In 1995, American pharmaceutical company Purdue Pharma marketed a new semi-synthetic opioid drug called OxyContin, designed for pain treatment. Opioids are known for being a very potent pain reliever, but they are also highly addictive due to their euphoric effects, especially in higher doses. One of the biggest selling points of OxyContin was its allegedly less addictive nature, a fact which the company aggressively marketed. At the same time, doctors were incentivized to prescribe OxyContin, which they often mistakenly believed to be relatively harmless. There was but one problem:it was a lie, and company employees knew it. In 2007, Purdue Pharma pleaded guilty to having misled the public about OxyContin's addictive properties and paid a fine of $600 million.  Interestingly , what had by then become an  epidemic primarily affected segments of the U.S. population in which substance abuse is usually not found, most notably white middle-aged working-class Americans. 

Between 1999 and 2013, death rates among white Americans without college education aged 45-54  increased by 134%. In comparison, death rates among other educational or ethno-racial groups in the same age bracket have all either decreased or at least remained unchanged. Among the causes of death, one specific category skyrocketed in that period: poisoning (a term often used interchangeably with drug overdose). Studies have underscored the connection between the level of increased mortality in this age group and deindustrialization. 

These fall into a broader category of so-called ‘deaths of despair’, which also include suicides, chronic liver disease (due to excessive drinking) and others, caused by the American working classes having to compete with workers from other nations, mainly China. 

The American opioid epidemic is usually divided into three distinct stages. The first one is defined as the period from the late 1990s to approximately 2010, when overdoses on prescription opioids, such as OxyContin, were most prevalent. Then, the United States saw a rapid increase in Heroin overdoses and related mortality. The cause was quite simple- as it dawned on American authorities that there was a crisis , laws tightened, which same with  a limit on the availability of prescription opioids. However, since millions of people were already addicted to opioids, they did not simply stop using when the supply of drugs manufactured by pharmaceutical companies dried out. Instead, they switched to an alternative they could obtain on the streets- heroin. 

Around 2013, the third wave began with the entrance of the new, and remarkably deadly, synthetic opioid  Fentanyl  on the U.S. market. Fentanyl is a remarkably potent drug-50 to 100 times stronger than Morphine-which greatly increases risk of overdose. A troubling development in recent years is that other drugs have been found to be laced with Fentanyl, which has increased the number of overdoses even more. This recent development is often described as a distinct fourth wave of the opioid epidemic, with its hallmark being  that it now predominantly affects social and ethnic groups different from white people, who had in the main been the worst-hit since the 1990s. 

Mortality rates among other groups have skyrocketed since the introduction of other drugs laced with Fentanyl. 

The highest mortality rates are now found among Black Americans and Native Americans . For the moment, no real solutions exist. 

While the number of drug overdose deaths in the U.S. finally stopped increasing in the past three years, over 100,000 annual deaths are still reported. Apart from public health,  the crisis has geopolitical implications. Most of the ingredients needed for the production of Fentanyl are made in China, with the final product synthesized mostly in Mexico. It is no coincidence that some U.S. politicians are portraying the Fentanyl crisis as a form of biological warfare perpetrated by China against the U.S. Members of U.S. Congress have also repeatedly called for direct military action against drug cartels operating in Mexico. Included in the many executive orders signed by President Trump on his inauguration day, was an ordering  of  the State Department to designate Mexico's drug cartels and two Latin American gangs as foreign terrorist organizations. 

In the future, we might even witness the transformation of the fentanyl crisis from a public health issue to one of  domestic  security.