We welcome the “tentative agreement” of Purdue Pharma to pay $12bn in settlement to thousands of municipal governments and nearly two dozen states in the United States, as a reckoning for the deaths of hundreds of thousands of people from overdoses and calamitous systemic costs. There were 70,200 drug overdose deaths in 2017 alone, in the US. According to the National Institute on Drug Abuse, opioids were responsible for 47,600 of these.

Big pharmaceutical corporations such as Purdue Pharma have put the aim of “generating astonishing profits from addictive prescription drugs,” above the life and well-being of people. PSI and its affiliates consider this horrendous. And we are convinced of the need to fight against this worrisome situation which is central to understanding the opioid epidemic.

Putting people over profit entails making such pharmaceutical corporations pay. No amount of money they pay can bring back the avoidable lives lost or destroyed because of their greed for expansive profit margins. But it can help stem the crisis. Purdue which produces OxyContin is one of the biggest players in the industry. It aggressively marketed prescription painkillers while misleading doctors and patients about their addiction and overdose risks. And even now its owners are trying to make a deal that could undermine the significant victory being won, by tying payment of the settlement to further production of opioids.

The billionaire Sackler family, which has been described as “the family that built an empire of pain”, owns Purdue. It has personal fortune estimated to be about $13bn, by Forbes. The family is taking steps to safeguard its fortune and would only pay $3bn over the next seven years. Meanwhile the terms of the settlement reached would allow Purdue, which is being put into trust to still make profits from the sales of drugs, including OxyContin, because such profits would be go into paying the settlement.

Andrew Kolodny who is an expert on addiction and drugs points out that “states will be put in the position of profiting off the future sales of Purdue products and that should be a non-starter. They should not be paid back for the opioid crisis from the sale of opioids.” And this, he added, is inappropriate.

Lawyers appear concerned that a long-drawn case without guarantees of legal victory might be a worse scenario. For example, on 26 August, an Oklahoma court found the pharmaceutical company Johnson & Johnson responsible for compromising the health and safety of thousands of people with “misleading marketing and promotion of opioids”. It was ordered to pay a $572m fine. And immediately, the company declared it would appeal.

The opioid crisis in the United States has roots in deep systemic issues, which include the power and influence of the pharmaceutical industry. Big pharmaceutical corporations have deep pockets for litigations and legislative lobbying. But with concerted efforts by trade unions, communities, and municipalities, their power can be defeated, and the opioid crisis they nurtured can be curtailed and stopped.

These systemic roots of the deadly epidemic, which has been described as a “uniquely American problem” include the structure of the US healthcare system. Most people who can obtain only private insurance are made to turn to prescription drugs as against more expensive therapies. As Professor Judith Feinberg notes, "Most insurance, especially for poor people, won't pay for anything but a pill.”

This is one of the main reasons why the fight for resources to combat the opioid crisis, must include the fight against cuts in Medicaid and the fight against repealing the Affordable Care Act, according to AFT, a PSI affiliate.

But it is important to note that the opioid epidemic is no more just an American problem, uniquely or otherwise. While about 80% of the global pharmaceutical opioid supply was being consumed in the United States, three years ago, big pharmaceuticals have started aggressive targeting of other countries, as they feel growing heat in the USA, such as the mobilisation which resulted in the recent landmark settlement.

Northern Ireland. Denmark, Estonia, Finland and Germany, in Europe, as well as Canada and Australia are just a few of the countries were increasing prescription opioid abuse have been reported in recent years. And in poorer countries like Nigeria and India, the use of similar drugs to opioids, such as tramadol have also become very widespread.

Big pharmaceuticals corporations have been found culpable of influencing international health policy process, thus establishing the global context for the evil seeds of the epidemic to grow like accursed weed across the world. For example, according to a report by members of the United States Congress Purdue Pharma corruptly influenced the World Health Organization in order to boost painkiller sales across the globe.

There is thus the urgent need for massive global mobilisation against the opioid crisis, at the heart of this must be the demand for people over profit, and the full realisation of the right to health. A critical lesson from the settlement Purdue has had foisted on it, despite its adroit negotiations is that when we are united and tenacious, we will win. We are many, they are few.