As the pharmaceutical company blamed for launching America's opioid crisis faces mounting lawsuits, its foreign arm is expanding globally, using some of the same dubious practices.
Other companies are getting in on the lucrative market, too, and prescription rates are spiking around the world. Public health experts warn that the U.S. epidemic could become a pandemic.
In a series of stories, The Associated Press examines the on-the-ground impact of Big Pharma's global ambitions: In Italy, a kickback case has embroiled more than 60 people and 10 companies, including Mundipharma, the international arm of U.S.-based Purdue Pharma.
Italy's most prominent pain doctor is accused of taking bribes to write studies with the message that opioids should be used for chronic pain and addiction risks are "exaggerated." Mundipharma executives pleaded guilty to criminal charges.
Australia is the new ground zero for opioid abuse. In some rural areas, prescription rates have skyrocketed; one town has a rate of 109,000 prescriptions for every 100,000 people. Mundipharma wants China sales to surpass the U.S.' by 2025.
Online black markets offer opioids, and chat rooms dedicated to addiction have formed. Yet, the Chinese government denies a problem. At the same time, China is piggybacking on Big Pharma, supplying a global black market for pills.
Governments have failed to learn the lessons of the American epidemic. As the U.S. tries to rein in the prescription opioid bonanza that launched its crisis, legislatures around the world are moving in the opposite direction: loosening the rules around opioid prescriptions.