The Scourge of Fentanyl
By Daniel Patrick Atchue
Amid the posturing and brinkmanship that has characterized the U.S.-China and U.S.-Mexico relationships throughout the Trump Administration—whether over trade, immigration, telecommunications, or China’s Belt and Road Initiative—a constant point of contention has been the scourge of illicitly manufactured fentanyl which continues to fuel the deadliest drug epidemic in American history.
Between 2000 and 2016, more Americans died from opioid overdoses than the total American servicemembers killed in World War I and World War II combined. In 2017 alone, the most recent year for which data is available, approximately 47,600 Americans succumbed to opioid overdoses—more than the total American fatalities in the wars in Iraq and Afghanistan. Just under 29,000 of the total number of opioid deaths in 2017, approximately 60 percent, were attributable to synthetic opioids—primarily fentanyl. The mortality rate from opioids in 2017 contributed to the third consecutive year in which life expectancy has declined in the United States, the first time such a phenomenon has occurred since the 1960s. And although provisional data from the Centers for Disease Control and Prevention indicate that overall drug overdoses fell in 2018, deaths from fentanyl and other synthetic opioids continued to rise. The enduring lethality of fentanyl, and the ease with which it is trafficked into the United States, represents a perilous threat to national security in need of a sustained response from law enforcement, public health officials, and international counterparts.
Unlike heroin, which is derived from the poppy plant, fentanyl is a synthetic opioid which is manufactured in laboratories using inexpensive precursor chemicals. While fentanyl was first developed as an intravenous anesthetic and is still used for that purpose today, illicit fentanyl is trafficked into the United States as a cheaper alternative to heroin to meet the demand of a population already addicted to opioids. Fentanyl is approximately fifty times more potent than heroin and 100 times stronger than morphine. It is often sold alone or in combination with either heroin or counterfeit pills imitating pharmaceutical drugs such as oxycodone. Like other opioids, fentanyl can elicit feelings of extreme happiness and sedation in users by increasing dopamine levels. But in the event of an overdose, it can cause respiratory arrest, hypoxia, and death.
Illicitly manufactured fentanyl is primarily trafficked into the United States from China and Mexico in the form of powder or counterfeit pills. Shipments from Mexico generally make it into the United States through legal ports of entry on the southwest border where smuggling operations are primarily controlled by the Sinaloa and Jalisco New Generation cartels. Fentanyl from China is shipped in smaller quantities and is transported in parcels which reach the United States via the United States Postal Service (“USPS”). Despite the smaller quantities in each shipment, Chinese fentanyl is more than 90 percent pure and thus carries a higher risk to American users than Mexican fentanyl which is less than 10 percent pure. The trafficking of Chinese-manufactured fentanyl into the United States is facilitated by purchases made by Americans on the “dark web” with payments made using money service businesses and virtual currencies.
The fentanyl epidemic is considered the “third wave” of America’s larger opioid epidemic which began in the 1990s with the marketing of addictive prescription painkillers, such as OxyContin, before morphing into a heroin crisis as patients sought cheaper alternatives to pharmaceuticals on the black market. Illicitly manufactured fentanyl emerged as a serious public health concern around 2013. Between that year and 2014, the number of drugs confiscated by law enforcement that tested positive for fentanyl increased by 426 percent and the number of fentanyl deaths more than tripled from 392 in 2013 to 1,400 in 2014.
Despite the slow initial response to the unique threat posed by illicitly manufactured fentanyl, the federal government has recently taken some measures to mitigate the crisis. The White House’s 2017 National Security Strategy specifically cites the dismantlement of transnational criminal organizations, including drug cartels and Chinese fentanyl traffickers, as a top national security priority alongside the defeat of jihadist terrorists and the defense against weapons of mass destruction. In October of 2017, President Trump declared the opioid epidemic a public health emergency. Concurrently, the Justice Department announced its first indictments against Chinese manufacturers of fentanyl. And in 2018, Congress passed the Support for Patients and Communities Act which expanded access to addiction treatment and provided funding for the research of alternative pain medications.
Although these measures are welcome, illicitly manufactured fentanyl continues to successfully reach the United States. Following the terrorist attacks on September 11, 2001, fearing that terrorists could mail biological weapons, Congress passed a law in 2002 requiring advanced electronic data on all packages entering the United States through commercial companies such as UPS and FedEx. However, the legislation exempted the USPS. In 2018, Congress passed another law, the “Synthetics Trafficking and Overdose Protection Act of 2018,” which the USPS tried to defeat. It still has not implemented all of the safeguards required by the legislation such as tracking senders and recipients of all packages from China.
President Trump has spent much of his administration hectoring his Chinese counterpart, President Xi Jinping, to crack down on illicit fentanyl manufacturing. Indeed, President Trump has cited China’s failure to address the smuggling as a justification for raising tariffs on Chinese goods. However, even if China were to clamp down on its underregulated chemical and pharmaceutical sectors, doing so would not eliminate the market for synthetic opioids of which American demand is the primary component. Therefore, in addition to working with law enforcement partners in China and Mexico and continuing to vigilantly monitor all incoming packages and vehicles entering the country, the United States must commit substantially more resources to combating the opioid epidemic domestically by expanding access to addiction treatment services, education, and primary care. As long as the American public suffers from opioid dependency, international suppliers—whether in China, Mexico, or India—will be incentivized to meet the demand at the expense of America’s national security.