Fentanyl in the US: A visual guide
Fentanyl is powerful synthetic opioid that can be up to 100 times more potent than morphine.
It can be prescribed in formal medical settings to relieve severe pain and treat breakthrough pain when longer-acting pain medications aren't enough. Injections may be used during or after surgery, for example, while patches help treat persistent pain in patients that may have become tolerant to other treatments. It can also be administered through a lozenge.
But fentanyl has become the most common drug involved in overdose deaths in the United States, fueling what the US Centers for Disease Control and Prevention has identified as the 'third wave' of the opioid overdose epidemic. Fentanyl is relatively cheap to make, and its high potency means that supply can stretch far, making it an attractive option in the illicit market. Illicit fentanyl is typically found in powder form or pressed into counterfeit pills that look like prescription opioids. It can also be mixed into other drugs such as heroin to raise the potency at lower cost.
President Donald Trump is using the drug epidemic as a key justification for tariffs on goods from Mexico, Canada and China; a fact sheet from the administration says that 'the flow of contraband drugs like fentanyl to the United States, through illicit distribution networks, has created a national emergency, including a public health crisis.' Tariffs on Mexico and Canada were put on hold for 30 days after the countries pledged to bolster border security, but a 10% tariff on goods from China took effect in early February.
The US imports the vast majority of medical fentanyl from China, which is shipped directly in finished form.
The illicit supply of fentanyl in the US also originates in China. At first, the illicit supply would also ship directly from China to the US, but it's evolved into disparate streams. Now, there is no evidence that legal fentanyl is being diverted to the black market. Large shipments of precursor ingredients for illicit fentanyl are sent from China to Mexico, where they are processed in labs and the final product is smuggled over the border into the US.
Most of the precursor ingredients 'are pretty basic chemicals with wide-scale applications, so hiding the shipments is not very complicated,' said Vanda Felbab-Brown, a senior fellow at the Brookings Institute who has led various initiatives centered on the opioid epidemic and global drug policy.
Mexican cartels then rely on established routes for drug trafficking that have been in place for a long time, often through legal ports of entry using US citizens that are recruited as mules.
Nearly 22,000 pounds of fentanyl were seized at US borders during the 2024 fiscal year, according to data from the US Customs and Border Protection. Nearly all of it – about 97% – was confiscated along the southwest border, with seizures in Tucson, Arizona, accounting for more than half and another 30% in San Diego.
Just a couple dozen pounds of fentanyl were seized along the northern US border with Canada last year, CBP data shows, and experts say that the illicit networks in Canada are almost entirely separate from those in the US.
'We don't get any significant amount of fentanyl from Canada,' Felbab-Brown said. 'The small seizures that have been conducted at the northern border have mostly to do with US citizens buying fentanyl in Canada for personal consumption and then smuggling it themselves.'
Although law enforcement seizures of illicit fentanyl have surged in recent years, there's also some evidence that the drug supply is changing again. The drug epidemic is dynamic, and the market can evolve quickly in response to different drivers of supply and demand, experts say – it's been happening for decades.
According to the CDC, the first wave of the opioid overdose epidemic started in the 1990s with the abuse of prescription opioids. Purdue Pharma and its owners, members of the Sackler family, reached a multibillion-dollar settlement this year to resolve thousands of lawsuits alleging that the pain medication OxyContin caused a widespread opioid addiction crisis in the US.
There were rapid increases in overdoses involving heroin starting in 2010, which the CDC considers the second wave, but synthetic opioids – primarily fentanyl – took over around 2013.
Overdoses surged during the Covid-19 pandemic, reaching a peak between the fall of 2022 and the summer of 2023, when the CDC estimates that there were nearly 115,000 overdose deaths in one year. Synthetic opioids, primarily fentanyl, were involved in about two-thirds of those deaths.
But overdose deaths started a rapid decline at the start of last year. Fentanyl is still involved in most cases, but the latest data shows that annual deaths are down 22% compared with a year earlier. There were about 58,000 deaths involving synthetic opioids in the 12-month period ending in August.
Some experts suggest that a 'fourth wave' of the opioid epidemic is underway, in which illicit fentanyl is more frequently mixed with other drugs, and the combination of fentanyl and stimulants can be particularly dangerous. During the time that overdose deaths involving opioids declined, those involving cocaine and psychostimulants such as methamphetamine increased, according to the preliminary data from the CDC.
Experts say that it's difficult to attribute the rapid decrease in overdose deaths to one factor. Instead, it's probably the result of a wide range of persistent efforts starting to make an impact.
Changes to supply started happening well before Trump's tariffs were announced. In November, the US Drug Enforcement Administration said it was finding lethal doses of fentanyl in fewer pills than it did a year earlier. About 5 out of every 10 fentanyl pills that the agency tested last year had lethal doses of the synthetic opioid painkiller fentanyl, down from about 7 in 10 the year before, the agency said.
Drug samples analyzed by the Center for Forensic Science Research and Education also showed a slight downward trend in the average purity of fentanyl powder, but it was a relatively small dip in a highly variable drug supply.
Under President Joe Biden, the US Department of Health and Human Services launched a coordinated national strategy to prevent overdoses, with efforts focused on harm reduction – such as fentanyl test strips, overdose reversal medications and safe injection sites – as well as prevention, treatment and recovery from substance use disorder.
'Finally treating this like a public health condition after so many years of effort and attention may be starting to pay off,' Dr. Sarah Wakeman, senior medical director for substance use disorder at Mass General Brigham, told CNN in September.
In a deep dive into the trends, street drug scientist Nabarun Dasgupta and colleagues at the University of North Carolina found that non-fatal overdoses have also fallen significantly and that trends are relatively consistent at the state level – all signs that help experts feel that the overall trend is solid.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
41 minutes ago
States can cut off Medicaid funding to Planned Parenthood, the Supreme Court rules
WASHINGTON -- A divided Supreme Court allowed states to cut off Medicaid money to Planned Parenthood in a ruling handed down Thursday amid a wider Republican-backed push to defund the country's biggest abortion provider. The case centers on funding for other health care services Planned Parenthood provides in South Carolina, but the ruling could have broader implications for Medicaid patients. The court split 6-3 in the opinion, with the three liberal justices dissenting. Public health care money generally can't be used to pay for abortions. Medicaid patients go to Planned Parenthood for things like contraception, cancer screenings and pregnancy testing, in part because it can be tough to find a doctor who takes the publicly funded insurance, the organization has said. South Carolina's Republican governor says no taxpayer money should go the organization. The budget bill backed by President Donald Trump in Congress would also cut Medicaid funding to Planned Parenthood. That could force the closure of about 200 centers, most of them in states where abortion is legal, the organization has said. Gov. Henry McMaster first moved to cut off Medicaid funding to Planned Parenthood in 2018 but was blocked in court after a lawsuit from a patient named Julie Edwards. Edwards wanted to keep going there for birth control because her diabetes makes pregnancy potentially dangerous, so she sued over a provision in Medicaid law that allows patients to choose their own qualified provider. South Carolina, though, argued that patients shouldn't be able to file those lawsuits. The state pointed to lower courts that have been swayed by similar arguments and allowed states such as Texas to block Medicaid funding from Planned Parenthood. Public health groups like the American Cancer Society, by contrast, said in court papers that lawsuits are the only real way that Medicaid patients have been able to enforce their right to choose their own doctor. Losing that right would reduce access to health care for people on the program, which is estimated to include one-quarter of everyone in the country. Rural areas could be especially affected, advocates said in court papers. In South Carolina, $90,000 in Medicaid funding goes to Planned Parenthood every year, a tiny fraction of the state's total Medicaid spending. The state banned abortion at about six weeks' gestation after the high court overturned it as a nationwide right in 2022.
Yahoo
an hour ago
- Yahoo
Senate struggle over Medicaid cuts threatens progress on Trump's big bill
WASHINGTON (AP) — One key unsettled issue stalling progress on President Donald Trump's big bill in Congress is particularly daunting: How to cut billions from health care without harming Americans or the hospitals and others that provide care? Republicans are struggling to devise a solution to the health care problem their package has created. Already, estimates say 10.9 million more people would be without health coverage under the House-passed version of the bill. GOP senators have proposed steeper reductions, which some say go too far. 'The Senate cuts in Medicaid are far deeper than the House cuts, and I think that's problematic,' said GOP Sen. Susan Collins of Maine. Senators have been meeting behind closed doors and with Trump administration officials as they rush to finish up the big bill ahead of the president's Fourth of July deadline. Much of the package, with its tax breaks and bolstered border security spending, is essentially drafted. But the size and scope of healthcare cuts are among the toughest remaining issues. It's reminiscent of the summer during Trump's first term, in 2017, when Republicans struggled to keep their campaign promise to 'repeal and replace' the Affordable Care Act, or Obamacare, only to see the GOP splinter over the prospect of Americans losing health coverage. That legislation collapsed when then-Sen. John McCain famously cast a thumbs-down vote. Senate Majority Leader John Thune is determined to avoid that outcome, sticking to the schedule and pressing ahead with voting expected by the end of the week. 'This is a good bill and it's going to be great for our country,' Thune said Wednesday, championing its potential to unleash economic growth and put money in people's pockets. The changes to the federal health care programs, particularly Medicaid, were always expected to become a centerpiece of the GOP package, a way to offset the costs of providing tax breaks for millions of Americans. Without action from Congress, taxes would go up next year when current tax law expires. The House-passed bill achieved some $1.5 trillion in savings overall, a large part of it coming from changes to health care. The Medicaid program has dramatically expanded in the 15 years since Obamacare became law and now serves some 80 million Americans. Republicans say that's far too high, and they want to shrink the program back to a smaller size covering mainly poorer women and children. House Democratic Leader Hakeem Jeffries said Republicans are 'trying to take away healthcare from tens of millions of Americans.' Democrats are uniformly opposed to what they call the 'big, ugly bill.' Much of the health care cost savings would come from new 80-hour-a-month work requirements on those who receive Medicaid benefits, even as most recipients already work. But another provision, the so-called provider tax that almost all the states impose to some degree on hospitals and others that serve Medicaid patients, is drawing particular concern for potential cuts to rural hospitals. Sen. Josh Hawley, R-Mo., said several senators spoke up Wednesday during a private meeting indicating they were not yet ready to start voting. 'That'll depend if we land the plane on rural hospitals,' he said. States impose the taxes as a way to help fund Medicaid, largely by boosting the reimbursements they receive from the federal government. Critics decry the system as a type of 'laundering' but almost every state except Alaska uses it to help provide the health care coverage. The House-passed bill would freeze the provider taxes at current levels, while the Senate proposal goes deeper by reducing the tax that some states are able to impose. 'I know the states are addicted to it,' said Sen. Roger Marshall, R-Kan. But he added, 'Obviously the provider tax needs to go away.' But a number of GOP senators, and the hospitals and other medical providers in their states, are raising steep concerns that the provider tax changes would decimate rural hospitals. In a plea to lawmakers, the American Hospital Association said the cuts won't just affect those who get health coverage through Medicaid, but would further strain emergency rooms 'as they become the family doctor to millions of newly uninsured people.' 'And worse, some hospitals, especially those in rural communities, may be forced to close altogether,' said Rick Pollack, president and CEO of the hospital group. The Catholic Health Association of the United States noted in its own letter that Medicaid provides health insurance coverage for one in five people and nearly half of all children. 'The proposed changes to Medicaid would have devastating consequences, particularly for those in small towns and rural communities, where Medicaid is often the primary source of health care coverage,' said Sister Mary Haddad, the group's president and CEO. Trying to engineer a fix to the problem, senators are considering creating a rural hospital fund to help offset the lost Medicaid money. GOP senators circulated a proposal to pour $15 billion to establish a new rural hospital fund. But several senators said that's too high, while others said it's insufficient. Collins has proposed that the fund be set at $100 billion. 'It won't be that big, but there will be a fund,' Thune said. Hawley, who has been among those most outspoken about the health care cuts, said he's interested in the rural hospital fund but needs to hear more about how it would work. He has also raised concerns about a new $35 per service co-pay that could be charged to those with Medicaid, which is in both the House and Senate versions of the bill. 'Getting the fund is good. That's important, a step forward,' Hawley said. But he asked: 'How does the fund actually distribute the money? Who will get it to hospitals? ... Or is this just going to be something that exists on paper?' A new analysis from the White House Council of Economic Advisers estimates the package would result in up to $2.3 trillion in deficit reduction over 10 years, a markedly different assessment from other analyses. In contrast, the nonpartisan Congressional Budget Office's dynamic analysis of the House-passed measure estimates an increase in deficits by $2.8 trillion over the next decade. __ Associated Press writers Kevin Freking, Mary Clare Jalonick, Joey Cappelletti and Fatima Hussein contributed to this story.
San Francisco Chronicle
an hour ago
- San Francisco Chronicle
States can cut off Medicaid funding to Planned Parenthood, the Supreme Court rules
WASHINGTON (AP) — A divided Supreme Court allowed states to cut off Medicaid money to Planned Parenthood in a ruling handed down Thursday amid a wider Republican-backed push to defund the country's biggest abortion provider. The case centers on funding for other health care services Planned Parenthood provides in South Carolina, but the ruling could have broader implications for Medicaid patients. The court split 6-3 in the opinion, with the three liberal justices dissenting. Public health care money generally can't be used to pay for abortions. Medicaid patients go to Planned Parenthood for things like contraception, cancer screenings and pregnancy testing, in part because it can be tough to find a doctor who takes the publicly funded insurance, the organization has said. South Carolina's Republican governor says no taxpayer money should go the organization. The budget bill backed by President Donald Trump in Congress would also cut Medicaid funding to Planned Parenthood. That could force the closure of about 200 centers, most of them in states where abortion is legal, the organization has said. Gov. Henry McMaster first moved to cut off Medicaid funding to Planned Parenthood in 2018 but was blocked in court after a lawsuit from a patient named Julie Edwards. Edwards wanted to keep going there for birth control because her diabetes makes pregnancy potentially dangerous, so she sued over a provision in Medicaid law that allows patients to choose their own qualified provider. South Carolina, though, argued that patients shouldn't be able to file those lawsuits. The state pointed to lower courts that have been swayed by similar arguments and allowed states such as Texas to block Medicaid funding from Planned Parenthood. Public health groups like the American Cancer Society, by contrast, said in court papers that lawsuits are the only real way that Medicaid patients have been able to enforce their right to choose their own doctor. Losing that right would reduce access to health care for people on the program, which is estimated to include one-quarter of everyone in the country. Rural areas could be especially affected, advocates said in court papers. In South Carolina, $90,000 in Medicaid funding goes to Planned Parenthood every year, a tiny fraction of the state's total Medicaid spending. The state banned abortion at about six weeks' gestation after the high court overturned it as a nationwide right in 2022. ___
