Since a previous contribution to this journal in 2012,2 the epidemic of opioid abuse has become increasingly frightening and tragic. That contribution focused on the relevance of OxyContin to prescription opioid diversion and abuse, the marketing tactics employed by pharmaceutical companies to promote products, and the associated economic medicalization of substance abuse and addiction. This update details dramatic changes in the epidemic and explores attempts being made to combat the rising opioid overdose death toll. Important legal developments arising from the marketing and distribution of prescription opioids are overviewed. Specifically, the proliferation of legal actions against firms involved in the epidemic has resulted in the consolidation of claims in a multidistrict litigation (MDA). The difficulty of stemming the epidemic through legal avenues shifts attention to recent attempts by regulators to stem the epidemic. The paper concludes with some pessimistic observations about the difficulties of using “harm reduction” solutions to address substance abuse and addiction problems with deep societal roots.