The uncoiling saga of the Murdaugh family, a well-connected legal dynasty in South Carolina, has thrown a spotlight on the state's rampant black market for prescription opioids and how officials have struggled to contain the booming drug crisis during the pandemic.
Among the questions that state investigators must untangle involving lawyer Alex Murdaugh, who was charged Thursday in connection with trying to stage his own death, are how much money he allegedly stole from his family's law firm, how it was spent and who profited from it.
Reports suggest "millions of dollars" were misappropriated, and his attorney, Richard "Dick" Harpootlian, said on NBC's "TODAY" show Wednesday that the "vast majority" of the funds were used to buy opioids and that there were "checks written to drug dealers."
The public fall of Murdaugh, a once-prominent personal injury attorney whose family patriarchs had previously wielded power as the top prosecutor in South Carolina's coastal Lowcountry, underscores how opioid abuse can ravage people of all backgrounds, said Christina Andrews, an associate professor in the department of health services policy and management at the University of South Carolina.
In addition, the perception from the outside that Murdaugh could hold a job — he also volunteered on cases for the 14th Circuit solicitor's office — should be a cautionary tale, she added.
"It's a common misconception that if you have a serious addiction that the signs will be unmissable," Andrews said. "It's not the case. People can absolutely abuse opioids for years and others miss it."
During his initial court appearance after surrendering to authorities Thursday, Murdaugh, 53, was granted a $20,000 bond as he faces charges of insurance fraud, conspiracy to commit insurance fraud and falsifying a police report — stemming from his part in attempting to set up his own death earlier this month so that his son, Buster, could collect a $10 million life insurance policy. Murdaugh did not enter a plea.
Harpootlian told a Hampton County judge that his client is a 20-year opioid addict, and his actions were the result of suffering from mental anguish in the wake of the June slayings of his wife, Margaret, and another son, Paul. Their deaths remain unsolved; Murdaugh's legal team has denied his involvement as the initial killings spawn other criminal investigations tied to the family.
Magistrate Judge Tonja Alexander ordered Murdaugh to surrender his passport but permitted him to return to a drug rehabilitation center out of state.
"He has fallen from grace," Harpootlian said, his client in tears.
"He's not a man of significant means anymore."
According to his attorneys, Murdaugh told South Carolina Law Enforcement Division agents that his "primary" opioid supplier was Curtis Edward Smith, a former client now accused of aiding him in the botched effort to stage his own death during a faked roadside attack over Labor Day weekend. Prosecutors say Murdaugh provided Smith with a gun and directed him to shoot him in the head, but Murdaugh was only superficially grazed.
Smith has been charged with conspiracy and insurance fraud and assisting a person in suicide, among other counts.
Murdaugh's attorneys have said their client suffers from an oxycodone addiction and was attempting to get off drugs when he started thinking about suicide. It's unclear how his drug dependence began, and a lawyer for Murdaugh did not respond to questions about whether he previously sought treatment for his addiction or whether his family and his colleagues knew the extent of it.
Opioid experts said painkiller addiction can get expensive, particularly after federal authorities and states like South Carolina have cracked down on prescriptions and sales through drug monitoring programs, which have inadvertently pushed addicted people into the black market.
For instance, 20 milligram oxycontin pills could cost around $25 each, Andrews said.
"You can rack up tens of thousands of dollars moving into the course of six figures over the year," she added.
And if a drug dealer knows their client is a person of means who wants to remain discreet, there's no telling what their addiction may cost. "This isn't an industry known for its highest level of ethics," said Andrews, who is studying the treatment of opioid use disorder for Medicaid recipients.
South Carolina has been awash in opioids to devastating effect.
State drug overdose deaths — the large majority driven by opioids, including fentanyl and heroin — rose by more than 50 percent in 2020, according to a preliminary Centers for Disease Control and Prevention report this summer. Nationwide, there were 93,000 drug overdoses — most of them opioid related — the highest figure recorded over 12 months and a nearly 30 percent rise from 2019.
South Carolina ranked fourth among states for the highest increase in fatal overdoses last year, behind Vermont, West Virginia and Kentucky.
Experts say lockdowns and restrictions during the pandemic likely left drug users and people grappling with substance abuse isolated and without their normal treatments.
While prescription painkillers once drove the nation's overdose epidemic, they were supplanted first by heroin and then by fentanyl, a dangerously powerful opioid, in recent years. Fentanyl was developed to treat intense pain from diseases like cancer but has increasingly been sold illicitly and mixed with other drugs.
"What's really driving the surge in overdoses is this increasingly poisoned drug supply," Shannon Monnat, an associate professor of sociology at Syracuse University who researches geographic patterns in overdoses, told The Associated Press. "Nearly all of this increase is fentanyl contamination in some way."
Officials in South Carolina have looked at ways to break up the underground opioid and illicit drug market. In July, Hampton County authorities' "Operation Pentagon" netted at least 19 people involved in the distribution of heroin, fentanyl and other drugs.
In recent years, various counties have sued drug companies and doctors for their part in fueling the opioid crisis.
South Carolina Gov. Henry McMaster, who has called opioids a "scourge," signed a bill in August that expands access to naloxone, the lifesaving overdose medication.
Andrews said the funding for treatment is essential to solving the problem, as is looking at ways to reduce the stigma of drug addiction.
"Addiction is a powerful illness," she said. "As we've seen, it can lead to cloudy decisionmaking and underestimating risks."