Among developed nations, the United States has been often afflicted with opiate and opioid addiction epidemics. This presentation examines four such epidemics: in the late nineteenth century, the late 1940s, the late 1960s, and the epidemic that began in the late 1990s and early 2000s, involving both pharmaceutical and illicit opioids, that has yet to run its course. What historical, social, political, and economic factors made such epidemics more frequent and extensive in the United States than in comparable western societies?