As drug overdoses have taken more and more lives, reaching record levels in 2022, the U.S. government has prioritized efforts to combat the international trafficking of fentanyl and other synthetic opioids and their precursors.Footnote ¹ The Department of Justice has announced multiple indictments of foreign fentanyl manufacturers and traffickers, the Department of the Treasury has designated for sanctions dozens of individuals and entities involved in the illicit drug trade, the Department of Homeland Security has devoted increased resources to identify and seize fentanyl at the southwest border, and the Department of State has engaged in bilateral and multilateral diplomacy to enlist other states in the fight against fentanyl, including through the establishment of a global coalition to counter synthetic drugs.Footnote ² With most fentanyl and related drugs and precursors entering the United States sourced from China, by way of Mexico, U.S. actions have focused on Chinese chemical companies and Mexican drug cartels. Fentanyl's devastating impact and growing domestic political salience has also made it an important issue in U.S. relations with China and Mexico.Footnote ³ These international actions supplement a wide range of domestic measures taken by the Biden administration to respond to the “overdose epidemic.”Footnote ⁴

Fentanyl is a synthetic opioid developed in 1959 that was initially used as an intravenous anesthetic.Footnote ⁵ A controlled substance,Footnote ⁶ since the late 1970s dealers have illicitly sold drugs laced with fentanyl and fentanyl analogues.Footnote ⁷ Synthetic drugs’ advantages compared to plant-based drugs have led to the former's proliferation over the past decade. Producers can easily, quickly, and covertly manufacture fentanyl and other synthetic drugs due to the availability of the ingredients, equipment, and chemical and pharmacological knowledge and the little space required to set up laboratories; smugglers can transport the highly concentrated drugs with relative ease in small packets; distributors and dealers can sell the drugs for less than $1 a pill.Footnote ⁸ Fentanyl is nearly fifty times more potent than heroin and one hundred times more potent than morphine, making it both addictive and extremely dangerous.Footnote ⁹ Drug producers often lace drugs, like cocaine, with fentanyl or create counterfeit pills.Footnote ¹⁰ Fatal fentanyl overdoses have risen in recent years, and the drug is now a leading cause of death in the United States for persons aged 18–49.Footnote ¹¹ The Centers for Disease Control and Prevention estimates that around 78,000 people died from synthetic opioid overdose in the twelve months ending June 2023.Footnote ¹²

The U.S. synthetic drug crisis has international roots.Footnote ¹³ The main illicit fentanyl supply chain currently runs from China to the United States through Mexico.Footnote ¹⁴ China produces the bulk of fentanyl precursors and sells them to “narcotics traffickers in the United States, dark web vendors, virtual currency money launderers, and Mexico-based criminal organizations such as the Sinaloa Cartel and the Jalisco New Generation Cartel.”Footnote ¹⁵ As Deputy Attorney General Lisa O. Monaco explained, “drug traffickers and money launderers . . . obtain precursor chemicals—largely from China—for the manufacture of synthetic drugs, manufacture [the] drugs in Mexico, move those drugs into the United States, and collect, launder, and transfer the proceeds of drug trafficking.”Footnote ¹⁶ Entities from China thus initiate the drug trade through manufacturing and exporting precursors, and Mexican cartels continue the process by producing synthetic opioids and smuggling them into the United States. Consequently, the United States has sought Chinese and Mexican assistance to curb the illicit operations that stock the U.S. synthetic drug market.Footnote ¹⁷ China's enforcement of its controls on synthetic drug exports and its cooperation with U.S. law enforcement authorities have decreased since 2020 as part of the broader deterioration of U.S.-Chinese relations.Footnote ¹⁸

In addition to bilateral measures, the United States has increasingly employed multilateral diplomacy to curtail the international supply of synthetic opioids. At the UN Commission on Narcotic Drugs, the United States has repeatedly pushed to add fentanyl analogues and precursors to the already listed fentanyl in the schedules and tables of the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substance, and the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.Footnote ¹⁹ In 2017, at the urging of the United States, the Commission for the first time voted to control two fentanyl precursors.Footnote ²⁰ And in 2022, the Commission voted to control three additional precursors, two synthetic opioids, and a synthetic stimulant.Footnote ²¹ There are dozens of fentanyl and fentanyl-related drugs now listed.Footnote ²² Listing the drugs triggers requirements on treaty member states to control these substances.Footnote ²³ At the Commission's sixty-sixth session in March 2023, Rahul Gupta, Director of the White House Office of National Drug Control Policy, noted that “[b]etween the use of illicit fentanyl in the United States, tramadol [an opioid] in Africa, captagon [an amphetamine] in the Middle East and Europe, nitazenes [an opioid] in Europe and North America, and methamphetamine and synthetic cannabinoids in nearly every region . . . the proliferation of illicit synthetic drugs has created a global, shared problem that poses an urgent threat to the health and safety of all Member States.”Footnote ²⁴ He called for “a global coalition of countries dedicated to driving solutions to this new threat.”Footnote ²⁵

Several months later, in July, the United States launched a Global Coalition to Address Synthetic Drug Threats at a ministerial-level meeting.Footnote ²⁶ Participants agreed that the new coalition would “strengthen the coordinated global response to the international public health and safety challenges posed by synthetic drugs through international cooperation to drive comprehensive, balanced, evidence-based, and effective actions at the national and international levels, in accordance with applicable international law.”Footnote ²⁷ Following up, the United States hosted an outreach event in September 2023 on the margins of the seventy-eighth session of the UN General Assembly.Footnote ²⁸ In his remarks, Secretary of State Antony J. Blinken explained that the coalition's working groups will focus on “preventing the illicit manufacture and trafficking of synthetic drugs and their chemical precursors, detecting emerging drug threats, and promoting public health solutions.”Footnote ²⁹ He also announced three steps the United States will take to further the goals of the Coalition: (1) name an envoy who will “work[] with countries around the world to confront this global threat”; (2) introduce a resolution in UN General Assembly that “highlight[]s the global health and security threat of synthetic drugs and urging international action to address them”; and (3) partner with technology companies to “find[] ways to deny criminals access to online platforms to market dangerous drugs, as well as developing tools to help those seeking treatment options for substance use disorders.”Footnote ³⁰ The coalition numbers 120 states (including Mexico, but not China) and the European Union.Footnote ³¹ On December 18, 2023, the General Assembly adopted a resolution, co-sponsored by the United States, on “Enhancing action at the national, regional and international levels to address the global public health and security challenges posed by synthetic drugs.”Footnote ³²

These multilateral diplomatic initiatives have been supplemented by U.S. law enforcement actions against individuals and organizations. Compared to prior years, the Justice Department in 2023 more actively pursued persons, groups, and corporations involved in the international trade of synthetic drugs and precursors than it had previously. In April 2023, the Department announced federal charges against Sinaloa Cartel leaders and other members of the organization in indictments in New York, Illinois, and the District of Columbia.Footnote ³³ Mexico, with U.S. encouragement (including visits by Secretary Blinken and Secretary of the Treasury Janet L. Yellen), has increased its efforts to combat fentanyl trafficking.Footnote ³⁴ In September, it extradited Ovidio Guzmán Lopez, a leader of the Sinaloa Cartel, to the United States in connection with fentanyl importation charges.Footnote ³⁵ In June, the Justice Department announced the first indictments against Chinese entities and individuals involved in the synthetic drug trade.Footnote ³⁶ These included charges against a Chinese biotech company and three of its executives and employees on charges of fentanyl trafficking, fentanyl precursor importation, and money laundering. In separate indictments, four Chinese companies and six individuals were charged with crimes arising from “criminal conspiracies . . . to manufacture and distribute fentanyl in the United States.”Footnote ³⁷ Another set of indictments against Chinese entities for the production and distribution of synthetic drugs came in October.Footnote ³⁸ Drug Enforcement Administration Administrator Anne Milgram stated that “Chinese chemical companies are fueling the fentanyl crisis in the United States by sending fentanyl precursors, fentanyl analogues, xylazine, and nitazenes into our country and into Mexico.”Footnote ³⁹ The Treasury Department has also sanctioned both Chinese and Mexican participants in the fentanyl supply chain pursuant to Executive Order 14,059 on Imposing Sanctions on Foreign Persons Involved in the Global Illicit Drug Trade.Footnote ⁴⁰ In 2023, the Office of Foreign Assets Control sanctioned dozens of individuals and entities located in China and Mexico.Footnote ⁴¹ In December, the Treasury Department announced the launch of a Counter-Fentanyl Strike Force “to marshal Treasury's resources and expertise in a coordinated and streamlined operation to combat the trafficking of illicit fentanyl.”Footnote ⁴²

Earlier, in September, President Joseph R. Biden, Jr. identified China as a “major drug transit or major illicit drug producing country” because it was a “major . . . source. . . of precursor chemicals used to produce illicit drugs significantly affecting the United States.”Footnote ⁴³ A Chinese Foreign Ministry spokesperson responded that “[t]his is a malicious smear against China. . . . [I]ncompetence and ineffective control is the true cause of the pervasive drug problem in the US, and the fundamental solution is to reduce domestic demand.”Footnote ⁴⁴ In November, President Biden and Chinese President Xi Jinping announced a deal that would result in a Chinese crackdown on fentanyl chemical manufacturers.Footnote ⁴⁵ Following the agreement, China's National Narcotics Control Commission, signaling stronger enforcement, issued a notice “remind[ing] relevant enterprises and the general public [that] when they are engaged in business activities to comply with relevant national laws and regulations at all times to prevent illegal crimes related to the production, trafficking, smuggling of narcotic drugs, psychotropic drugs, and drug-making substances.”Footnote ⁴⁶ According to the White House, China “has [also] begun taking law enforcement action against Chinese synthetic drug and chemical precursor suppliers.”Footnote ⁴⁷ In exchange, the Commerce Department removed the Chinese Ministry of Public Security's Institute of Forensic Science of China from the Export Administration Regulations Entity List, resolving a longstanding Chinese grievance.Footnote ⁴⁸ Even if China is able to clamp down, though, laboratories in other countries, such as India, will seek to satisfy the U.S. demand for fentanyl and other synthetic drugs.Footnote ⁴⁹