Pennsylvania sued the opioid maker Purdue Pharma on Tuesday, marking the latest effort by a state attorney general to hold accountable the company that popularized OxyContin and that many have blamed for fueling the opioid epidemic.

Attorney General Josh Shapiro announced the suit in Philadelphia, one of the cities most affected by the opioid crisis. An estimated 26,300 people died statewide from opioids between 1999 and 2017, the lawsuit says.

“Simply stated, Purdue took advantage of addiction to make money,” the suit alleges. The Stamford, Conn.-based company has sold more than 2.9 million prescriptions – or, more than 200 million doses – of opioids in Pennsylvania since May 8, 2007, according to the suit.

The lawsuit alleges a massive marketing effort by Purdue, with what the suit calls more than 500,000 misleading and deceptive messages about the addictive nature of opioids directed at Pennsylvania doctors. With the exception of California, the suit says, Purdue “made more sales visits in Pennsylvania than any other state.”

Companies that make and distribute opioids are facing more than 2,000 lawsuits brought by counties and, cities – including dozens in Pennsylvania – along with Native American tribes, labor unions, and other groups. About 1,600 of those suits have been consolidated in a federal court in Cleveland while others are proceeding in local courts.

Purdue and other pharma companies have been fighting that litigation, and have denied wrongdoing. Purdue said it “vigorously denies the allegations filed today in Pennsylvania and will continue to defend itself against these misleading attacks.”

This year, lawsuits by state attorneys general in Massachusetts and New York opened a more aggressive front against Purdue, by exposing internal emails and records at the highest levels of the company, and by naming as defendants members of its wealthy founding family, the Sacklers. As the prospect of a televised trial approached in Oklahoma, Purdue reached a $270 million settlement with that state’s attorney general in March.

Purdue has exerted pressure publicly, as well – in part by saying it may file for bankruptcy, which could delay or frustrate any payouts.

Shapiro said Pennsylvania’s suit in Commonwealth Court is unique in uncovering how the company used its sales force to target prescribers – visiting doctors, or “detailing” them, 131 times a day on average, and showering them with gifts, meals, trips, and “cold-hard cash.” As for the company’s Oklahoma settlement, Shapiro said such a deal wouldn’t suffice for Pennsylvania, because that agreement set aside only $15 million for cities and counties and no money for the state itself.

And Shapiro singled out Purdue, compared with eight other pharma companies that his office is investigating, for its unwillingness to engage in “serious” talks.

Purdue Pharma “has not been willing to negotiate in good faith, and come to the table with a meaningful settlement offer. And that is unacceptable,” said Shapiro. He is one of the leaders of a 41-state coalition that began investigating opioid makers and distributors in 2017. Talks with the other companies remain ongoing, Shapiro said.

While Shapiro’s Purdue suit does not name the company’s CEO or members of its sales force as defendants, the attorney general said he has not ruled out adding others to the suit. “We are not done here,” he said.

A Purdue spokesperson said the lawsuit “is part of a continuing effort to try these cases in the court of public opinion rather than the justice system. Such allegations demand clear evidence linking the conduct alleged to the harm described, but we believe the state fails to show such causation and offers little evidence to support its sweeping legal claims.”

Purdue had an “insatiable appetite” for sales in Pennsylvania, Shapiro said. The company blanketed the state with a pervasive and deceptive campaign, he said, even after the company pleaded guilty to a felony charge in 2007, and agreed to a $634.5 million settlement with the Justice Department.

“They got caught. They paid the fine. Then they kept on breaking the law,” Shapiro said.

Between 2007 and 2017, according to the suit, Purdue rewarded “high-prescribing” doctors, and spent more than $1.5 million on sales visits to nearly 15,000 Pennsylvania providers.

The visits allegedly helped guarantee that a doctor would write a prescription, before a patient actually walked in the door. “Purdue salespersons asked doctors to list specific patients they were scheduled to see, and pushed them to ‘commit’ to putting the patients on Purdue opioids,” the suit says.

Sales reps who “generated the most prescriptions won bonuses and prizes,” according to the lawsuit, while those who fell short "were placed on probation, put on performance improvement plans, and fired.”

The company paid special attention to a Delaware County doctor who was eventually arrested in 2014 and charged with illegally prescribing opioids, the suit says. For more than a decade before his arrest, the suit says, “Purdue assigned six sales representatives to visit his office more than 190 times.”

Two of the sales reps who allegedly visited the doctor on a regular basis “frequently won yearly bonuses in the tens of thousands of dollars” based on the volume of prescriptions by doctors. By 2012, the suit claims, Purdue knew the Delaware County doctor was writing suspicious prescriptions but did nothing and “chose profits over keeping his patients safe.”

Purdue’s marketing promoted the concept of “pseudo-addiction” – a condition that Purdue “completely fabricated,” Shapiro said, and used to justify more sales. The company allegedly “advised doctors to ignore actual signs of addiction,” and instead claimed that “pseudo-addiction” behaviors showed that a patient was still in pain, and needed more opioids.