This dot represents ten people and this dot represents one hundred people. In 2015, this many died from gun violence in America, this many died in car crashes, but even more Americans died from a drug overdose. 52,000 people. That’s more people than there are seats at Yankee Stadium. More people are dying because of the opioid epidemic: a public health crisis that is causing waves of progressive drug use. First, Americans got hooked on prescription painkillers. Next, addicted users moved on to more potent drugs, like heroin. Now, an increasing number of Americans are overdosing on an even more powerful opioid: “Fentanyl is taking the opioid epidemic to a new level…” “…fentanyl…” “…more potent than heroin…” “Another drug is surging…” “Fentanyl. So potent you could die with the syringe still in your arm.” The explanation for the rise of fentanyl begins in the late 1990s… “Since I’ve been on this new pain medication, I have not missed one day of work and my boss really appreciates that. ‘Lauren is there every day’.” That’s when pharmaceutical companies began advertising new opioids that were supposedly non-addictive. “…but these are the same drugs that have a reputation for causing addiction and other terrible things. They do not have serious medical side effects, and so these drugs, which I repeat: are our best, strongest pain medications, should be used much more than they are for patients in pain.” American doctors started prescribing opioids, like OxyContin, Percocet, and Vicodin, at record numbers and overdoses began spiking. In the 2000s, the government took steps to limit the supply of prescription pills. Pharmaceutical manufacturers were sued for falsely marketing their products as non-addictive, doctors were prosecuted for overprescribing pain pills, and authorities tightened limits on painkillers. By 2013, prescription drug abuse leveled off as pills became harder to find, but that didn’t help Americans who were already hooked. When addicts couldn’t get pills, they found more dangerous drugs. Many started using heroin, an extremely potent opioid that is made from the sap of the opium poppy. It’s this transition that has led the opioid crisis to epidemic proportions. The Center for Disease Control found that people addicted to prescription painkillers are 40 times more likely to be addicted to heroin. Heroin is more potent than prescription pain pills and therefore more lethal. Soon, heroin overdoses began skyrocketing and as usage became widespread, users with a high tolerance for heroin began seeking even stronger opioids. And that’s part of what led to fentanyl: a synthetic opioid that is more powerful and cheaper to make than heroin. Unlike heroin, fentanyl can easily be made in a lab. It was first developed as an anesthetic for surgeries in the 1960s and later found use as a treatment for chronic pain in the 1990s. Since then, it continues to be approved for restricted medical use and is prescribed for advanced cancer patients. In regulated medical settings, fentanyl is often delivered by injection, or as a patch or lozenge: forms which allow the drug to be dispensed gradually. Similar to other opioids like morphine and heroin, fentanyl sedates the user by reacting with receptors in the brain to release dopamine. But fentanyl is about 100 times more potent than morphine. Drug traffickers have been using it to cut heroin to increase the potency and profits from their product. So heroin addicts can consume fentanyl unknowingly, which increases the chances of an accidental overdose. Exposure to the drug is so dangerous that The CDC requires first responders to wear protective gear when fentanyl is suspected at a scene. “It’s a scary situation….” In Ohio, an unprotected police officer accidentally overdosed after particles of fentanyl settled on his clothing during a traffic stop. “That he would just accidentally bump up against something while he was searching this vehicle, and for him to drop out like that…It’s shocking.” Three years after heroin deaths began to spike, fentanyl overdoses began rising. Already, new opioids are fulfilling the next iteration of this progression. Carfentanil, an opioid used as an elephant tranquilizer, is a growing cause of overdoses in The United States. This photo compares a potentially lethal dose of all three drugs, showing that it could take just a few grains of carfentail to kill someone. The fact that cracking down on prescription painkillers has pushed users to even more dangerous opioids demonstrates the need for better drug policies. In addition to targeting the supply of drugs, providing better treatment options for addiction will reduce the demand for them. In 2016, preliminary estimates of Americans that died by drug overdose are as high as 65,000 people. Experts estimate 2017 will be even worse. As long as people are addicted, they’re going to find ways to satisfy that addiction even if it means using more dangerous drugs, like fentanyl.