy. and save at trelegy.com. dad! noour son says, house. ask your doctor about once-daily trelegy. since tide antibacterial fabric spray kills 99.9% of bacteria. just to be sure. he wants us to spray everything every time we walk into the door. it's just to be sure. just to be sure! i thought you just sprayed those. ma, it's just to be sure. see, he takes after my side of the family. for every just to be sure, it's got to be tide antibacterial fabric spray.

buffalo's fight against the opioid epidemic comes down to people like april. whose last name we are withholding at her request. she's a yoga instructor who became addicted to opioids as a teenager in the early 2000s. she has struggled ever since. >> i used just sporadically. in high school. maybe cocaine on the weekends, go to the club, drink. but opiates started after my second daughter. i remember taking my first pain pill for back pain. and i remember liking the way i felt. i just remember when i didn't have it i thought i had the flu at first. >> april took her first bag of heroin at the age of 26.

>> the use kept me normal. i needed it to wake up in the morning in order to function. i had a job, i have a house, a car. i was there for my children. i wasn't stealing or prostituting. i worked for the drugs and became part of my life. >> three years ago it was a first time i overdosed. i remember going to the bathroom, i had a fight with my boyfriend at the time and i shot up. i remember putting it away, hiding it, and the next thing i remember i'm sitting on the kitchen. there's paramedics, police around me. they gave me narcan twice. i felt so bad my children were home. all they knew was mom fell in the bathroom. i could still see the their faces. you know, they were scared. it's just not a good feeling.

not a good feeling at all. >> hello? >> my, mom. >> hi, baby. >> april lost custody of her children and soon after nearly everything else. >> my ex-husband found out what happened. and he used that to take me to court to get custody of my children. >> i lost my apartment. my car. >> you look good. >> your hair is still purple. >> yeah. >> knowing i lost my girls i didn't have that motivation to do right. i fell down worse after that. >> how was school? >> you called us in class. >> did it ring? >> yeah. >> it hurt so bad to not have my children that i couldn't even allow myself to think about it. so i used the drugs to numb myself even more and not care.

>> many drug dependents like april resort to felonies to fund their habits. if they are arrested they are sent to a special opioid court. in which judges function more like drug counselors or social workers than officers of the law. >> it really wasn't that much. i guess your testing is very -- very good. >> maybe it was more than you thought, all right? >> yeah. >> the court was the brain child of city judge craig hannah. his main idea was to suspend criminal charges in return for adherence to a strict recovery regimen. >> we put their criminal case on pause. everything is held in abeyance while we focus on the medical needs. the second a person touches the

criminal justice system, get them help immediately. people said you can't do that. and we said, why not? >> anybody new this morning? >> no. >> anybody picked up? >> this morning? no. >> judges and officers are the most conservative profession you can be in, and they all want the appearance of being tough on crime. but we have to be smart on crime. if you just throw them in jail and put a band-aid on it, the second they leave jail, they still have an addiction or a problem that wasn't addressed. >> what can we do to help you get this out of your system? >> i went to a meeting yesterday. >> our job is to let them know there's no perfect path to recovery. they have to find their path. >> have you talked to your counselor? >> so they are going to use again. and again, i know it sounds odd, but relapse is a part of recovery. >> the judge should know. before becoming a judge several decades ago, he was addicted to cocaine.

>> i tell the clients the only difference between myself and them is clean time. i have 21 years' clean time. they have 21 hours. >> i'm willing to give you another shot. we want to get you the help you need. >> i appreciate it. >> the judge shannon is now the presiding judge in the opioid court. >> if i put them in jail for 30 days instead of treatment they come back out -- it's a cycle. they'll keep stealing and feed their habit. you have to go to the source and fix the habit. >> you have them come to court every day. which sounds kind of exhausting, but we want to make sure they stay busy and focused on their recovery. >> always tell them when you're trying to get high and cop some dope, you got up every day to do it. this is the new thing you do every day. >> i'm doing the best that i can. a national or hometown charity. and subaru and our retailers would proudly make a donation.

but now, in times like these, companies are having a hard choice to make. but subaru is more than a car company. and as charities struggle, we cannot just stand by. which is why we plan to donate over twenty four million dollars, again this year. the subaru share the love event, going on now. balanced nutrition for strength and energy. whoo-hoo! great tasting ensure with 9 grams of protein, 27 vitamins and minerals,

and nutrients to support immune health. and nutri♪nts to ♪ ♪

the experience of peopling like april shows both the benefits and challenges of a nonpunitive approach to breaking addiction. keeping opioid users away from drugs without putting them behind bars requires enormous resources and patience. >> i've been going to court a couple years, but the last time i was in court was end of july. and i was supposed to go to rehab and i didn't go. i spent a week in jail. i was going through withdrawal from heroin in jail. i was really only sick for maybe the first three days. i tried to sleep all day and you go through the hot and cold sweats and stomach cramps. but after that then, you know, i just kind of slept it up. i've been going back to court

now since last wednesday five days a week. hopefully this time i'll make it through. >> morning, april. how are you? >> i'm okay. i had a rough day yesterday. i was home yesterday with the neighbor and she's like throwing snowballs at my window and i let her in and of course she was using and i kind of -- >> stop blaming others for -- >> i'm not blaming and i even told her you can't come over here anymore because i felt bad like immediately. i felt bad as soon as i let her in. >> there's so many bad batches going around these days. it's not worth it. >> you're absolutely right. i see the doctor tomorrow. >> well, baby steps. >> one of the biggest challenges is to keep users from selling their maintenance drugs on the streets to other addicts. >> there's definitely a high demand for the suboxone.

it is a lot of money. $20 for one 8 gram adds up. >> why do people want it? >> it still has a blocker in it but it still gives you the opiate. a lot of people choose to be on suboxone so they can sell the medication. being in opioid court doesn't keep me from using. i keep myself from using. honey, mom's here. it definitely reminds me that i have this problem that i have to work on, but ultimately i think it is up to me to decide if i'm going to stay clean and sober. >> everyone said why are we treating this different? people can walk out of our courtroom shake our hands, say i'm good judge, i'll see you tomorrow, go get a shot and they're gone. that's why this has to be handled differently because their lives are at stake. >> this area is heavily

populated with drug use. the biggest problem that we're seeing when people overdose is that terrible drug fentanyl. people die with the needle still in their arms. it's the craziest thing to see. >> until the covid pandemic hit in the winter of 2020 buffalo was making steady progress in its fight against opioids seeing a decline in deaths every year since 2017. when we first spoke to leaders of the task force the thing that kept them up at night was not a virus but the probability of even more powerful opioids yet to appear. >> what worries me as a police officer in terms of not losing ground in this war that we have with opioids is the next new drug, the next new compound that comes out that we're not aware of hits the market is just goes like wildfire causing deaths that we're just not prepared

for. >> the unexpected outbreak of the covid-19 pandemic has reversed the gains made in the fight against opioids. >> we distributed 21 narcan kits so far today, and people came here for that specifically. >> taxing an already overstretched system to its limits. >> i don't think people were aware of the effects were going to be on people struggling with opioid use. looking at the numbers in buffalo, they've reflected the whole country. i've been on multiple national calls and everyone is saying the same thing. they're seeing increases in numbers of overdoses and increases in deaths. >> according to the american medical association more than 40 states have reported increases in opioid related deaths since the pandemic began. while the epidemic rages on -- >> perdue pharma has now reached a settlement over its marketing of oxy conten. >> one of the companies that started it all, purdue pharma,

pleaded guilty to three federal criminal charges including paying kick backs to doctors to prescribe oxycontin. >> the family and purdue executives themselves aren't going to face any criminal charges. >> critics say with purdue in bankruptcy it's unlikely the company will ever really pay $8 billion. >> other companies have also settled large civil lawsuits. in november 2020 opioid manufacturer johnson & johnson and three distributors, mckesson, cardinal health and amerisource bergen reached a $26 million settlement with states and municipalities across the country. purdue says it has proposed a $10 billion settlement to address the crisis including 100% of the company's assets to claimants and communities. the majority of the funds would provide for addiction treatment.

many states say they are not yet satisfied that justice has been done. >> it seems like it has only energized state attorneys general even more in their fight for justice. >> state a.g.'s, we're going to continue to press our state claims in court. and we owe that to our families. >> the people who in their grief and loss brought the opioid crisis to light are still fighting to see that it does not again recede into the shadows. >> i'm getting a vibe that i'm going to try everything to make sure they don't get immunity and make sure the documents don't get sealed. they might get away with it, but we're going to try everything we can. we want to see the truth. it works naturally with the water in your body

to unblock your gut. free your gut, and your mood will follow. and ask your doctor about biktarvy. biktarvy is a complete, one-pill, once-a-day treatment used for h-i-v in certain adults. it's not a cure, but with one small pill, biktarvy fights h-i-v to help you get to and stay undetectable. that's when the amount of virus is so low it cannot be measured by a lab test. research shows people who take h-i-v treatment every day and get to and stay undetectable can no longer transmit h-i-v through sex. serious side effects can occur, including kidney problems and kidney failure. rare, life-threatening side effects include a buildup of lactic acid and liver problems. do not take biktarvy

if you take dofetilide or rifampin. tell your doctor about all the medicines and supplements you take, if you are pregnant or breastfeeding, or if you have kidney or liver problems, including hepatitis. if you have hepatitis b, do not stop taking biktarvy without talking to your doctor. common side effects were diarrhea, nausea, and headache. if you're living with hiv, keep loving who you are. and ask your doctor if biktarvy is right for you.

this is an msnbc special series. >> together we will begin the next great chapter in the american story! >> the time for games has passed. now is the season for action. >> yes, we can! yes, we can! yes, we can! >> you have done what the cynics said we couldn't do.