We all read and hear about the opioid crisis on virtually a daily basis. It is presently responsible for the deaths of tens of thousands of Americans every year, but as a public health issue it is far from the largest preventable cause of premature death. Its origins date to the early 2000s, and have been largely attributed to the pharmaceutical industry, overprescribing, and the culture of medicine to combat pain. However, while these phenomena have some role to play in our present circumstance, the true origins are far more complicated and ingrained in our present economic and political realities. The opioid crisis is sadly here to stay for the foreseeable future.