The opioid crisis in the United States was significantly fueled by patterns in opioid prescribing that began in the late 1990s and early 2000s. During this period, healthcare providers dramatically increased the prescribing of opioid medications, driven in part by misleading assurances from pharmaceutical companies that these drugs posed a low risk of addiction. Opioids were widely promoted for the treatment of both acute and chronic pain, leading to a surge in prescriptions across a range of clinical settings, often without sufficient attention to alternative treatments, patient risk factors, or long-term consequences. This widespread availability of prescription opioids contributed to increased misuse, diversion, and dependence among patients and communities. As tolerance built and prescriptions ran out, some individuals transitioned to illicit opioids like heroin and, more recently, fentanyl—fuels of the current overdose epidemic. Although prescribing practices have shifted in response to growing awareness, clinical guidelines, and regulatory oversight, the legacy of overprescribing remains a central factor in the trajectory of the opioid crisis. Addressing its impact requires ongoing efforts to balance appropriate pain management with the prevention of misuse, alongside expanded access to treatment and harm reduction services.