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.'

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.

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.

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.

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.

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.

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.

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

Synthetic opioids kill someone in the US every 16 minutes. Communities across the country have been ravaged by deaths, overdoses, jail time, and babies born with drug-related medical problems as opioid abuse became a typical feature of many American towns. This seven-part exposé provides an inside look at the effect in southern Ohio and northern Kentucky.

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.

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.

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.

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.

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.

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.

Overuse of opioids can lead to hypersensitivity to pain.

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

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.

Prince died in 2016 from an accidental fentanyl overdose

The music legend was found dead in an elevator at his Paisley Park residence on April 21, 2016. The cause of death was an accidental overdose from taking pills he believed to be Vicodin, but were actually counterfeit pills laced with fentanyl. Law enforcement was unable to determine who provided him with those pills. He was 57 at the time of his death.

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.

The story of Olympian Ryan Wedding's rise and fall as drug kingpin

After a disappointing finish representing Canada in the slalom at the 2002 Winter Olympics, Wedding turned to growing cannabis and selling cocaine. After serving prison time, he upped his game and came to control major drug routes in North America, finding himself on the FBI's 10 Most Wanted List. He was captured in Mexico City in January 2026.

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.

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.

​Why heroin became associated with the grunge world

The drug was popular with several Seattle acts in the early 1990s, with artists like Hole's Courtney Love even publicizing her use in a magazine profile. A 1992 New York Times story on Seattle said the city's principal drugs were "espresso, beer, and heroin."

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.

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.

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.

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...

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.

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...

How a government chemist founded the FDA—by poisoning people

The Poison Squad tells the story of government chemist Dr. Harvey Wiley who, determined to banish these dangerous substances from dinner tables, took on the powerful food manufacturers and their allies.

Listen to an amputee describe what it was like in the aftermath of his partial foot amputation and how his chronic, extreme pain fueled his depression and his decision to attempt to alleviate the pain with the radical surgery.

This Texas city is having an 'amputation crisis'

Texas has some of the highest rates of diabetes-related amputations in the country. Towering over the rest of the Longhorn state is the city of San Antonio, where men are nearly three times as likely to lose a limb to diabetes than women. This article explains how men in this majority Mexican American city are genetically and culturally at risk of Type 2 diabetes, a disease involving issues with the blood sugar-regulating hormone insulin.

Opioids mimic naturally produced endorphins to dull pain.

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...

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.

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.

Trauma is a primary risk factor for substance use disorder later in life

Studies indicate 75% of people with substance use disorder have experienced at least one traumatic experience in their life. These experiences alter brain function, leading to heightened stress and emotional pain. Substances offer temporary relief, but this often results in dependency.

Fame can trigger addictive, drug-like highs in the brain

Differences in the type of fame, such as movie stardom, sports, and internet virality, can produce varying degrees of dependence on individuals based on their age and background. Some individuals—particularly children—can develop drug-seeking behavior as they pursue continuous dopamine spikes if they lack an existing sense of fulfillment from elsewhere.

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.

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.

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 Missouri farmer sold $140M worth of fake organic feed

Randy Constant sold nonorganic feed to other farmers, who fed it to their animals, which were then sold as organic meat. The scheme began sometime in the mid-2000s and ended after a tip, likely from one of Constant’s competitors, to the US Department of Agriculture. Constant pleaded guilty and was sentenced to 10 years in prison, but died by suicide before serving time.

Addictive drugs can cause dopamine levels to become ten times higher than normal.

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,...

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.

A 49-year-old American died at an ibogaine clinic in Mexico, underscoring its risks

The man had sought out the drug to help him overcome his substance abuse disorder. Though anecdotal reports indicate potential promise, there's been no large-scale clinical trials on ibogaine's safety and efficacy. The plant is derived from a root bark named iboga and has been used for centuries by indigenous communities in Gabon, but first entered scientific consciousness in 1901 after its alkaloid was isolated from Iboga.

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.

Watch the craziest ways cartels traffic drugs

The war on drugs has forced cartels to be increasingly creative when it comes to smuggling drugs. As police develop methods to catch smugglers, drug traffickers come up with new ways to get their products from producer to seller to buyer. This cycle...

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."

Fracking brought short-term wealth and long-term collapse to Rock Springs, Wyoming

In the early 2000s, the fracking boom transformed the quiet mining town into a hub of oil field laborers with plentiful job opportunities. Once the boom faded and industry left, unaffordable housing, unsafe working conditions, and drug epidemics left many residents with no prospects amid a disappearing way of life.