For over two decades, a crisis of opioid overdoses has been one of the most urgent health care emergencies in the United States. Initially driven by the over-prescription of pharmaceutical opioids such as Oxycontin, a “second wave” of addiction deaths began as people transitioned from prescription opioids to heroin, a much riskier drug. The so-called “third wave” was marked by the proliferation of potent synthetic opioids such as fentanyl.
This crisis has been seemingly intractable, with new, record-high deaths year after year. When the Covid-19 pandemic hit in 2020, a perfect storm of an overwhelmed public health system and an even more toxic drug supply made things still more dire. The overdose epidemic has evolved into a new phase that experts are referring to as the “fourth wave.”