Which wave of the US opioid epidemic was characterized by a rise in heroin overdose deaths?

• A. Wave 1
• B. Wave 2
• C. Wave 3
• D. Wave 4

Answer: (B)

Opioid overdose deaths rose in phases tied to the predominant drug driving mortality. The period characterized by a clear increase in heroin overdoses happened when many people who had been misusing prescription opioids switched to heroin because prescription pills became harder to obtain and more tightly regulated. Heroin then became cheaper and more available, leading to a notable surge in heroin-related deaths and driving the overall overdose mortality upward during the early to mid-2010s. Later waves were driven more by fentanyl and other synthetic opioids, which changed the pattern again. Understanding this shift helps explain why heroin deaths surged during this era and how subsequent waves unfolded with synthetic opioids taking the lead.