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by Bobby C. The opioid epidemic in the United States is considered the worst drug overdose crisis in the country's history, resulting in over 700,000 deaths between 1999 and 2024. The crisis is characterized by three distinct, overlapping waves driven by different types of opioids—prescription pain relievers, heroin, and synthetic opioids—largely caused by aggressive pharmaceutical marketing, overprescribing, and the rise of illicitly produced fentanyl. The Three Waves of the Epidemic: Wave 1: Prescription Opioids (1990s–2010): The crisis began in the mid-1990s with the introduction of new opioid-based products, most notably OxyContin in 1995, marketed by Purdue Pharma as a less-addictive, mild form of opioid. Physicians were encouraged to treat pain as a "fifth vital sign," leading to an explosion of prescriptions for non-cancer-related and chronic pain. By 2010, the rate of overdose deaths involving prescription opioids had doubled from 1999. Wave 2: Heroin (2010–2013): As regulators and medical professionals began tightening restrictions on prescriptions, many individuals dependent on prescription painkillers switched to heroin, a cheaper and more accessible alternative. Mexican drug trafficking organizations increased production, flooding the US market with cheap heroin, causing overdose deaths from the drug to quadruple between 2002 and 2013. Wave 3: Synthetic Opioids (2013–Present): Beginning around 2013, the crisis shifted to synthetic opioids, particularly illegally manufactured fentanyl. Fentanyl is 50 to 100 times more potent than morphine. Drug traffickers started mixing fentanyl—which is easier to produce and transport than heroin—into counterfeit pills, heroin, and cocaine. This shift led to a massive, rapid increase in overdose deaths, with synthetic opioids accounting for nearly 90% of all opioid-involved deaths by the early 2020s.