Newly released documents from consulting behemoth McKinsey & Company have cast an even harsher light on the company’s relationships with opioid manufacturers, suggesting its role fueling the opioid epidemic was even more extensive than previously understood.

The Opioid Industry Documents Archive, maintained by Johns Hopkins University and the University of California, San Francisco, released some 114,000 documents this week showcasing McKinsey’s work with Purdue Pharma, Endo Pharmaceuticals, Johnson & Johnson and Mallinckrodt over the course of 15 years.

It was previously known that McKinsey had counseled companies other than Purdue, but the new documents show the breadth of those relationships as far greater than initially understood, according to Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health.

“There was some understanding, but this shows just how involved they were,” Sharfstein said. “It raises a profound question of responsibility.”

The documents – a collection of proposals, presentations, invoices, spreadsheets and emails – show how McKinsey pushed aggressive marketing tactics for Endo’s opioid Opana. The company also counseled Johnson & Johnson on its subsidiary Tasmanian Alkaloids, which supplied opioid raw materials even as the epidemic peaked, according to a New York Times report.

“The most impressive part of the new documents is how long McKinsey’s advocacy for aggressive opioid marketing continued,” Sharfstein noted. “A lot of the revelations based on the new documents had to do with the mid-2010s, when it was very clear that we were in the middle of a major problem with opioids. Even then, McKinsey was telling Purdue Pharma and Endo that they should be more aggressively marketing products.”

In February 2021, McKinsey reached a $573 million settlement with 47 states over its role in the opioid crisis. In May 2022, the Food and Drug Administration cut ties with McKinsey over the firm’s failure to disclose potential conflicts of interest over its work with opioid makers.

In response to the newly released documents, McKinsey issued a statement Wednesday, noting that its work with the other companies was “much more limited” than its work with Purdue. The McKinsey spokesperson also said the company “did not counsel or recommend to Endo that it promote Opana more aggressively.”

As part of its efforts to promote full transparency, the Opioid Industry Documents Archive gathers documents made available via legal action against opioid makers. It’s modeled on UCSF’s Truth Tobacco Industry Documents archive, a collection of 14 million documents detailing tobacco companies’ advertising, political and manufacturing practices.

“Oftentimes, these consultants feel unaccountable, because their job is to help the company make money by any means necessary,” Sharfstein explained. “Here, the consultants are being held accountable by the harsh glare of transparency.”

“I do think that transparency and the release of the documents can have wide-ranging consequences over time,” Sharfstein continued. “It’s going to allow people to study the playbook of the industry and of McKinsey, and to see the signs of a problem faster in the future.”