of ailments, even for relatively minor treatments such as cough relief. bayer began marketing heroin commercially in 1898. beginning around 1920, however, the addictiveness was recognized, and doctors became reluctant to prescribe opiates. heroin was made an illegal drug with the anti-heroin act of 1924, in which the us congress banned the sale, importation, or manufacture of heroin. in the 1950s heroin addiction was still fairly uncommon among average americans, many of whom saw it as a frightening condition. the fear extended into the 1960s and 1970s, although it became common to hear or read about drugs such as cannabis and psychedelics, which were widely used at rock concerts like woodstock. heroin addiction began to make the news around 1970 when rock star janis joplin died from an overdose. during and after the vietnam war, addicted soldiers returned from vietnam, where heroin was easily bought. heroin addiction grew within low-income housing projects during the same time period. in 1971, congressmen released an explosive report on the growing heroin epidemic among us servicemen in vietnam, finding that ten to fifteen percent were addicted to heroin. "the nixon white house panicked," wrote political editor christopher caldwell, and declared drug abuse "public enemy number one". by 1973, there were 1.5 overdose deaths per 100,000 people. modern prescription opiates such as vicodin and percocet entered the market in the 1970s, but acceptance took several years and doctors were apprehensive about prescribing them. until the 1980s, physicians had been taught to avoid prescribing opioids because of their addictive nature. a brief letter published in the new england journal of medicine (nejm) in january 1980, titled "addiction rare in patients treated with narcotics", generated much attention and changed this thinking. a group of researchers in canada claim that the letter may have originated and contributed to the opioid crisis. the nejm published its rebuttal to the 1980 letter in june 2017, pointing out among other things that the conclusions were based on hospitalized patients only, and not on patients taking the drugs after they were sent home. the original author, dr. hershel jick, has said that he never intended for the article to justify widespread opioid use. in the mid-to-late 1980s, the crack epidemic followed widespread cocaine use in american cities. the death rate was worse, reaching almost 2 per 100,000. in 1982, vice president george h. w. bush and his aides began pushing for the involvement of the cia and the us military in drug interdiction efforts, the so-called war on drugs. the initial promotion and marketing of oxycontin was an organized effort throughout 1996–2001, to dismiss the risk of opioid addiction. purdue pharmaceuticals, which heavily promoted oxycodone, increasing their earning to us$35 billion by 2017. purdue pharma hosted over forty promotional conferences at three select locations in the southwest and southeast of the united states. coupling a convincing "partners against pain" campaign with an incentivized bonus system, purdue trained its salesforce to convey the message that the risk of addiction was under one percent, ultimately influencing the prescribing habits of the medical professionals that attended these conferences. consulting firm mckinsey & company reached a nearly $600 million settlement with 49 of 50 u.s. states in 2021 over the firm's role in driving opioid sales for purdue pharma and other pharmaceutical companies. in 2016, the opioid epidemic was killing on average 10.3 people per 100,000, with the highest rates including over 30 per 100,000 in new hampshire and over 40 per 100,000 in west virginia. according to the substance abuse and mental health services administration's national survey on drug use and health, in 2016 more than 11 million americans misused prescription opioids, nearly 1 million used heroin, and 2.1 million had an addiction to prescription opioids or heroin. while rates of overdose of legal prescription opiates have leveled off in the past decade, overdoses of illicit opiates have surged since 2010, nearly tripling. in a 2015 report, the us drug enforcement administration stated that "overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels.": iii nearly half of all opioid overdose deaths in 2016 involved prescription opioids. from 1999 to 2008, overdose death rates, sales, and substance use disorder treatment admissions related to opioid pain relievers all increased substantially. by 2015, there were more than 50,000 annual deaths from drug overdose, causing more deaths than either car accidents or guns. in 2016, around 64,000 americans died from overdoses, 21 percent more than the approximately 53,000 in 2015. by comparison, the figure was 16,000 in 2010, and 4,000 in 1999. while death rates varied by state, in 2017 public health experts estimated that nationwide over 500,000 people could die from the epidemic over the next 10 years. in canada, half of the overdoses were accidental, while a third were intentional. the remainder were unknown. many of the deaths are from an extremely potent opioid, fentanyl, which is trafficked from mexico. the epidemic cost the united states an estimated $504 billion in 2015. in 2017, around 70,200 americans died from drug overdose. 28,466 deaths were associated with synthetic opioids such as fentanyl and fentanyl analogs, 15,482 were associated with heroin use, 17,029 with prescription opioids (including methadone), 13,942 with cocaine use, and 10,333 with psychostimulants (including methamphetamine). in 2021, there was an increase in overdose deaths; more than 106,000 drug-related overdoses occurred, including deaths caused by both illegal and prescribed opioids. of this, 70,601 deaths were caused by synthetic opioids primarily fentanyl. additionally, 32,537 overdose deaths involved stimulants like cocaine or psychostimulants with abuse potential (primarily methamphetamine). between 2017 and 2019, rappers lil peep, mac miller, and juice wrld died of drug overdoses related to opioids. william d. bodner of the drug enforcement administration's los angeles field division and special agent in charge of the investigation into miller's death said in a statement, “the tragic death of mac miller is a high-profile example of the tragedy that is occurring on the streets of america every day.” heroin between 4–6% of people who misuse prescription opioids turn to heroin, and 80% of heroin addicts began abusing prescription opioids. many people addicted to opioids switch from taking prescription opioids to heroin because heroin is less expensive and more easily acquired on the black market. women are at a higher risk of overdosing on heroin than men. overall, opioids are among the biggest killers of every race. heroin use has been increasing over the years. an estimated 374,000 americans used heroin in 2002–2005, and this estimate grew to nearly double where 607,000 of americans had used heroin in 2009–2011. during the first two waves of the opioid epidemic, heroin use increased among non-hispanic whites but decreased among non-white groups; additionally during this time , the vulnerability for overdose shifted to younger age groups. in 2014, it was estimated that more than half a million americans had an addiction to heroin. oxycodone oxycodone is the most widely used recreational opioid in the united states. the us department of health and human services estimates that about 11 million people in the us consume oxycodone in a non-medical way annually. a chart outlining the structural features that define opiates and opioids, including distinctions between semi-synthetic and fully synthetic opiate structures oxycodone was first made available in the united states in 1939. in the 1970s, the fda classified oxycodone as a schedule ii drug, indicating a high potential for non-medical use and addiction. after its 1995 approval by the fda by deputy director curtis wright iv, purdue pharma introduced oxycontin, a controlled release formulation of oxycodone in 1996. however, drug users quickly learned how to simply crush the controlled release tablet to swallow, inhale, or inject the high-strength opioid for a powerful morphine-like high. in fact, purdue's private testing conducted in 1995 determined that 68% of the oxycodone could be extracted from an oxycontin tablet when crushed. in 2007, purdue paid $600 million in fines after being prosecuted for making false claims about the risk of opioid use disorder associated with oxycodone. in 2010, purdue pharma reformulated oxycontin, using a polymer to make the pills extremely difficult to crush or dissolve in water to reduce non-medical use of oxycontin. the fda approved relabeling the reformulated version as abuse-resistant. oxycontin use following the 2010 reformulation declined slightly while no changes were observed in the use of other opioids. in june 2017, the fda asked the manufacturer to remove its long-acting form of oxymorphone (opana er) from the us market, because the drug's benefits may no longer outweigh its risks, this being the first time the agency has asked to remove a currently marketed opioid pain medication from sale due to public health consequences of non-medical use. hydrocodone hydrocodone is second among the list of top prescribed opioid painkillers, but it is also high on the list of most frequently used for recreational use. in 2011, the non-medical use of hydrocodone was responsible for more than 97,000 visits to the emergency room. in 2012, the food and drug administration (fda) rescheduled it from a schedule iii drug to a schedule ii drug, recognizing its high potential for non-medical use and addiction. hydrocodone can be prescribed under a different brand name. these brand names include norco, lortab, and vicodin. hydrocodone can also exist in other formulations where it is combined with another non-opioid pain reliever such as acetaminophen, or even a cough suppressant. when opioids like hydrocodone are taken as prescribed, for the indication prescribed, and for a short period of time, then the risk of non-medical use and addiction is small. problems have surfaced over the last decade however, due to its wide overuse and misuse in the setting of chronic pain. the elderly are at an increased risk for opioid related overdose because several different classes of medications can interact with opioids and older patients are often taking multiple prescribed medications at a single time. one class of drug that is commonly prescribed in this patient population is benzodiazepines. benzodiazepines by themselves put older people at risk for falls and fractures due to associated side effects related to dizziness and sedation. opioids by themselves put older people at risk of respiratory depression and impaired ability to operate vehicles and other machinery. combining these two drugs together not only increases a person's risk of the aforementioned adverse effects, but it can increase a person's risk of overdose and death. benzodiazepines is also the second leading cause of teen overdose death after fentanyl. it killed 152 people in 2021, less than a fifth of fentanyl's death toll. statistics show that hydrocodone ranks in at number 4 on the list of the most common drugs used recreationally in the united states and that more than 40% of drug-related emergencies occur due to opioid use disorder. twenty percent of people who use opioids recreationally, another statistic reports, were prescribed the medication they used. hydrocodone was declared the most widely prescribed opioid between 2007 and 2016, and in 2015 the international narcotics control board reported that greater than 98% of the hydrocodone consumed in the entire world was consumed by americans. codeine codeine is a prescription opiate used to treat mild to moderate pain. it is available as a tablet and cough syrup. approximately 33 million people use codeine each year. a 2013 study on the concoction of codeine with alcohol or soda, also known as "purple drank," discovered that codeine is most widely used in a recreational way by men, native americans and hispanics, urban students, and lgbt persons. the study also noted that all people who used "purple drank" reported using alcohol within the past month, and roughly 10 percent of cannabis users reported abusing "purple drank". adolescent use of prescription codeine for recreational use raises concerns. in 2008, the samhsa reported 3 million young adults, ranging from ages 12 to 25, had used codeine-based cough syrup to get high. in 2014, 467,000 american adolescents used these opiates for non-medical purposes, and 168,000 of these were considered to have an addiction. due to its high rates of non-medical use, the drug enforcement administration (dea) reclassified codeine as schedule iii for increased meticulous monitoring. fentanyl as of 2021, america's drug epidemic was the deadliest it had ever been, according to federal data. more than 100,000 people died of drug overdoses in the united states during