The three waves of the opioid crisis: overprescription, heroin, and fentanyl

From prescriptions to street drugs: Opioids trajectory across America

Exclusive data obtained by The Washington Post from the Centers for Disease Control and Prevention shows how individual counties moved through three waves of the opioid crisis, each wave paving the way for the next. Between 2011 and 2017, the drug responsible for the majority of overdose deaths shifted from prescription pills to heroin to fentanyl. Together, oxycodone, hydrocodone, heroin, and fentanyl have been major drivers in declining life expectancy in the US.

Opioid prescription rates by states and counties

The origins of the US' ongoing opioid crisis are typically traced to the more than 1 billion prescription pain pills that flooded medicine cabinets between 2005 and 2019. This prescription opioid epidemic resulted in more than 210,000 fatal overdoses and set the stage for the ongoing crisis fueled by heroin and fentanyl.

One person dies from opioids every 7 to 8 minutes

This collection of infographics by the National Institute for Health Care Management helps put the crisis into perspective. The opioid epidemic has had three waves. Opioid-related deaths increasingly involve synthetic versions of the drug class, contributing to 83 percent of all opioid-related deaths in 2020. Use these infographics to learn more about the crisis.

Fast, cheap, and deadly: How fentanyl replaced heroin and hooked America

This interactive article details how fentanyl has largely replaced heroin in the drug trade, with fatal results. Fentanyl was first developed in 1959 as an anesthetic for pain relief, but the drug took hold in the US black market in 2014 and has since exploded in the intervening decade.

Synthetic opioids: a historical and clinical review

In the 19th century, researchers began synthesizing and isolating poppy plant alkaloids, leading to the invention of morphine, codeine, heroin, oxycodone, and others. These highly addictive variants eventually gave rise to illicit use and a widespread underground market, laying the foundation for the current opioid crisis.

Opioids are a class of drugs including fentanyl, heroin, oxycodone, and more

Since the dawn of pain, living things have sought ways to mitigate this evolutionary warning signal. One of nature's most effective painkillers is opium, a highly addictive, milky latex extracted from poppy plants. This forms the basis of one of the most prescribed classes of modern drugs.

Learn about the US opioid crisis in this free course

Where did the US opioid crisis come from, and how did it spread? Learn this and more in this free, online Harvard University course. Learn about the disease model of addiction treatment and management, and get up-to-date with public health and law enforcement's current harm reduction practices. This free resource gives users a greater understanding of opioid addiction and the epidemic still haunting the US.

Fentanyl can be up to 100 times more potent than morphine

A synthetic opioid, fentanyl is highly addictive and incredibly fast-acting—a fatal dose is equal to a few grains of table salt. Once it enters the body, fentanyl floods naturally occurring opioid receptors, which can cause the body to shut down its breathing reflex, leading to a fatal overdose.

The Cincinnati Enquirer's Pulitzer-winning look at the opioid epidemic

Synthetic opioids kill someone in the US every 16 minutes. Communities across the country have been ravaged by deaths, overdoses, jail time, and babies born with drug-related medical problems as opioid abuse became a typical feature of many American towns. This seven-part exposé provides an inside look at the effect in southern Ohio and northern Kentucky.

Opioid epidemic 101: lawsuits and settlements

State and local governments trying to address the opioid epidemic have sued organizations they believe started and supported the crisis. Companies that made, distributed, or contributed to sales of the highly addictive painkillers are expected to pay more than $50B in settlements. These settlements specifically state that at least 85% of settlement funds must be spent on addressing the epidemic, though where exactly the money is going is unclear.

See how DOJ prosecutors took down a pharmaceutical company's executives over the opioid crisis

This FRONTLINE documentary follows federal prosecutors as they used anti-racketeering laws to convict executives at Insys Therapeutics, a pharmaceutical company that bribed doctors to overprescribe a fentanyl painkiller.

The story of the Sackler empire behind highly addictive OxyContin

This investigative report examines how the Sackler family built its fortune through Purdue Pharma’s aggressive marketing of OxyContin, a highly addictive painkiller. Through 2017, the drug had generated more than $30B in sales for Purdue Pharma, controlled by the Sacklers.

Overuse of opioids can lead to hypersensitivity to pain

Opioid misuse can lead opioid-induced hyperalgesia, where the body becomes increasingly sensitive to pain. The body produces its own opioids as a way to temporarily block pain signals. When met with external opioid use, the body ratchets up pain sensitivity to ensure it senses the pain necessary to trigger its own response.

The US war on drugs, explained

The United States has been fighting a global war on drugs for decades. By making drugs more expensive and less available, the US has sought to reduce drug use and inhibit the international drug trade. However, increasing prison populations,...

How America's cocaine habit fueled its migrant crisis

The United States has been facing a migration crisis along its southern border. Thousands of people have been fleeing their homes in Central America, traveling north through Mexico, and claiming asylum in the USA. Much of this crisis can be traced...

How did the pandemic affect mental health?

Read this research brief to learn more about why heightened mental health and substance use concerns persist three years after the outbreak of COVID-19. According to a recent survey, the vast majority of American adults view the nation as facing a...

How the Myanmar coup fueled a rise in illegal drugs

According to the UN, Myanmar remains the world’s second-largest producer of heroin. Inside Myanmar, almost all the drugs come from one place: Shan state in the Golden Triangle region, south of China, where Myanmar meets Thailand and Laos. The...

Oil shocks, war, and the 1970s crisis that remade American energy and economics

The oil crises of the 1970s—fueled by Middle East conflict and OPEC’s dominance—triggered inflation, price controls, and policy failure. But they also accelerated fracking, alternative energy, and the rise of free-market economics.

Murder rates spiked in the US after COVID-19, and then declined in 2023

Criminologist and former investigator Jillian Peterson says whether a murder is solved in the US is nearly up to the flip of a coin, with the clearance rate for murder cases being about 50%. The US, which has more guns than citizens, has about roughly five gun homicides per 100,000 residents, resulting in the 28th-highest rate of deaths from gun violence compared to the rest of the world.

Fame can trigger addictive, drug-like highs in the brain

Differences in the type of fame, such as movie stardom, sports, and internet virality, can produce varying degrees of dependence on individuals based on their age and background. Some individuals—particularly children—can develop drug-seeking behavior as they pursue continuous dopamine spikes if they lack an existing sense of fulfillment from elsewhere.

Within months of a landmark 2002 study that indicated HRT harms, sales dropped by about half

In the early 2000s, Women's Health Initiative studies indicated HRT increased risk of breast cancer, heart disease, and stroke in some women—so many physicians stopped prescribing it to help with menopause symptoms. But further research has concluded that much of the elevated risk was overblown and that it was also disproportionately seen in women in their 70s who had been taking an older HRT formulation.

Candida auris spreads easily in healthcare facilities and causes high death rates

This fungus has spread rapidly in healthcare settings since the first US case was reported in 2016, and it has grown increasingly resistant to echinocandins, the antifungal medicine most commonly used to treat it. Often, it’s resistant to multiple antifungal drugs, contributing to its high death toll. It can most readily infect those with invasive medical devices like intravenous catheters and those with frequent or long-duration stays in healthcare facilities.

The bubonic plague spread in three waves over 600 years

The Black Death refers to the first wave of the plague, which swept through Europe in the 14th century and killed 25 to 50 million people. Caused by the bacterium Yersinia pestis carried by fleas (often on rats), the human toll was roughly one-third of Europe's population at the time.

FTX, one of the world's largest crypto exchanges, collapsed in 2022

As crypto markets declined during the post-pandemic slowdown, Sam Bankman-Fried propped up the markets with billions he'd earned leading FTX, one of the largest crypto exchanges. Then, in one of the most rapid financial implosions in modern history, the exchange collapsed as investors rushed to withdraw money.

Why Haiti is in crisis

Haiti’s crisis is decades in the making. Burdened by colonial debt, political instability, and economic collapse, the country faces worsening conditions. Gangs now control much of Port-au-Prince, hunger has reached near-famine levels, and violence continues to escalate. Here’s how Haiti got here—and what’s happening now.

11 people died from firework injuries in the US in 2024.

US consumers collectively owe more than $1T to credit card companies—almost as much as they owe in auto loans.

Telehealth demand for GLP-1s for weight loss is booming as consumers seek easier access.

See the evolution of Ebola vaccine and treatment development.

Discover the catastrophic consequences of a failure of the US electrical grid—something that is more likely than many Americans think.

The hormonal disorder PCOS was renamed PMOS in 2026, a move designed to improve care and research by shifting the focus to the hormonal causes of this condition that affects 1 in 8 women.

While the first exchange-traded fund (a 'basket' of different assets that can be bought and sold on a stock exchange) in the US only launched in 1993, the global ETF market has grown to more than $10T in the short time since.

Listen to an in-depth conversation on the links between Parkinson's disease and herbicide exposure and the challenging pace of scientific investigation.

A century of Billboard issues documenting the evolution of popular music.

After her fellow cult members tried to kill her with an LSD-infused hamburger, one member of the Manson Family, the murderous cult led by Charles Manson, decided to testify against the group's leader.

Domino's Pizza's 30-minute delivery guarantee was responsible for the chain's 1980s surge, but it was discontinued after the company was found liable for delivery driver accidents.

A Yale student wrote a profound essay about the consulting industry's influence on elite college students that was published in a book of her writing after she died in a post-graduation car accident.

Volcanic activity may have triggered the Black Death by spewing gases that led to crop failures in Europe, thus forcing the import of grain ships with plague-infested fleas.

A 2019 Facebook event called on attendees to "Storm Area 51, They Can't Stop All of Us," resulting in countless memes, the creation of a music festival, and eventually the arrests of those who did try to approach the area.

Animal phobias are likely the most common type of phobias, followed by an extreme fear of heights.

For centuries, it was common to sleep in two shifts: a few hours at the beginning of the night, and a longer period beginning around midnight

The Russia-Ukraine conflict is the largest ground war in Europe since World War II in casualties, forces mobilized, and displacement of civilians.

Waves off the coast of Nazaré, Portugal, can reach over 100 feet and are caused by the area's deep underwater canyon geography

'Shogun,' a 1980s TV series, helped popularize sushi in the US by stimulating an American interest in Japanese culture.

Poison ivy's characteristic rash is caused by an allergic response to an oily compound in the plant called urushiol.

Art theft is the third-largest source of criminal revenues worldwide, thanks in part to the subjective nature of valuing a work of art.

How fusion—which releases energy when two lighter atoms combine to form a heavier atom—differs from fission

Massive 3D printers have been used to build homes by stacking layers of 'concrete toothpaste,' a fire-resistant material that effectively insulates against outside noise.

Recent research found that the brain doesn't seem to massively rewire following amputation—upending earlier beliefs about the cause of phantom limb pain.