A rational human being might assume that the first priority of a pharmaceutical company would be to create drugs that help people be healthy. But in the case of several companies that manufacture opioids, it seems that the first priority may have been to make as much money as possible by selling drugs that were making patients sick and actually killing some of them—at least according to a lawsuit recently filed by Sullivan County, NY.

That lawsuit, filed against Purdue Pharma, Cephalon, Teva Pharmaceuticals USA, Johnson & Johnson, Janssen Pharmaceuticals, Endo Pharmaceuticals and others, alleges that the companies knew the harm they were causing as they set out to up-end the management of chronic pain in the United States. The plan of these companies worked like a charm: their profits sky-rocketed along with the number of people who suffered overdoses and death.

The lawsuit charges that in the late ‘90s, opioid manufacturers deliberately set out to convince the medical community that opioids were suitable to prescribe for long-term pain, when before that they had been considered suitable only for short-term care and for palliative purposes in end-of-life care.

The industry was able to do this by using unbranded messaging to spread their message, meaning they promoted the use of opioids in general, but did not name specific brands. They also worked with “key opinion leaders,” friendly industry groups, to spread the word about the benefits of opioids and spread information that was, according to the suit, “incorrect and misleading.”

The lawsuit says, “The unbranded marketing materials that Defendants assisted in creating and distributing either did not disclose the risks of addiction, abuse, misuse and overdose, or affirmatively denied or minimized those risks.”

Accord to the lawsuit, the pharmaceutical companies were able to manipulate opioid prescription guidelines by giving generous grants to organizations that wrote the guidelines, and studies regarding the safety of opioids were limited to short-term use studies.

The campaign was remarkably effective. Doctors began to prescribe opioids for management of chronic pain in record numbers, and the rate of addiction and death from overdoses rose correspondingly. The lawsuit notes, “In Sullivan County in 2014, there were 234 opioid-related emergency department admissions, the highest rate per 100,000 residents of all counties in New York (and a 134% increase since 2010). Law enforcement in Sullivan County have [sic] administered Naloxone, a medication used to block the effects of opioids, especially in overdose, a reported 25 times through December 31, 2015, one of the highest administration rates of all counties in the State of New York. Even with preventative efforts in force, in 2015 alone there were 11 deaths reported in Sullivan County from overdoses involving opioid pain relievers.”

Nationwide, according to the Centers for Disease control, “Overdose deaths involving prescription opioids have quadrupled since 1999, and so have sales of these prescription drugs. From 1999 to 2015, more than 183,000 people have died in the U.S. from overdoses related to prescription opioids.”

If it were only Sullivan County that was bringing a lawsuit, the matter might be written off as being as overreaching, but increasingly states and municipalities are challenging the drug companies, and in a few cases the drug companies are beginning to pay up rather than go to trial.

According to the lawsuit, “Cephalon and Purdue entered into settlements in the hundreds of millions of dollars to resolve criminal and federal charges involving nearly identical conduct” as that laid out in the complaint.

Separately, other counties in the United States are now receiving settlements. In late May, Teva Pharmaceuticals agreed to pay some $1.6 million to settle a case brought by Santa Clara and Orange counties in California. The agreement calls for Teva to refrain from deceptive marketing practices. One would think it would be illegal to engage in the kinds of practices the opioid manufacturers are accused of, but clearly there was not a regulatory agency with enough authority or resources to prevent the enormous loss of life that the opioid epidemic has wrought.

There is an ongoing argument in the United States about whether there is too much regulation, and whether we wouldn’t all be better off letting the market dictate everything. But when a market is totally unfettered, too often the bottom line becomes more important than everything else, even human health and life itself.

Not only do we have a health system in the United States that doesn’t provide care for everyone that needs it, we actually have a system in which some players are willing to make people sicker and cause them to die for the sake of selling more drugs.

The Sullivan County Legislature has made a positive move in the right direction. It is too late to bring back the people who have died from opioid overdoses, but perhaps any settlement money could be used to help treat the addicted.