rise in heroin use and overdose deaths. Between 2005 and 2012, the number of people who used heroin almost doubled from 380,000 to 670,000. In 2010, there were 2,789 fatal heroin overdoses, almost a 50% increase from the years prior. This spike reflects the increase in heroin supplies in the United States and the decrease in prices, which encouraged a large proportion of individuals with an established dependency and tolerance on opioids to transition towards a more concentrated and cheaper alternative. During this same period, there was also a reformulation of OxyContin that made it more difficult to crush and use it; however, the effect of this formulation on the rise in heroin use is still unclear. The third and most recent wave of the opioid epidemic began in 2013 and is ongoing. This wave coincides with the steep rise in overdose deaths that involved synthetic opioids, particularly illegally produced fentanyl. The epidemic has been described as a "uniquely American problem." The structure of the U.S. healthcare system, in which people not qualifying for government programs are required to obtain private insurance, favors prescribing drugs over more expensive therapies. According to Professor Judith Feinberg, "Most insurance, especially for poor people, won't pay for anything but a pill." Prescription rates for opioids in the United States are 40 percent higher than the rate in other developed countries such as Germany or Canada. While the rates of opioid prescriptions increased between 2001 and 2010, the prescription of non-opioid pain relievers (aspirin, ibuprofen, etc.) decreased from 38% to 29% of ambulatory visits in the same period, and there has been no change in the amount of pain reported in the United States. This has led to differing medical opinions, with some noting that there is little evidence that opioids are effective for chronic pain not caused by cancer. The annual opioid prescribing rates have been slowly decreasing since 2012, but the number is still high. There were about 58 opioid prescriptions per 100 Americans in 2017. Characteristics of jurisdictions with a greater number of opioid prescriptions per resident include small cities or large towns, cities with more dentists and primary care doctors per capita, cities with a higher percentage of white residents, cities with a higher uninsured/unemployment rate, and cities with more residents who have diabetes, arthritis, or a disability.[2]. Several studies have been conducted to find out how opioids were primarily acquired,