Earlier this week a drugmaker made a plea deal with two counties in Ohio who had sued demanding compensation for the costs of dealing with the opioid epidemic.

McKesson Corp., Cardinal Health Inc., AmerisourceBergen Corp. and Israel-based drugmaker Teva Pharmaceutical Industries Ltd. will pay a total of $215 million under terms of the deal, said Hunter Shkolnik, who represents Cuyahoga County. Teva would contribute $20 million in cash and $25 million worth of Suboxone, used to treat opioid addiction…

The Ohio case had been set to be the first federal trial related to an opioid epidemic that has claimed an estimated 400,000 American lives over two decades. Cuyahoga and Summit counties sued Teva, the distributors and Walgreens, claiming their practices contributed to the epidemic.

The Ohio case seems to reinforce an idea I’ve also seen pop up on television shows, i.e. Americans get addicted to prescription pills and later die as a result of the addiction made possible by the greed of drugmakers. There definitely are some people dying from prescription pills, but a new study in Massachusetts found it’s much less common than you might imagine. From Reason:

Alexander Walley, an associate professor of medicine at Boston University, and five other researchers looked at nearly 3,000 opioid-related deaths with complete toxicology reports from 2013 through 2015. “In Massachusetts, prescribed opioids do not appear to be the major proximal cause of opioid-related overdose deaths,” Walley et al. write in the journal Public Health Reports. “Prescription opioids were detected in postmortem toxicology reports of fewer than half of the decedents; when opioids were prescribed at the time of death, they were commonly not detected in postmortem toxicology reports….The major proximal contributors to opioid-related overdose deaths in Massachusetts during the study period were illicitly made fentanyl and heroin.”

The study confirms that the link between opioid prescriptions and opioid-related deaths is far less straightforward than it is usually portrayed. “Commonly the medication that people are prescribed is not the one that’s present when they die,” Walley told Pain News Network. “And vice versa: The people who died with a prescription opioid like oxycodone in their toxicology screen often don’t have a prescription for it.”

When I read this my first thought was that perhaps people are getting addicted to the prescription pills and then switching to the illegal drugs once they can’t get the prescription pills any longer. Reason’s Jacob Sullum wrote about that assumption back in August:

A 2018 BMJ analysis of medical records found evidence of “opioid misuse” in 1 percent of patients who took pain pills after surgery. While studies find that misuse is more common among chronic pain patients, a 2016 New England Journal of Medicine article concluded that “rates of carefully diagnosed addiction” average less than 8 percent.

That study, which was co-authored by Nora Volkow, director of the National Institute on Drug Abuse, noted that “addiction occurs in only a small percentage of persons who are exposed to opioids—even among those with preexisting vulnerabilities.”

The opioid crisis is real and is killing far too many Americans, but it isn’t being driven by people who get hurt, get addicted, and wind up overdosing. Perhaps that story is more satisfying in a sense because it creates a clear villain: The drug companies profiting from the drug abuse. This study seems like compelling evidence that the real crisis is more complicated than the one that is often presented to the public.