The Opioid Epidemic

The Opioid Epidemic Quick Facts

The opioid epidemic refers to the widespread abuse of prescription and non-prescription opioids in the United States.

While its roots trace back to the 1990s, the U.S. Department of Human Health Services (HHS) declared the opioid epidemic a public health emergency in 2017.

• Around 6.1 million people had an opioid use disorder in 2022.
• Over 80,000 people died from opioid-related overdoses in 2022 alone.
• The opioid epidemic has three distinct “waves,” ranging between the 1990s and 2013, with emerging data suggesting that a fourth wave has begun.
• 2024 research indicates that nearly half of all non-fatal overdoses also involve stimulant drugs

What Are Opioids?

Opioids are drugs that you can get through a doctor’s prescription, like Oxycodone, or through illegally manufactured drugs found on the black market, such as heroin.

Some opioids are natural and come from poppies, while others are synthetic or semi-synthetic, meaning they’re made fully or partially in a lab. Synthetic opioids, like fentanyl, may be stronger than naturally derived ones, but all varieties of opioids can have abuse potential.

Examples of natural opioids include: 

• Codeine
• Morphine
• Heroin

Semi-synthetic opioids include: 

• Oxycodone
• Hydrocodone
• Oxymorphone

Fully synthetic opioids include:

• Methadone
• Fentanyl

How Do Opioids Work?

Opioids interact with nerve cells called “opioid receptors,” which may reduce pain. At the same time, opioids can also cause the release of hormones that make you feel good. In high enough doses, you’ll feel euphoric.

Over time, your body can crave the way you feel when you take opioids, leading you to take them more often. You can also build up a tolerance, requiring higher doses to get the same effects.

Eventually, you can become dependent on opioids, meaning you get withdrawal symptoms if you cut back or stop taking them—potentially leading to addiction (i.e., substance use disorder).

Physical and Mental Health Impacts

Opioid abuse can cause a full range of physical and mental symptoms, from changes in your body to trouble at work or school.

Physical symptoms of opioid abuse can include the following:

• Drowsiness or changes in sleep habits
• Flu-like symptoms, like nausea, vomiting, or sweating
• Weight loss or gain
• Appetite changes
• Slower breathing

The mental effects of opioids can include the following symptoms: 

• Drug cravings
• Poor work or academic performance
• Social isolation or secretive behavior
• Withdrawing from activities or social events
• An increase in risky behavior, like stealing

Causes of the Opioid Epidemic

Opioids have been used as medications for thousands of years, dating back as far as Ancient Egypt and the Roman Empire. Records of opium poisonings have been recorded as early as the 1830s.

However, the emergence of the modern opioid epidemic is fairly recent and can be traced back to around 30 years ago.

First Wave

The foundation of the opioid epidemic emerged in the early 1990s when misleading information about pain management and the addictive potential of opioids surged.

Drug manufacturers promoted newly-approved opioids like OxyContin as “less addictive” than older opioids without evidence. The strategy prompted an increase in opioid prescriptions, which, in turn, increased rates of opioid addiction and overdoses.

Second Wave

In the 2010s, heroin became more readily available and pure, spiking a “second wave” of the opioid epidemic with increased heroin-related deaths.

Some people believe that policy changes making prescription opioids harder to get caused this surge: Opioid addicts may have been unable to get prescription opioids as easily and switched to heroin as a more readily available option.

However, data indicates that at the time of the second wave, only 3 to 5% of heroin users reported abusing prescription opioids in the previous year. So, policy changes may not have played as big of a role as previously thought.

Third Wave

The third wave began around 2013 when a spike of high-powered synthetic opioids like fentanyl flooded the drug market and led to another surge in overdoses.

Fentanyl is much more powerful than other opioids (50 times stronger than heroin) and is cheaper to make. So, some drug dealers began to mix Fentanyl with other drugs as a way to increase the drug’s weight while keeping costs down.

But many people who buy these drugs don’t know that they contain fentanyl, which can lead to a higher risk of overdoses. Synthetic opioid-related deaths increased ten times between 2010 and 2017.

Current Trends: Fourth Wave?

Today, some researchers believe that we’ve already entered the fourth wave of the opioid epidemic since evidence suggests that more people are combining opioids with stimulant drugs, like cocaine or amphetamines.

A 2024 study across 9 hospitals found that around half of all reported non-fatal opioid overdoses also involved stimulants.

Opioid Epidemic Timeline

The opioid epidemic has unfolded over several decades, with key events shaping the crisis and its devastating impact on public health.

Understanding this timeline helps highlight how medical practices, regulatory actions, and the rise of illicit substances have fueled the ongoing epidemic.

Below is an overview of pivotal moments:

• 1990s: The Food and Drug Administration (FDA) approved OxyContin, and misinformation surrounding the drug’s abuse potential led to over-prescription of opioid medications.
• 1995: The (now-disbanded) American Pain Society launched its “Pain as The Fifth Vital Sign” campaign. The campaign advocated for more widely available, standardized methods of pain treatment, which further contributed to health professionals prescribing opioids in record numbers.
• 2010s: The second wave began as heroin became more accessible and affordable on the black market.
• 2013: Fentanyl entered the illicit drug market, prompting the “third wave” of opioid-related deaths.
• Present: Emerging evidence suggests that a “fourth wave” may have begun, which is characterized by mixing opioids with stimulants.

Effects of the Opioid Epidemic

All waves of the opioid epidemic brought devastating consequences to Americans, with overdoses and deaths increasing more than 10 times between 1999 and 2022.

While the opioid epidemic has impacted Americans from all backgrounds, some races, age groups, and other communities may have experienced more severe consequences than others, such as people of color and rural counties.

Opioid Overdoses and Deaths

Opioid abuse is one of the leading causes of drug-related deaths in America.

Statistics about opioid deaths and overdoses include the following:

• 75% of 2020 drug overdose deaths involved opioids.
• 81,806 people died of an opioid-related overdose in 2022, an increase of around 64% from 2019.
• Between 2021 and 2022, prescription opioid-related deaths decreased by 12%, while deaths related to illegally manufactured synthetic opioids increased by 4%.
• People aged 35-44 have the highest overall opioid overdose deaths compared to other age groups.

Impact on Communities

Recent data suggests that the following demographics may be uniquely impacted by opioid abuse. 

• Teens and young adults. In 2020, young people aged 15-24 experienced the highest percentage increase in opioid deaths.
• Men. A 2020 research review found that men were more likely to be dependent on opioids than women. Men also die from opioids more than women, with men making up nearly 70% of opioid-related deaths in 2017.
• People of color. According to 2023 research, black males were 1.5 times more likely to die from an overdose than white males in 2020. Native Americans and Alaskan Natives may also be more severely affected.
• Rural areas. Rural counties have a smaller healthcare infrastructure compared to urban areas, meaning they generally have fewer resources to deal with the epidemic. West Virginia had the highest opioid-related death rate of all states in 2022, with nearly 81 deaths per thousand people.
• North Eastern and Midwest Regions. The Midwest had the highest percentage increase in opioid deaths between 2016 and 2019, but mortality rates are also high in Appalachia and New England.

Opioid Addiction Prevention and Harm Reduction

The opioid epidemic’s devastating consequences can’t be overstated. But, healthcare providers, researchers, and community volunteers are working to stop the effects of opioid abuse in America through tools like education, monitoring programs, and harm reduction strategies.

How Can We Prevent Opioid Addiction?

Thankfully, it is possible to stop opioid addiction before it takes root through prevention initiatives. According to the CDC, the following methods can be effective for preventing opioid abuse and addictions.

• Responsible prescription use. Providers and patients should thoroughly discuss the potential benefits and risks associated with prescription opioids to create safer care plans.
• Access to education. Educational programs help people better understand the risks associated with opioids and how to help someone who is overdosing.
• Prescription drug monitoring programs. These state-run programs track the prescriptions of controlled substances like opioids, which can inform a provider’s prescribing practices.

How Harm Reduction Helps Fight the Epidemic

Harm reduction is a method that aims to minimize the harm done through illicit drug use. Instead of abstinence-only interventions, harm reduction recognizes that some people will continue to use drugs and offers ways to reduce the risks associated with them.

Common harm reduction strategies include: 

• Supervised injection sites.
• Syringe service programs
• Drug test strips
• Drug supervision hotlines, like Never Use Alone
• Naloxone (Narcan) distribution programs

Research indicates that harm reduction initiatives can be highly effective for opioid abuse. For example, Naloxone distribution at 136 syringe service programs collectively prevented over 26,000 overdoses between 1999 and 2014.

Treatment and Recovery Options for Opioid Addiction

While the effects of opioid addiction can be devastating for addicts and their families, there are ways to treat opioid use disorder, allowing affected individuals to lead a fulfilling, drug-free life.

Most addictions need a combined treatment approach of medical and mental health interventions.

Some of the most common opioid treatment services include the following. 

• Medical Detox: You’ll slowly taper off opioids under medical supervision to minimize uncomfortable side effects.
• Rehab: Inpatient and outpatient rehab programs can often combine medical detox with mental health treatment to help you stop using drugs and develop coping skills for sober living.
• Medication-assisted treatment: Lower-strength opioids like methadone, buprenorphine, or naltrexone may help normalize your brain chemistry and support successful recovery from addiction.
• Counseling: Therapy interventions can be effective for addictions, including evidence-based approaches like cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT.)
• Support groups: 12-step programs like Narcotics Anonymous (NA) help you connect with other people dealing with addiction while giving you a framework to encourage recovery.

Relapses are common with opioid addiction, and the results can be deadly. For example, if you stop taking opioids, your tolerance may lower. Then, when you relapse and take your usual dose, your body can’t handle it, leading to an overdose.

It’s why ongoing treatment and support is essential to stay in recovery long-term.

Get Help for Opioid Addiction

If the opioid epidemic has impacted you or a loved one, don’t wait to seek help. You can start your recovery journey by visiting the Substance Abuse and Mental Health Services Administration (SAMSHA) online treatment locator or by calling 1-800-662-4357.

You can also visit our treatment help page for multiple options.

Written by

Brooke Helton

Medical Content Writer

Brooke Helton is a freelance writer passionate about wellness topics, especially the relationship between physical and mental health. As a contributor to AddictionHelp.com, she’s proud to combine her writing and research skills to inform and empower people impacted by substance abuse.

Reviewed by

• Fact-Checked
• Editor

Kent S. Hoffman, D.O.

Founder & Chief Medical Officer

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.