The Cincinnati Enquirer's Pulitzer-winning look at the opioid epidemic

From prescriptions to street drugs: Opioids trajectory across America

Exclusive data obtained by The Washington Post from the Centers for Disease Control and Prevention shows how individual counties moved through three waves of the opioid crisis, each wave paving the way for the next. Between 2011 and 2017, the drug responsible for the majority of overdose deaths shifted from prescription pills to heroin to fentanyl. Together, oxycodone, hydrocodone, heroin, and fentanyl have been major drivers in declining life expectancy in the US.

The story of the Sackler empire behind highly addictive OxyContin

This investigative report examines how the Sackler family built its fortune through Purdue Pharma’s aggressive marketing of OxyContin, a highly addictive painkiller. Through 2017, the drug had generated more than $30B in sales for Purdue Pharma, controlled by the Sacklers.

One person dies from opioids every 7 to 8 minutes

This collection of infographics by the National Institute for Health Care Management helps put the crisis into perspective. The opioid epidemic has had three waves. Opioid-related deaths increasingly involve synthetic versions of the drug class, contributing to 83 percent of all opioid-related deaths in 2020. Use these infographics to learn more about the crisis.

See how DOJ prosecutors took down a pharmaceutical company's executives over the opioid crisis

This FRONTLINE documentary follows federal prosecutors as they used anti-racketeering laws to convict executives at Insys Therapeutics, a pharmaceutical company that bribed doctors to overprescribe a fentanyl painkiller.

Opioid prescription rates by states and counties

The origins of the US' ongoing opioid crisis are typically traced to the more than 1 billion prescription pain pills that flooded medicine cabinets between 2005 and 2019. This prescription opioid epidemic resulted in more than 210,000 fatal overdoses and set the stage for the ongoing crisis fueled by heroin and fentanyl.

The three waves of the opioid crisis: overprescription, heroin, and fentanyl

The US opioid crisis has unfurled in three distinct waves, each spiraling into an epidemic that's killed millions. The first crested in the 1990s with the overprescription of opioids for pain relief. The second manifested as heroin overdoses in the 2010s. The third began in 2013 with the rise of deaths related to tramadol and fentanyl.

Synthetic opioids: a historical and clinical review

In the 19th century, researchers began synthesizing and isolating poppy plant alkaloids, leading to the invention of morphine, codeine, heroin, oxycodone, and others. These highly addictive variants eventually gave rise to illicit use and a widespread underground market, laying the foundation for the current opioid crisis.

A workplace back injury and the opioid prescription that followed set one Texas father on the path the Washington Post's video profile calls his rise to fentanyl 'kingpin.'

Fast, cheap, and deadly: How fentanyl replaced heroin and hooked America

This interactive article details how fentanyl has largely replaced heroin in the drug trade, with fatal results. Fentanyl was first developed in 1959 as an anesthetic for pain relief, but the drug took hold in the US black market in 2014 and has since exploded in the intervening decade.

Learn about the US opioid crisis in this free course

Where did the US opioid crisis come from, and how did it spread? Learn this and more in this free, online Harvard University course. Learn about the disease model of addiction treatment and management, and get up-to-date with public health and law enforcement's current harm reduction practices. This free resource gives users a greater understanding of opioid addiction and the epidemic still haunting the US.

Opioid epidemic 101: lawsuits and settlements

State and local governments trying to address the opioid epidemic have sued organizations they believe started and supported the crisis. Companies that made, distributed, or contributed to sales of the highly addictive painkillers are expected to pay more than $50B in settlements. These settlements specifically state that at least 85% of settlement funds must be spent on addressing the epidemic, though where exactly the money is going is unclear.

Why is fentanyl poisoning street drugs?

A few grains of fentanyl, a synthetic opioid far more potent than heroin or morphine, is enough to kill a typical adult human. It's made its way into other, less lethal street drugs, where it may be used to increase the highs experienced by unknowing users, increasing their likelihood of addiction and overdose. This 39-minute podcast episode is the first half of a two-part series exploring fentanyl's rise.

Overuse of opioids can lead to hypersensitivity to pain.

USA Today asked readers about their grief—and received more than 700 responses

The submissions included one moving story of two women whose sons died by drug overdose. The duo wrote that they found each other in a support group and decided to navigate their respective difficult situations by starting a podcast together called "Two Moms with Two Dead Kids," which focused on what life was like in the years following the deaths of their children.

Why are drug dealers putting fentanyl in everything?

A few grains of fentanyl, a synthetic opioid far more potent than heroin or morphine, are enough to kill a typical adult human. It's made its way into other, less lethal street drugs, where it may be used to increase the highs experienced by unknowing users, increasing their likelihood of addiction and overdose.

Opioids are a class of drugs including fentanyl, heroin, oxycodone, and more.

Barbara Kingsolver's 'Demon Copperhead' reframes Dickens for the opioid crisis

The 2022 novel is a retelling of Dickens' autobiographical coming-of-age novel "David Copperfield." Kingsolver moves the story from Victorian England to contemporary Appalachia, where the opioid crisis is raging. The book won the 2023 Pulitzer Prize for Fiction.

The Washington Post's Janet Cooke returned her Pulitzer

When Washington Post reporter Janet Cooke published her profile of an 8-year-old heroin addict named Jimmy in 1980, it created an instant uproar. Social workers, police officers, and even the mayor of Washington, DC, all jumped into action to try to get the child help, but no one could find him. Within hours of Cooke receiving a Pulitzer for the piece, everything began to unravel as it was revealed that she had fabricated not just Jimmy's story, but her own as well. She eventually returned the award.

Fentanyl can be up to 100 times more potent than morphine

A synthetic opioid, fentanyl is highly addictive and incredibly fast-acting—a fatal dose is equal to a few grains of table salt. Once it enters the body, fentanyl floods naturally occurring opioid receptors, which can cause the body to shut down its breathing reflex, leading to a fatal overdose.

Why the human brain loves opioids

When opioids enter the brain, they dock in receptors, blocking electrical pulses such as those that communicate pain. They also trigger the release of dopamine, a neurotransmitter tied to motivation and associated with stress relief.

A podcast uncovering drug killings in the Philippines

This podcast investigates how many people have been killed in the Philippines since its War on Drugs began. In 2016, Rodrigo Duterte became the President of the Philippines, framing drugs as an existential threat and the root of all crime, saying...

Doctors ignored women's pain as a nurse replaced their fentanyl with saline

This five-part podcast series, produced by Serial Productions, focuses on the experiences of women undergoing fertility treatments at a Yale clinic where a nurse secretly replaced pain medication with saline solution. This led to women experiencing excruciating pain during procedures, but the clinic downplayed or ignored their complaints.

Opioids mimic naturally produced endorphins to dull pain.

An eye-opening interactive journey into the global drug trade

POPPY Interactive reveals how drug money destabilizes entire countries, fuels global conflicts, and allows a worldwide illegal economy to grow. Navigating the site involves diving into three major routes—the Northern Route, the Balkan Route, and...

How El Chapo’s sons built a fentanyl empire poisoning America

Los Chapitos are the four sons of El Chapo, the infamous leader of Mexico’s Sinaloa Cartel. Once dismissed as “narco brats,” the Chapitos are now key figures in the Sinaloa Cartel, accused by the US Drug Enforcement Administration (DEA) of pioneering the “manufacture and trafficking of the deadliest drug [the USA] has ever faced.” Read Reuters’ special report to chronicle the rapid rise of the Sinaloa Cartel’s new generation.

Explore the gap in what Americans die from versus news coverage on death causes

Top killers like heart disease, stroke, and liver disease, though they represent a significant burden nationally, are not often extensively covered in the media.

Morphine, heroin, codeine, and more were derived from opium

Opium reached the US at about the time early colonists were itching for ways to soothe aches and pains. The active ingredient in the substance was isolated in the early 19th century, eventually leading to the manufacture and commercial sale of morphine, heroin, and other opium-based drugs.

An interactive investigation into drugs and migration in San Francisco

This interactive article investigates the connection between the boom in US migration from Honduras and drug dealing in San Francisco. A high concentration of Hondurans are fleeing Siria Valley, where poverty and national murder rates run high...

Opium is a milky liquid substance extracted from unripe poppy plant seeds

It's been used for ages to reduce pain and induce euphoria, both of which are side effects of the plant's alkaloids—nitrogen-based compounds with pronounced physical effects. Isolating and synthesizing derivatives of these naturally occurring chemicals enabled the invention of morphine, heroin, and other opioids.

A podcast detailing the drug markets of East and Southern Africa

The African continent plays a critical role in the global illicit drug market. Often forgotten when discussing drug trafficking, organized criminal networks in Africa have established relationships with other criminal organizations around the world....

Investigating 'the city that kills women'

For nearly three decades, thousands of women have disappeared near Ciudad Juarez, Mexico. Some were mutilated in ways that led authorities to suggest it the work of a serial killer, some were trafficked into slavery, and others have never been found. Opening with a hail of bullets, this 10-part podcast series hopes to uncover those responsible for the femicides.

Drugs 101: An interactive guide

What's the difference between opioids and psychedelics? This guide details specific drugs and their various associated effects. Drugs in this wheel fall into seven categories: stimulants, depressants, empathogens, psychedelics, dissociatives, cannabinoids, and opioids.

A video showing how drug dealing really works

What motivates people to sell drugs? The "News on Drugs" series asks how people get drawn into the drug trade, unpacking the different goals and aims involved in dealing drugs. While there is a lot of focus on cartels, traffickers, and gangs...

Explore a database of generic drugs to trace their origins and identify any safety concerns.

Listen to a reporter discuss his story spotlighting a decadeslong corporate cover-up about forever chemicals, substances, which can persist in the environment for hundreds of years—though not forever.

Narcan is an opioid antagonist that can rapidly reverse overdoses

Naloxone, also known by the brand name Narcan, is an opioid-overdose reversal medication that typically begins working within a few minutes. An opioid antagonist, the treatment attaches to opioid receptors without activating them, forcing opioid molecules out of their respective receptors and allowing users' breathing rates to normalize.

The US war on drugs, explained

The United States has been fighting a global war on drugs for decades. By making drugs more expensive and less available, the US has sought to reduce drug use and inhibit the international drug trade. However, increasing prison populations,...

Who was behind the fatal 1982 Tylenol poisonings?

In 1982, an unknown suspect laced Tylenol packages with potassium cyanide in a Chicago pharmacy. Seven people were killed, and the case led to a nationwide panic, as well as the development of tamper-resistant packaging. No one was ever charged with the deaths, and the lead suspect died in 2023 after serving time in prison for trying to extort $1 million from a manufacturer to "stop the killing."

Opium's history traces from religious use to mass-market commercial products

Religious or medical use of opium was present across Europe and Asia as early as 5000 BCE. By the 16th century, humanity had come to see opium as more than medicine: It was a marketable product. This perspective also defines today's relationship with opioids, highly addictive painkillers at the heart of an ongoing drug crisis.

Cocainenomics

How did Pablo Escobar rise up out of the Medellin barrios to become the CEO of a $4 billion business? This immersive look at the global drug trade spawned by the notorious drug lord, who at his peak controlled 80% of the cocaine supply in the US. This deep dive includes visualizations showing how logistics of drug smuggling evolved over the years and traces the economic impact of the industry.

Fentanyl is better at crossing the blood-brain barrier than other opioids

Among opioids, fentanyl is uniquely adept at crossing the blood-brain barrier—the brain's security fence against harmful substances. This enables a lightning-fast high. It ends just as quickly, sometimes within minutes (where a heroin high lasts hours), and still results in the same withdrawal symptoms.

Evidence of opium use dates to as early as 5000 BCE

Archaeological evidence shows the use of the poppy plant for its pain-killing properties likely originated in the Mediterranean before making its way to the East and West via trade. It has since inspired two eponymous wars, and highly addictive derivatives of the naturally occurring substance have led to an ongoing overdose crisis.

Methadone binds to the same receptors as heroin and other opioids

Methadone is a long-acting opioid agonist that works by binding to the same brain receptors as other opioids (like heroin or morphine), but without producing intense euphoria. It reduces withdrawal symptoms and cravings, helping people stabilize and avoid illicit opioid use.

When America's deadliest serial killer went undetected

Samuel Little, who, for years, washed in and out of the justice system on violent charges eroded into lesser offenses, ultimately admitted to killing 93 people, mostly women, over more than 30 years. He tended to target those on the fringes of society—runaways, drug users, sex workers—people whose deaths were more likely to go unnoticed, he remarked, referring to them as fruits to be plucked at will.

A deep dive into the Murdaugh murder saga

Former South Carolina lawyer Alex Murdaugh was sentenced to life in prison for the double murder of his wife and son. In 2024, 40 more years were added to the sentence for theft-related charges. The case gained nationwide coverage and revealed a twisting saga of drugs, deceit, violence, and more. Dive into this 93-episode podcast series with journalist Mandy Matney, who reported on the family for years.

The body produces its own opioids that act on several receptor types throughout the body, triggering the release of dopamine and suppression of noradrenaline, neurotransmitters associated with reward and alertness, respectively.

A family's yearslong poisoning

Over 14 years, a southern Indian family slowly lost six members, several of whom were found foaming at their mouths. Upon the third death, a post-mortem examination was requested, revealing cyanide had been ingested, though it was ruled as self-inflicted. Several will edits and three deaths later, relatives turned a critical eye toward Joliyamma "Jolly" Joseph, who had married into the family and been present at each death.

The East Palestine, Ohio, train derailment explained

A train transporting a number of potentially dangerous chemicals derailed near the Ohio–Pennsylvania border in early February 2023. The extent of the leak has caused a number of environmental concerns and required a controlled burn to clear most...

This American Life explored Ohio's gerrymandering battle

In 2022, Ohio lawmakers repeatedly drew congressional districts that the state Supreme Court ruled unconstitutional. This defiance violated a voter-approved reform intended to prohibit partisan gerrymandering.

The story of Marie Nyswander, the woman who co-discovered methadone maintenance

Methadone, an opioid with distinct effects from heroin, revolutionized heroin addiction in the 1960s. Marie Nyswander was a psychoanalyst who helped discover the treatment process which is still in use today. Here's a podcast episode examining her life and role in the field of addiction treatment.