Previous research on the burgeoning opioid epidemic finds that prescription opioids provided the foundation for increasing opioid demand. This thesis replicates prior studies documenting changes in the factors associated with opioid overdose using data from 2008-2010 and 2015-2017 to attend to shifting patterns over time. I also attempt to address the interaction of institutional, racial, and class forces in contributing to high prescribing and overdose rates. With a sample of 546 U.S. counties, I conduct regression analyses to examine how social ecology provokes the flood of prescriptions into an area and how these factors are associated with death rates from both prescription and illicit opioids. Consistent with my hypotheses, high levels of economic distress and a high percent of the population identifying as white interact to predict high prescription rates in both time periods. Economic conditions and racial composition. These factors are also predictive of overdose rates, but are mediated by prescription rates in the earlier time period. However, prescription rate loses predictive power in the second time period, which warrants further research into the racialized roots of this public health crisis and the underground market driving overdose rates today.