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The US Opioid Overdose Epidemic: The History to Today

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By Editorial Team

Last Updated:

3 min read

Drug overdoses have been with us as long as drugs have existed. But the United States had a dramatic increase in overdose deaths beginning in the early 2000s. In fact, overdose deaths increased 540 percent between 1999 and 2022. In 2000, more than 17,000 people died of a drug overdose. That number was more than 107,000 in 2022.1,2

Opioids were responsible for 3 out of 4 of these deaths. But the type of opioid responsible has changed in the last 2 decades. Prescription opioids fueled the epidemic in the early 2000s. Over time, that changed to illegal substances like heroin and illegally manufactured fentanyl. In 2022, fentanyl accounted for 90 percent of opioid overdose deaths.1,2

The opioid overdose epidemic continues to change as governments and doctors respond to the crisis. Recent research shows that deaths involving multiple drugs, such as an opioid and methamphetamine, are becoming more common.1,2

How did we get here?

Experts generally agree that the US overdose epidemic came in 3 waves. The first was in the 1990s. At that time, doctors were encouraged to more seriously consider pain as a problem. Around the same time, the US Food and Drug Administration approved Purdue Pharma’s opioid OxyContin®. A rapid increase in opioid prescriptions meant more people:1,3

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  • Developed opioid use disorder (OUD)
  • Began misusing their prescriptions

Opioid overdose deaths grew steadily. In 2011, the US Centers for Disease Control and Prevention (CDC) declared an epidemic of prescription painkiller deaths.1

Fentanyl’s scourge begins

The second wave of opioid deaths came as governments and doctors tried to address the overdose epidemic. Doctors reduced the number of prescriptions they gave out. People dependent on opioids found they could no longer get prescription painkillers. So some began turning to illegal opioids like heroin.1,3

By 2014, deaths from fentanyl, a cheaply made and powerful opioid, began to climb. Today, fentanyl and similar lab-made chemical compounds are the leading cause of opioid overdose deaths.1,3

A third wave began around 2020. Deaths increased more slowly. But they continue to rise, with most caused by:1

  • Fentanyl
  • Methamphetamine
  • Cocaine

To address the epidemic, the CDC put out guidelines to reduce how often opioid painkillers were prescribed. Several states created legal restrictions on the number of opioids a doctor could prescribe. And many doctors became more cautious about prescribing opioids.1,3

These efforts had limited success. That is because from 2010 to 2017, fentanyl began to flood US drug markets. Fentanyl is easier and cheaper to make and sell than heroin. It is also 50 times more potent than heroin. That makes it easier to smuggle and easier to overdose on.1,3

What’s being done today?

The overdose epidemic is a complex problem. There is no single solution. But as the crisis continues, experts are gaining a better understanding of OUD and how to address it.2,3

Prevention of OUD is the first step. Government regulations and monitoring have made it harder for doctors to overprescribe opioids. Hospitals and clinics now have additional rules about the handling of opioids. These steps have helped to prevent the drugs from being diverted to illegal use.4

Public information campaigns are another step. These campaigns increase awareness of the:1-4

  • Opioid overdose epidemic and its causes
  • Dangers of fentanyl
  • Use of naloxone to prevent opioid-related deaths
  • Need to reduce stigma attached to OUD

Naloxone is a drug used to reverse the effects of an opioid overdose.5

Increasing healthcare workers’ awareness of the symptoms of OUD and the benefits of carrying naloxone also plays a role in decreasing opioid-related deaths. One study found that nearly 3 out of 5 people who overdosed had at least 1 opportunity to be linked to care or receive life-saving action before their death.2

We can all help prevent opioid deaths by encouraging people with OUD to seek medical help. Carrying naloxone at all times can also save lives.4

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