Examines the origins, development, and rise of the opioid epidemic in the United States from the perspective of the public policy process.

Written by two political scientists, discusses institutional features of the American political system that impact the making of public policy, arguing that the fragmentation of that system hinders the ability to coherently address policy problems, taking the opioid epidemic as an example.

Analyzes indicators and warning signs pointing to the emergence of a significant public problem, reasons the crisis emerged in the United States and not in other Western countries, the nature and scope of the opioid crisis, including socio-economic and demographic characteristics and the human, social, and economic costs, and parallels between the role played by opioid manufacturers and tobacco/cigarette manufacturers in creating the problem of addiction, resulting in high mortality rates, and the public policy response to both.