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By Philip Whiteside, international news reporter

Few news stories about health have captivated the attention of the US public as much over the last few years as the opioid scandal.

More than 400,000 people are said to have died as a result of it in the US alone.

It has been called a "uniquely American problem", but availability of drugs that mimic the effects of opium-derived compounds have spilled over into other countries including the UK.

So, what is the opioid scandal and how did it come about?

What is an opioid?

An opioid is a drug that acts on parts of the brain and body, called opioid receptors, that help moderate sensations like pain, mood, appetite and various bodily functions.

Opioids exist in nature - for example in the form of opium - and have been used for thousands of years by humans, who have gradually refined them into other forms like codeine, heroin or morphine.

In recent years, scientists have improved their potency by synthesizing drugs that act ever more effectively, so that many powerful compounds are now on the market to treat chronic or acute pain, some bowel conditions and severe coughs.

What are the effects?

They have become increasingly popular in the US because doctors have issued them to treat what has been described as an epidemic of pain.

According to the American Psychological Association, at least 100 million adults in the US suffer from chronic pain - from conditions like a bad back, arthritis, rheumatism, fibromyalgia and other diseases. Some who suffer pain do so as a result of conditions they have some control over, like obesity or poor posture.

Rather than treat underlying causes, or promote other treatments, like exercise, some commentators have accused the US medical community of offering opioids as a convenient solution to the pain felt by millions.

Others have found themselves prescribed the drug as a treatment after surgery, ensuring they can avoid an expensive stay in hospital to recover.

Why are they controlled?

Unlike over-the-counter painkillers, like paracetamol or ibuprofen, opioids should only be prescribed by a doctor.

It is because they can produce feelings of euphoria and are chemically addictive at the same time.

As millions of Americans were prescribed branded opioids like OxyContin to control their pain, many of them became dependant.

As they are used, they also become less effective, which results in users requiring higher doses.

Like all addiction cycles, the problem mushroomed, so that opioid consumption went from 46,946kg in 2000 to a peak of 165,525kg in 2012, according to National Centre for Biotechnology Information authors Mark R Jones et al.

With communities across the US flooded with opioids, just a few years later, the number fatally overdosing started to surge.

In October 2017, the US government declared the opioid epidemic a public health emergency.

Harry Shapiro, director of British drug awareness charity Drugwise, told Sky News: "Rather than release its painkilling properties all at once, [an opioid like OxyContin] releases it over a period of time - that was the claim they were making that made these pills less addictive.

"Doctors in America wanted to hear this because they were being pressured to find a pill they could prescribe. When this new generation [of painkillers] came along they were seduced into believing they could prescribe this kind of medication with impunity."

What about their illegal use?

With potentially millions of Americans addicted to a drug they were legitimately given to stop them feeling pain in the short term, there has been a growing amount of abuse.

The development of one of the most potent opioids, fentanyl, has made the problem worse.

Fentanyl is around 100 times stronger than morphine. A lethal dose is estimated to be 2 thousandths of a gram (2mg), according to the European Monitoring Centre for Drugs and Drug Addiction.

Others who have become addicted to prescription opioids have switched to heroin, as its price has fallen relative to inflation since 2010.

While the number dying from prescription opioids has risen steadily but slowly over the last 18 years, the death rate from other synthetic narcotics, mainly from fentanyl, has rocketed, particularly in the last four years.

Are the drug companies to blame?

Johnson & Johnson has been ordered to pay $572m (£470m) for helping to fuel the opioid crisis after a three-month court case.

It was brought by Oklahoma's attorney general and was the first to go to trial out of thousands of lawsuits filed by state and local governments against opioid manufacturers and distributors.

It was alleged Johnson & Johnson's marketing practices helped fuel the opioid epidemic by flooding the market with painkillers, resulting in the deaths of more than 4,600 in Oklahoma alone.

In the battle over who is to blame, legal firepower has been targeted on what has become known as big pharma - the drug companies which made billions from the sale of these medicines.

Some have said that the situation is as grave for the industry as that which nearly finished the tobacco firms in the last century.

Big tobacco was dragged through the courts from the mid-1950s until it reached a $206bn "master" settlement in November 1998.

Among those being eyed for compensation are the US and British Sackler family, the founders of Purdue Pharma, which developed OxyContin.

Some members of the philanthropic family have been told not to donate any more money to major world art museums including the National Portrait Gallery and the Tate because of their association with the scandal.

NBC News has reported that Purdue has offered up to $12bn (£9.8bn) to settle the opioid cases against it.

In any case, the Oklahoma case has been labelled the "tip of the iceberg" for future litigation.

Mr Shapiro told Sky: "There are other pharmaceutical companies involved. This is very similar to what happened to the tobacco industry. Maybe the same will happen here.

"In the States, they have had hundreds of thousands of overdoses… In the US we had rogue doctors setting up shop in shopping malls and just selling prescriptions with no medical care attached. The system they have in America, it's a money-based system. You give a doctor money, he gives you pills.

"In the most deprived areas… in the Mid West, the 'rust belt', where there had been massive unemployment… you saw a dramatic rise in the use of opioid painkillers… and when people couldn't afford the pills, because they were costing $200-250 per prescription, they switched to the cheap heroin that also came flooding in."