The U.S. Fentanyl Crisis: What to Know

What’s happening?

Last month, the U.S. Drug Enforcement Administration (DEA) issued a public safety warning—the agency’s first in six years—about an “alarming” increase in the sale of counterfeit pills laced with fentanyl, a deadly synthetic opioid that is fifty to one hundred times more potent than morphine. As part of a coordinated effort with federal, state, and local law enforcement, the DEA seized 1.8 million counterfeit pills and arrested more than 800 suspected drug traffickers in August and September. 

The surge in supply has led to an uptick in reports of accidental overdoses in towns and cities across the country, from California to New York, though the nationwide toll is still unclear. The trend is part of a broader worsening of the long-running opioid epidemic amid the COVID-19 pandemic and is heightening concerns about the growing threat to public health, national security, and the economy.

What is the scale of the fentanyl crisis?

The Centers for Disease Control and Prevention (CDC) estimates that, in 2020, the number of opioid-related overdose deaths shot up from around fifty thousand the previous year to nearly seventy thousand—making up the vast majority of the country’s record ninety-three thousand overdose deaths. More than 80 percent of these deaths are attributed to synthetic opioids, primarily fentanyl.

The surge in fentanyl-related deaths marks a new point in the decades-long opioid epidemic, which took off in the 1990s with the overuse of prescription opioids for pain relief. Though federal agencies have successfully cracked down on the overprescription of legal opioids in recent years, the shift in demand to illegal opioids such as heroin and fentanyl presents a new, potentially more serious challenge.

Where are the pills coming from?

Criminal drug networks based in Mexico have ramped up their production of illicit fentanyl, including fentanyl-laced fake pills, in recent years. The synthetic opioid is easier and cheaper to produce than heroin and can be made in pill form to look like legal prescription opioids, such as Vicodin, or mixed with illegal drugs, such as cocaine.

Mexican drug cartels use chemicals largely manufactured in China, which was formerly the top source for fentanyl before a clampdown by Beijing. The cartels distribute these pills through their networks in the United States, often online and through social media.

Are other countries struggling with the same problem?

Canada has also been struggling with an illegal opioid crisis, and provinces and cities are experimenting with different strategies to combat it. British Columbia, for example, launched a prescription program earlier this year to distribute relatively strong opioids. It is one of a number of what are known as harm-reduction strategies, which promote safer and managed use of drugs as opposed to abstinence. Some cities are seeking decriminalization of all illegal drugs, arguing among other points that legal drugs are regulated for safety and quality, thereby reducing the risk of overdoses.

Crackdowns by law enforcement helped to cut off an illegal drug market dominated by fentanyl in the small country of Estonia, though abuse of other synthetic drugs has jumped in the last few years. More broadly, Europe has evaded a crisis on the scale of North America’s, but there are growing fears about the increased availability of some opioids. And as fentanyl seeps into regional drug markets, experts say a similar threat faces Asia.

How is the United States responding?

Many health experts say fentanyl test strips—small pieces of paper that can detect the presence of fentanyl in a batch of drugs—are an affordable and easy way to save lives. However, test strips are not widely used, in part because some states classify them as illegal drug paraphernalia. 

In April, the CDC and the Substance Abuse and Mental Health Services Administration announced that states and territories could begin using federal funding to purchase rapid fentanyl test strips. Additionally, states such as Arizona and Rhode Island have legalized them and are working to make them more accessible.

That same month, the Food and Drug Administration (FDA) authorized a higher-dose version of naloxone—a drug to reverse opioid overdoses in emergencies—to counter more potent opioids such as fentanyl, though some health experts have concerns about the marketing of a higher-dose drug.

And in September, the Joe Biden administration asked Congress to permanently classify all fentanyl-related substances as Schedule I drugs, a category reserved for those considered to pose the highest risk for abuse and dependence. However, many civil society and community health groups have opposed the move, saying it will lead to unnecessary prosecutions and will fail to address the root causes of overdoses.

The drug-scheduling proposal is part of President Biden’s broad plan to tackle the opioid crisis, which would also invest tens of billions of dollars to support law enforcement efforts to curb the influx of fentanyl and other illegal drugs and would expand prevention and treatment services. Addiction experts warn that many states cut funding for opioid-recovery programs last year as they faced financial woes from the pandemic, and that recent settlements from lawsuits against drugmakers such as Purdue Pharma will not provide states with enough money to combat the opioid crisis.

Melissa Manno contributed to this In Brief. Will Merrow created the graphic.