About the Opioid Epidemic

Wave 1 (1999-2009)

During the first wave of the crisis, the U.S. medical community was rethinking the way that pain was treated. As part of broader efforts to improve pain care, the FDA approved OxyContin to treat moderate to severe pain in 1995. Despite positive intentions, this decision stemmed from misrepresentations of OxyContin as “less than 1% addictive”. This false claim was heavily marketed, and in turn created a widespread belief that opioids were safe for long term use. Opioid prescriptions were written in record numbers, fueled by pharmaceutical companies’ assertion that these drugs were a low-risk solution for a wide range of medical issues. OxyContin, originally intended for moderate to severe pain, was being misprescribed at alarming rates to treat even headaches or toothaches.

Pain was, and still is, widely misunderstood. Education and research in relation to pain management and prescription application is lacking. David Julius, chair of physiology at the University of California, San Francisco School of Medicine, says, “We use ‘pain’ as one word, but I think it reflects a panoply of different disorders.” Pain has long been treated with a limited array of drugs that don’t necessarily distinguish one type of pain from another. By the early 2000’s pain was categorized as a “fifth vital sign,” though this designation was removed only three years later due to concerns about the impact of overprescribing. New standards encouraged hospitals to have patients rate their pain on a 10-point scale to give clinicians quantitative information on which to base treatment decisions. The rethinking of pain management led to new concepts such as “pseudoaddiction”, the idea that addictive behaviors could be seen as undertreated pain, with the solution being to prescribe more opioids. These initiatives to redefine pain were heavily supported by pharmaceutical manufacturers, as they could be used to promote their opioid products.

Wave 2 (2010-2012)

An overreliance on prescribed opioids exposed patients to the risk of tolerance, dependence, and opioid use disorder (OUD). Around 2010, regulations on prescription opioids were tightened, marking the beginning of Wave 2 of the opioid epidemic. In 2011, the White House released a strategy for Responding to America’s Prescription Drug Crisis. In this strategy, federal agencies worked with states to educate providers, pharmacists, patients, and families about the dangers of prescription drug misuse and the need for proper prescribing, dispensing, use, and disposal.

While efforts to educate medical professionals on responsible prescribing practices were widely considered successful, there were unintended consequences. Many using opioids for pain management found alternatives to opioids to be less effective, and with access to their prescriptions cut off, many with OUD resorted to cheaper and more accessible alternatives like heroin.

From 2011 to 2014, deaths from prescription pills plateaued while deaths from heroin more than doubled. Heroin is a very addictive drug made from morphine, a substance derived from resin of the opium poppy plant. Data from 2011 showed that about 80 percent of people who used heroin, first misused prescription opioids. In a 2017 survey of individuals who misused prescription opioids, about 50% said they obtained them from a friend or family member for free.

Wave 3 (2013-Present)

In 2013, overdoses involving synthetic opioids increased significantly, driven by fentanyl-related overdoses. Fentanyl is about 50 times more potent than heroin, making it easier to accidentally overdose on small quantities. Illicit substances like heroin, cocaine, and counterfeit pills have also been laced with fentanyl, additionally increasing the chances of an accidental overdose. By 2021, synthetic opioid-related overdoses accounted for nearly 88% of all opioid-involved deaths. 

With the uptick in overdoses and an increasing presence of more potent substances like fentanyl, more organizations have emphasized the importance of harm reduction strategies to prevent overdose and lower the risk of infection and disease transmission. Harm reduction strategies can include things like testing substances for adulterants with fentanyl test strips (FTS), carrying naloxone, and using clean needles to prevent the spread of other diseases like HIV and Hepatitis B.

Despite increasing awareness and acceptance of these strategies, overdoses surged in 2020 with the onset of the COVID-19 pandemic. In the 12-month period ending April 2021, there were an estimated 100,000 deaths due to drug overdose, with over 75% of these fatalities involving opioids. New data suggests a new fourth wave of the epidemic has begun, characterized by an uptick in overdoses from stimulant drugs combined with opioids.

For More Information

• The Opioid Epidemic at a Glance – Fast Facts

  This PDF gives an overview of the opioid epidemic and provides quick facts. Please feel free to use this information and share with others.

• Minnesota Department of Health (MDH) Opioid Dashboard

  The MDH Opioid Dashboard is a comprehensive resource for information about the opioid epidemic in Minnesota, both past and present. Here you can find the most recent numbers on opioid overdose deaths in the state, current initiatives by the state to combat the crisis, and many other informational resources.

• The CDC – Opioids Homepage

  The Center for Disease Control and Prevention’s opioid homepage provides information general information about opioids, overdose data, information for healthcare providers, and more.