Combating the International Dimensions of the Opioid Crisis

July 2019

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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 2017, more than 70,000 Americans died from drug overdoses.
  • Deaths involving illicit synthetic opioids – likely trafficked from overseas –spiked sharply, constituting nearly 70% of all drug overdose deaths in 2017.
  • The number of drug overdose deaths involving fentanyl increased by more than 1000 percent from 1,663 in 2011 to 18,335 in 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.
  • Deaths involving illicit synthetic opioids – likely trafficked from overseas –spiked sharply, constituting nearly 70% of all drug overdose deaths in 2017.
  • President Trump reinforced this point when he called on the international community to address the world drug problem saying, “if we take these steps together, we can save the lives of countless people in all corners of the world. All of us must work together to dismantle drug production and defeat drug addiction.”


The State Department has made combating the opioid epidemic a priority, with Assistant Secretary Kirsten Madison of the Bureau of International Narcotics and Law Enforcement Affairs telling Congress, “We understand that the work we do to forge partnerships and consensus, to secure international cooperation, and to use foreign assistance to build the capacity of our partners to help disrupt the flow of opioids and other illicit narcotics to our country is about one thing: contributing to a larger effort in our country to save America lives, American families, and American communities.”

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 all fentanyl-related drugs in April 2019. This has 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 put carfentanil, a synthetic opioid 10,000 times more potent than morphine, under tighter controls.
  • At the UN General Assembly in 2018, the U.S. convinced 130 countries to sign an agreement to combat the global drug problem, pledging to strengthen international cooperation on law enforcement, education, justice, and health, and cut off the supply by stopping production.

How International Programs Are Cracking Down on the Flow of Opioids from Overseas

  • 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.


  • The Synthetics Trafficking and Overdose Prevention (STOP) Act (H.R. 5788; S. 3057) was passed and signed into law as part of the Support for Patients and Communities Act, requiring 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 legislation has enabled the U.S. Customs and Border Patrol stop six times more packages containing fentanyl.
  • 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. In the Administration’s FY20 budget request, the President proposed a similar 37% cut, but given extensive bipartisan support in Congress, the House and Senate are expected to reject this cut as well.