Skip to Main Content

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.”

In the last few years, there has been a significant increase in deaths associated with poly-substance use — meaning drug users are combining types of drugs, most commonly opioids and methamphetamine.


In this short documentary, STAT looks at how the overdose crisis has changed shape since the fourth wave came ashore.

This story is part of a series on addiction in 2022, supported by a grant from the National Institute of Health Care Management.