What were the three waves of the US opioid crisis?
The same crisis has been driven by three different drugs in three different decades: pills, then heroin, then fentanyl.
Guess first
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Which one is it?
The US opioid crisis is usually told as three waves, each driven by a different drug. The Centers for Disease Control and Prevention (CDC) says the number of opioid overdose deaths rose in three distinct waves over about 25 years. From 1999 to 2023, approximately 806,000 people in the United States died from an opioid overdose.
The first wave began in the 1990s, with a rise in . Between 1990 and 1999, the number of opioid prescriptions grew from 76 million to about 116 million, making them the most prescribed class of medications in the country. Medical organizations were urging doctors to take pain more seriously, calling it the "fifth ", and, according to one account, drug companies insisted patients could not become addicted.
The second wave started around 2010 and was marked by heroin. Heroin was available and its price was falling, and many people who were already dependent on opioids switched to it. Researchers are unsure how much a 2010-era of OxyContin, made harder to crush and misuse, contributed to the switch.
The third wave, from 2013, was driven by , mostly illegally made fentanyl. The death rate involving synthetic opioids rose tenfold as they flooded the US market. Fentanyl is described as 50 to 100 times more potent than morphine, and it is often mixed into heroin or cocaine.
1990s
Wave 1: more opioid
About 2010
Wave 2: heroin surges
2013
Wave 3: , mainly illegal fentanyl
Since 2016
A fourth wave, with several drugs together, per 2022 research
Some researchers describe a fourth wave since 2016, in which several drugs are combined. The waves overlap rather than replace each other, but together they show how one crisis changed its face.
Try it
A decade of rising prescriptions
y = 0x + 76
Challenge · Keep 1990 at 76 million and find the yearly increase that reaches about 116 million in 1999 (year 9). Roughly how many extra prescriptions a year is that?
Quiz me
0/3
Recap
The crisis moved from pills to heroin to fentanyl, and the waves overlap rather than replace each other.
💡 A trick to remember it · Pills, then powder, then potent synthetics: three layers, each added on top of the last.
Surprising fact · A 1980 letter often cited to support wider opioid use was never meant to, according to its own author.
Connects to
- ⚖️ How did OxyContin's marketing and the Purdue Pharma settlements shape the opioid crisis?
- 📉 How many Americans die of overdoses, and why did deaths fall after 2023?
- 💊 What are opioids, and how do they work in the brain?
- 💰 Why do GLP-1 drugs cost so much, and who pays for them?
- ⚗️ Why is fentanyl so potent that tiny amounts can kill?
- Naloxone
Sources (2)
No source, no claim. Every fact in this lesson (15 claims) cites at least one of these.