In 2017, lower than two years later, the F.D.A. took the uncommon step of demanding that Endo pull Opana from the market, citing the grave public well being penalties of its abuse. The corporate complied.

Over the 5 years from the looks of the blood-disease cluster in Tennessee to the drug’s withdrawal from the market, the painkiller had introduced in additional than $844 million in income, in accordance with company filings.

In Indiana, legislation enforcement officers broke up a drug-trafficking ring in 2016. One man admitted acquiring Opana in Detroit and promoting it in bulk to a seller. He was sentenced to 6 years in jail.

“Well being care, the colleges, the welfare division, the entire thing is crumbling due to medicine, medicine that you simply helped make out there,” stated the choose within the case, scolding him.

“You’re not chargeable for all of that, in fact, however you probably did your half.”

In June 2017, Tom Latkovic rose to talk at a well being care convention in Chicago sponsored by his employer, McKinsey.

“I begin immediately by asking, ‘Why can we proceed to prescribe, dispense, pay for opioid prescriptions to those who we all know, or at the least we might know, have an extremely excessive propensity to abuse them?’”

Mr. Latkovic, a senior associate, was not a member of McKinsey’s pharmaceutical follow. As a substitute, his workforce centered on utilizing information evaluation instruments to deal with advanced well being care issues, and it had more and more homed in on the opioid epidemic.

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Within the hopes of broadening this work, Mr. Latkovic advised the viewers, “We’re launching a brand new heart centered on opioids and insights.”

The consumer checklist for the brand new enterprise got here to incorporate state governments, insurers and well being techniques. One among McKinsey’s extra bold efforts was in Philadelphia, a metropolis that had one of many highest death rates within the nation from opioid overdoses.

In 2019, consultants spent nearly two months working with the town authorities, in accordance with two individuals who have been native officers on the time. Each praised McKinsey’s work, which got here for gratis to the town however was later shelved after Covid-19.

But as Mr. Latkovic’s workforce tried to fight the opioid epidemic, the agency didn’t cease serving the corporate typically blamed for sparking it, Purdue. And on at the least two events, the paperwork present, drafts of publications ready by Mr. Latkovic’s workforce got to consultants for pharmaceutical shoppers to evaluate. The aim, a supervisor within the pharmaceutical follow wrote, was to evaluate “whether or not this might create any waves on social media or from journalists that might be dangerous to our Pharma shoppers.”

As adverse information protection and lawsuits towards Purdue mounted, a number of the consultants fretted internally that scrutiny may prolong to McKinsey.

In 2019, across the time of the Philadelphia undertaking, McKinsey determined to cease advising corporations on opioids — after the agency’s 15-year relationship with Purdue turned public as a part of a courtroom submitting by the Massachusetts lawyer normal’s workplace. Since Mr. Latkovic’s 2017 speech, McKinsey had collected $7.8 million in charges from Purdue, the paperwork present.

The disclosure that McKinsey had suggested Purdue led to debate inside the agency. “We could not have achieved something mistaken, however did we ask ourselves what the adverse penalties of the work we have been doing was, and the way it might be minimized?” one marketing consultant wrote.

Dr. Ghatak, a driving power behind McKinsey’s work for Purdue and Endo, discovered himself within the highlight. A lot as he had achieved for pharmaceutical executives, he crafted speaking factors, this time for himself.

“Opioid disaster is horrible,” he wrote. “Acknowledge that up entrance.” However by advising shoppers to develop merchandise that might be harder to abuse, “we have been immediately engaged on an answer to a public well being disaster, not a silver bullet however undoubtedly an answer.”

In 2020, paperwork launched as a part of a Purdue authorized case indicated that Dr. Ghatak and one other marketing consultant, Martin Elling, had mentioned destroying records. McKinsey quickly fired them.

The agency settled with the state attorneys normal in early 2021, and the paperwork it turned over are housed in an archive managed by the College of California, San Francisco, and Johns Hopkins College.

A few of McKinsey’s former shoppers confronted doubtlessly crushing damages in courtroom. Purdue filed for chapter safety in 2019, and Mallinckrodt did the identical the next yr. Johnson & Johnson had beforehand offered its narcotics enterprise to a personal funding agency and has settled a lot of lawsuits associated to its advertising of opioids, which the corporate stated in an announcement was “applicable and accountable.”

Endo has additionally floated the opportunity of chapter amid a wave of litigation over its advertising of opioids, particularly Opana. The corporate stated in a regulatory submitting that it had acquired a subpoena in 2020 from the U.S. lawyer’s workplace for the Western District of Virginia, which years earlier had gained responsible pleas from Purdue executives. This time, in accordance with Endo’s disclosure, the workplace wished data on McKinsey.

High illustration by Mark Weaver.