[14] Opioids are a diverse class of strong, addictive, and inexpensive drugs, which include opiates (i.e., morphine and codeine), oxycodone (OxyContin, Percocet), hydrocodone (Vicodin, Norco), and fentanyl.

[31][32] Mirroring the positive trend in the volume of opioid pain relievers prescribed is an increase in admissions for substance use disorder treatments and opioid-related deaths.

"[47] The structure of the U.S. healthcare system, in which people not qualifying for government programs are required to obtain private insurance, favors prescribing drugs over more expensive therapies.

[56] Though aggressive opioid prescription practices played the biggest role in creating the epidemic, the popularity of illegal substances such as potent heroin and illicit fentanyl has become an increasingly large factor.

[62] A brief letter published in the New England Journal of Medicine (NEJM) in January 1980, titled "Addiction Rare in Patients Treated with Narcotics", generated much attention and changed this thinking.

After its 1995 approval by the FDA by Deputy Director Curtis Wright IV,[105] Purdue Pharma introduced OxyContin, a controlled release formulation of oxycodone[71] in 1996.

However, drug users quickly learned how to simply crush the controlled release tablet to swallow, inhale, or inject the high-strength opioid for a powerful morphine-like high.

More than 100,000 people died of drug overdoses in the United States during the 12-month period ending April 2021, according to provisional data published November 17, 2021, by the US Centers for Disease Control and Prevention.

[121] Synthetic opioids, primarily fentanyl, caused nearly two-thirds (64%) of all drug overdose deaths in the 12-month period ending April 2021, up 49% from the year before, the CDC's 's National Center for Health Statistics found.

[148]In 2016, the medical news site STAT reported that while Mexican cartels are the main source of heroin smuggled into the US, Chinese suppliers provide both raw fentanyl and the machinery necessary for its production.

According to the DEA, one kilogram (2.2 lb) of fentanyl can be bought in China for $3,000 to $5,000, and then smuggled into the United States by mail or Mexican drug cartels to generate over $1.5 million in revenue.

[165] The national focus being on prescription of opioids for pain management is a leading cause for non-Hispanic Black Americans receiving unequal treatment opportunities.

[185] United States Representative Jackie Walorski sponsored a bill in the memory of the doctor who would not over-prescribe; the Dr. Todd Graham Pain Management Improvement Act is intended to address the opioid epidemic.

[212] The House and Senate passed the Ensuring Patient Access and Effective Drug Enforcement Act which was signed into law by President Obama on April 19, 2016, and may have decreased the DEA's ability to intervene in the opioid crisis.

[213] In December 2016, the 21st Century Cures Act, which includes $1 billion in state grants to fight the opioid epidemic, was passed by Congress by a wide bipartisan majority (94–5 in the Senate, 392–26 in the House of Representatives),[214] and was signed into law by President Obama.

[234][235] Federal and state interventions are working on employing health information technology in order to expand the impact of existing drug monitoring programs.

[236] Recent research shows promising results in mortality and morbidity reductions when a state integrates drug monitoring programs with health information technologies and shares data through a centralized platform.

The bill includes Medicare and Medicaid reform in order to improve treatment, recovery, and prevention efforts while also strengthening the fight against synthetic drugs like fentanyl.

[240][241] In September 2019, President Trump issued an executive order to block shipments of fentanyl and counterfeit goods from other countries, where illegal distributors were using regular mail for deliveries.

[253] In February 2020, 21 US states turned down an $18 billion (US), 18-year offer from McKesson Corporation, Cardinal Health Inc, and AmerisourceBergen Corp. that would have resolved litigation against the pharmaceutical companies over their distribution of the addictive painkillers.

[254] Four major drug manufacturers and distributors, J&J, McKesson, Cardinal Health, and AmerisourceBergen, have agreed to a settlement announced by a group of state attorneys general in July 2021.

[255] The United States' three largest pharmaceutical distributors, AmerisourceBergen, Cardinal Health and McKesson Corporation reached an agreement in October 2019 where they will pay two Ohio counties a combined US$215 million.

[263] Silvia Martins, an epidemiologist at Columbia University, has suggested getting out more information about the risks:The greater "social acceptance" for using these medications (versus illegal substances) and the misconception that they are "safe" may be contributing factors to their misuse.

[168]Hence, a major target for intervention is the general public, including parents and youth, who must be better informed about the negative consequences of sharing with others medications prescribed for their own ailments.

[270] Researcher Chris Delcher also concluded that "there was a concurrent rise in fatal overdoses from fentanyl, heroin and morphine" due to ease of availability and lower cost following prescription drug crackdowns.

Patrice A. Harris, chair of the AMA Opioid Task Force, urges increased participation by physicians, saying "what is needed now is a concerted effort to greatly expand access to high quality care for pain and for substance use disorders.

[281] Programs are required to be accredited by SAMHSA or the Drug Enforcement Administration which is a lengthy, time- and resource-consuming process including intensive training and site visit reviews.

[284] Despite the fact that there is a shortage of opioid treatment programs across the United States, many clinicians do not want to start their own because the time and effort required to comply with the regulations is prohibitive.

[319] NEP have also been known to increase admittance into addiction treatment centers, offer counseling, housing support and help users begin the path to recovery through outreach from trusted staff.

Both the Center for Disease Control and National Institute of Health support the idea that NEP are a crucial aspect to a comprehensive approach to the opioid crisis.