Alex Murdaugh was taking a large amount of oxycodone pills, specifically instant-release 30-milligram oxycodone, mixed with some OxyContin. He admitted in court to taking up to 60 oxycodone pills a day in the months leading up to the murders of his wife and son. His opioid use began after a college football knee injury that led to surgery and subsequent use of pain medication. This excessive use indicated a severe opioid addiction where he had built a high tolerance to the drug, requiring large amounts to avoid withdrawal and maintain function. His family, including his son Paul, was aware of his drug problem, with pills being found in his possession shortly before the murders.