Abstract The United States is facing an unprecedented drug overdose crisis, distinguished from prior epidemics by its severity, widespread impact, and demographic incidence. This study examines demographic overdose trends during the opioid crisis relative to historical disparities. Using a simple decomposition framework, I assess the contributions of specific demographic factors while accounting for other characteristics, finding that many disparities intensify when adjusted for covarying factors. Additionally, I analyze the long-term impacts of OxyContin’s launch, discovering that it induced substantial differences in overdose rates by sex and education. While OxyContin contributed to some racial/ethnic disparities, there is evidence that other factors independently shaped these trends. Nonetheless, all demographic groups were substantially impacted by the introduction and promotion of OxyContin. This research highlights how certain groups have been disproportionately affected by the opioid crisis and the foundational role of supply-side shocks to opioid access in explaining the demographics of the overdose death crisis.