Combating the International Dimensions of the Opioid Crisis

July 2018

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The horrific facts of opioid addiction and overdose deaths in the U.S. require a dramatic response:

  • Since 1999, overdose deaths in the U.S. involving opioids have increased by over 500%.
  • Every county in the U.S. has seen an increase in drug-related mortality. In 2016, 64,000 Americans died from all drug overdoses, growing among all ethnicities and in all regions.
  • Deaths involving illicit synthetic opioids – likely trafficked from overseas – have spiked sharply, more than doubling from 2015 to 2016.
  • Experts predict nearly 500,000 Americans could lose their lives to opioids over the next decade.


While the priority is focused on the domestic response, we must also recognize the international nature of the crisis and strengthen U.S. diplomatic efforts to curtail the supply of deadly opioids entering our country.

  • While the number of opioids prescribed in the U.S. has declined since 2010 after a campaign to curb their use, most illicit synthetic opioids – like fentanyl – are produced in China and trafficked from overseas.
  • Most fentanyl produced in China is either sold online by Chinese distributors and shipped directly to the U.S. by postal mail, or delivered to Mexico and then smuggled into the U.S.
  • President Trump reinforced this point last October when he declared that the U.S. will “have to work with other countries to stop these drugs where they originate… whether that country is China, whether it’s a country in Latin America, it makes no difference.”


The State Department has made combating the opioid epidemic a priority, with Deputy Assistant Secretary James Walsh of the Bureau of International Narcotics and Law Enforcement Affairs declaring at a summit in April 2018, “The global nature of the crisis means the State Department needs to take action, and we have. We are working vigorously… to leverage our partnerships and foreign assistance tools with the objective of driving down the supply of heroin and illicit opioids.”

Leveraging Diplomatic Tools to Curb the Production of Synthetic Opioids

  • Recognizing the threat, the State Department is working with other countries to curb the production of synthetic opioids. After diplomatic pressure from the United States to cut Chinese production, Beijing banned four fentanyl-analog drugs in 2017. This enabled Chinese and U.S. officials to carry out joint investigations and prosecute producers and distributors in China.
  • Through concerted international engagement, U.S. diplomats successfully advocated for the UN Commission on Narcotics Control to strictly regulate the leading chemicals used to produce fentanyl, making the creation of the drug in other nations increasingly difficult.
  • The State Department is also working to prevent the creation of new synthetic opioids which can be even more deadly. The U.S. recently secured a unanimous vote at the UN to schedule carfentanil, a synthetic opioid 10,000 times more potent than morphine.

Leveraging Diplomatic Tools to Curb the Production of Synthetic Opioids

  • The State Department is pressing other countries to increase the collection of electronic information on the contents and source of packages shipped to the United States, which will help the U.S. Postal Service halt the flow of packages containing synthetic opioids from producers abroad. Unlike private carriers – like UPS, FedEx, and DHL who can choose to deny service from suspect customers – the U.S. Postal Service (USPS) is currently required by international agreements to deliver all the mail it receives from other countries. Currently, USPS is only able to gather advanced electronic data on 36% of all international packages to ensure dangerous drugs do not enter the United States.
  • The State Department’s Bureau for International Narcotics and Law Enforcement (INL) is spearheading the “Merida Initiative” to partner with Mexican law enforcement to stop the flow of drugs across the U.S.-Mexico border. One recent success is the Mexican police’s seizure of thousands of fentanyl pills hidden in coffee and shoes through the use of canines trained to detect fentanyl. These dogs were provided to Mexican police through a partnership with the State Department.
  • With support from U.S. diplomats, the UN Office on Drugs and Crime created a system for monitoring illicit crop cultivation in Mexico through satellite imagery and aerial photographs. This information enabled the Mexican army to destroy nearly 200,000 plots of poppy in 2017, up 22% from the previous year.


While the priority is focused on the domestic response, we must also recognize the international nature of the crisis and strengthen U.S. diplomatic efforts to curtail the supply of deadly opioids entering our country.

  • The Synthetics Trafficking and Overdose Prevention (STOP) Act (H.R. 5788; S. 3057), which was introduced by bipartisan members in the House and Senate, would require the U.S. Postal Service to collect data on 100% of incoming foreign mail in an effort to combat the illicit flow of synthetic drugs through international shipping. The House passed H.R. 5788 by a vote of 353-52.
  • Members of Congress have also pressed the State Department to use its diplomatic programs to address the international production and trafficking of opioids, including language in the FY19 State-Foreign Operations funding bill that “directs the Secretary of State to develop an international diplomatic and assistance strategy to stop the flow of opioids into the United States
  • Even while acknowledging the international dimensions of the opioid crisis, the Administration proposed cutting the International Narcotics Control and Law Enforcement (INCLE) account by 30% in its FY19 budget proposal. However, the House and Senate rejected the cut by providing $1.4 billion in funding in their respective State-Foreign Operations bills.