Something about the nature of this epidemic delayed the sense of calamity. As the coroner of Montgomery County, Ohio, has said, it’s a “mass-casualty event,” but one played out in slow motion. First, in the nineteen-nineties, came mounting overdose deaths from prescription drugs such as OxyContin; then, around 2000, many users switched to heroin, a cheaper alternative; in the past few years, people increasingly have been dying from potent synthetic painkillers such as fentanyl and carfentanil. The quietness of the tragedy is also connected to the effects of opioids themselves: people hooked on them numb their pain, whatever its causes, rather than raging against it.