These Eight Charts Show Why Fentanyl Is a Huge Foreign Policy Problem

An explosion of fentanyl-linked overdoses in recent years has driven what has become the deadliest drug crisis in U.S. history. Overdoses involving fentanyl and other synthetic opioids are now by far the leading cause of death for American adults aged eighteen to forty-five, and has become “the single greatest challenge we face as a country,” said Department of Homeland Security (DHS) Secretary Alejandro N. Mayorkas in March 2023. Fentanyl poses an extraordinary threat because the drug is cheap to make, easy to smuggle, and extremely lethal in small doses. Despite growing alarm among the public and policymakers, the crisis continues to devastate communities and overwhelm law enforcement officials. 

Fentanyl has also become a major U.S. foreign policy and national security challenge, as the drug’s supply chain largely runs through China and Mexico. President Joe Biden has declared fentanyl trafficking a national emergency, and he has pushed Chinese President Xi Jinping and Mexican President Andrés Manuel López Obrador to do more to cut the flow of the drug into the United States.

The Human Toll 

Fentanyl is the latest and deadliest culprit in what the Centers for Disease Control and Prevention (CDC) characterizes as the three “waves” of the opioid overdose crisis. The first wave began in the 1990s with prescription-opioid overdoses, followed in the early 2010s with heroin, and a few years later, the rise of fentanyl. Some health officials say a “fourth wave” is emerging amid an increase in overdoses from fentanyl mixed with other stimulants.   

Fentanyl deaths tripled between 2016 and 2021, with overdoses involving the drug and other synthetic opioids quickly rising to become the biggest killer of Americans between the ages of eighteen and forty-five. Overdoses spiked during COVID-19 lockdowns, as social-distancing measures led more people to take drugs alone.

This boom in overdose deaths is due in large part to the fact that many users take the drug unknowingly. Fentanyl is incredibly cheap to produce, and it is increasingly being blended with other illicit drugs, such as cocaine and methamphetamine, as well as fake prescription medicines, often without the user’s knowledge. Out of every ten fake prescription pills sold in the United States, six contain a lethal dose of fentanyl, according to the U.S. Drug Enforcement Administration (DEA). 

Fentanyl and the wider opioid crisis are wreaking havoc on the United States to a degree not seen in other parts of the world.

While opioid addictions have emerged as a significant problem in other countries in recent years, no nation has faced death rates as high as the United States’.

The Global Supply Chain

The majority of the illicit fentanyl consumed in the United States is manufactured abroad. (Meanwhile, the legally made fentanyl used in health-care settings is mostly manufactured within the United States.) The supply chain typically begins in China, where most of fentanyl’s precursor chemicals—the ingredients for the drug—are made. China banned the production and sale of fentanyl in 2019, but it continues to be the primary manufacturer of fentanyl’s precursors. India has also emerged [PDF] as a major source of fentanyl precursors.

Once manufactured, fentanyl precursors are distributed around the world, generally via international mail services. The most common destination is Mexico, where the precursors are synthesized into fentanyl. (Other routes ship the precursors to Canada or directly to the United States.) In 2022, the U.S. State Department identified Mexico as the “sole significant source” [PDF] of illicit fentanyl that crosses the southern U.S. border. Mexican transnational criminal organizations—principally the Jalisco New Generation Cartel and the Sinaloa Cartel—serve as the main producers and traffickers of finished illicit fentanyl.

The Biden administration has taken steps to curb the flow of fentanyl precursors into the United States, including by imposing sanctions against more than two dozen Chinese companies and individuals and adding China to the U.S. list of major illicit drug–producing or drug-transit countries, alongside others such as Colombia, India, and Mexico. More recently, at the Asia-Pacific Economic Cooperation summit in San Francisco in November 2023, Biden reached separate agreements with Chinese President Xi and Mexican President López Obrador to boost bilateral cooperation on curbing the manufacturing and distribution of fentanyl precursor chemicals abroad. However, some experts say the agreement with China, which remains to be finalized, will not be enough to curb rising overdoses.

The Smuggling Challenge

The bulk of the fentanyl that ends up in the United States is smuggled across the U.S.-Mexico border; it is one of the drugs most seized by customs and border patrol officials. Like other illicit drugs, fentanyl is frequently hidden in cargo that passes through legal ports of entry, including road and rail border crossings, or in concealed compartments in vehicles. Traffickers also smuggle fentanyl into the country on foot, through tunnels, and by boat, drone, and plane. In many cases, Mexican criminal groups hire U.S. citizens to smuggle drugs across the border. Data indicates that in fiscal year 2022, Americans accounted for nearly 90 percent [PDF] of fentanyl trafficking convictions.

The potency and portability of fentanyl, compared to other drugs such as marijuana, adds to the challenge facing law enforcement. Most fentanyl is smuggled across the border as pills or powders, or even mixed into other drugs, making it easy to conceal. As little as two milligrams of fentanyl, equivalent to between ten and fifteen grains of table salt, can be lethal. Because fentanyl is often transported in small, hard-to-detect quantities—and because substantially less fentanyl needs to be smuggled into the United States to meet demand—some experts say that relying on catching it at the border is futile.

Some of the busiest crossing points for fentanyl on the southern U.S. border are San Diego, California—described by some officials as the epicenter for fentanyl trafficking—and Tucson, Arizona, both of which have seen overall fentanyl seizures climb in recent years.

It’s also relatively easy for drug cartels to hide their fentanyl production facilities in Mexico, exacerbating the challenge for counternarcotics authorities. One kilogram (about two pounds) of fentanyl—enough for more than fifty thousand doses—can be produced in just a few days in clandestine labs as small as eighteen square meters, or roughly the size of the average American’s living room. By comparison, roughly ten thousand square meters of land, about the area of two football fields, are needed to grow enough poppy plants, the main source of opium, to produce about one kilogram of pure heroin.

The Economic Cost 

Mexican cartels are estimated to have reaped hundreds of millions of dollars from fentanyl trafficking, spurring on a drug crisis that has caused immense damage to the U.S. economy, analysts say. A 2022 report [PDF] by the U.S. Joint Economic Committee stated that the opioid crisis cost the country $1.5 trillion in 2020 alone. This extraordinary figure incorporates the costs of health care, lost productivity in the workforce, counternarcotics and criminal justice efforts, reduced quality of life for overdose survivors, and all human lives lost. This sum is more than the federal government spends on any of its largest agencies or programs, including Medicare, social security, and national defense.

Additional Resources

This Backgrounder by Mariel Ferragamo and Claire Klobucista looks at how fentanyl is exacerbating the U.S. opioid epidemic.

For Think Global Health, CFR Senior Fellow David P. Fidler outlines the foreign policy implications of the U.S. fentanyl crisis.

This episode of the Why It Matters podcast explores China’s role in the U.S. fentanyl crisis.

The Congressional Research Service offers a historical recap of the U.S. opioid crisis in this 2022 report [PDF].

At this CFR webinar, participants discuss policies aimed at ending the opioid crisis and challenges in stopping the flow of fentanyl across U.S. borders.

The Brookings Institution’s Julia Paris and Caitlin Rowley explore the economic impact of the opioid epidemic.

Michael Bricknell and Will Merrow helped create the graphics for this article.