From the legacy of morphine-addicted Civil War veterans to the rock-and-roll drug culture of the ’60s, the United States has had a long dark history with opioid abuse. But today’s burgeoning overdose crisis is threatening to become the deadliest chapter in the country’s relationship with heroin.

InsideSources offers a look at how this generation’s wave of heroin addiction has exploded into a national crisis:


Too Many Prescriptions

The crisis has its roots in the 1990s and early 2000s, when drug manufacturer Purdue Pharma promoted new painkiller OxyContin as less addictive than older drugs, fueling a prescription-writing boom across the U.S. (and Canada).

It wasn’t until May 2007 that the Stamford, Conn.-based company pleaded guilty to misleading doctors about the risk of addiction. After coughing up $600 million in penalties, Purdue reconfigured its flagship painkiller to be more “abuse resistant.” Since then, sales of OxyContin and other powerful painkillers like Vicodin, Percocet and Dilaudid have only grown.

Dr. David Juurlink, head of Clinical Pharmacology and Toxicology at the University of Toronto, told InsideSources that U.S. and Canadian physicians have to look to alternative therapies to help patients in need. Otherwise, the overdose deaths will continue.

“It’s a product of the overprescribing of these drugs over the last 20 years,” Juurlink said.


Mexican Poppies

According to the American Society of Addiction Medicine, four in five new heroin users started out misusing prescription painkillers. And as concerns about prescription abuse tightened access in recent years, addicts who couldn’t get a fix at their doctor’s office turned to a cheap and plentiful alternative available on the street.

Cutting Afghanistan out of the heroin trade, Mexican drug cartels started growing their own poppies in rural Mexico, using long-established smuggling routes to flood the Unites States with high-grade white heroin.

Mexican farmers turned to heroin in part because the growing trend of legalized marijuana in the United States was cutting into the pot business.

Recreational or medical marijuana has been approved by voters in the District of Columbia and 23 U.S. states, with Colorado, Washington state, Alaska and Oregon fully legalizing the drug. Greenhouse-grown American pot, more potent and higher quality than marijuana from Mexico, forced the cartels to turn to harder drugs like heroin and meth to stay in business.


This Is Heroin on Steroids

The heroin that U.S. soldiers encountered in Vietnam in the 1960s and 1970s may have been 5 percent pure drug cut with fillers. But the heroin coming from Mexico now commonly ranges from 50 percent to as much as 80 percent pure. The higher the purity level, the higher the risk of overdose, especially for unsuspecting addicts.


Maybe Nancy Reagan Was Right After All

Florida Rep. John Mica, like many other Republicans, blames today’s overdose crisis in part on the Obama administration’s decision to relax some elements of the country’s decades-long “War on Drugs.”

Mica has said the president has sent mixed signals on drug use, especially marijuana, which the GOP congressman called a gateway to heroin. The “Just Say No,” anti-drug slogan of the Reagan administration, Mica lamented at Tuesday’s House Oversight and Government Reform Committee hearing, has become “Just say OK.”


Racism in the Reaction? 

Rep. Elijah E. Cummings, a black Democrat from Baltimore, noted during the same hearing that the country seems more empathetic now toward those swept up in addiction and trafficking than when his hometown was ravaged by drug wars 20 years ago.

“In Baltimore, where many of the victims were poor and black … We incarcerated a generation rather than giving them the treatment they needed,” Cummings said. “Between 2006 and 2013, the number of first-time heroin users nearly doubled, and about 90 percent of these first-time users were white.”


People Are Dying at Alarming Rates

Politicians, law enforcement officials and medical professionals may differ on the root causes, but there is little disagreement that the country, from New Hampshire to Ohio to Florida, is in the midst of an opioid crisis.

According to the Department of Health and Human Services, mortality rates from unintentional drug overdose have risen steadily since the early 1970s, with opioid abuse claiming five times more lives now than during the “black tar” heroin epidemic of the mid-1970s.

From 2000 to 2014 nearly half a million Americans died from drug overdoses, the Centers for Disease Control reported in December. Opioid overdose deaths, including both opioid pain relievers and heroin, hit record levels in 2014 — an estimated 28,000 lives lost.

That’s up from less than 6,000 in 2001.

The House is considering a sweeping anti-opioid-abuse measure that passed the Senate 94-1 earlier this month. The $600 million legislation would expand access to treatment and provide local communities with an overdose antidote called naloxone. The White House, in its proposed 2017 budget, had sought $1.1 billion, but even the less-costly Senate bill is stalled in the House over budgetary concerns.