Combatting the Rise of Fentanyl and Synthetic Drugs through U.S. Foreign Policy

April 2024

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Synthetic drug use and addiction – including opioids and illicit fentanyl – is one of the most devastating public health and geopolitical crises with widespread implications for the U.S. economy and national security. The global fentanyl crisis reflects a rise in drug supply, manufacturing, and trafficking requiring a whole-of-government response to combat the epidemic, curb production and trafficking, and promote global cooperation to save lives in the United States and abroad. Tough bilateral diplomacy, global cooperation, holding countries accountable, and leveraging our full global civilian toolkit to protect American lives is critical to address the growing domestic and worldwide crisis on fentanyl and synthetic drugs.

The Growing Crisis at Home

Synthetic drugs like fentanyl are particularly dangerous because they are cheap for drug traffickers to manufacture and smuggle and are incredibly potent in small doses. Across the United States, synthetic drugs are the number one killer of Americans between the ages of 18-49 today.

  • From November 2019 to October 2023, approximately 270,000 Americans died from an overdose of a synthetic opioid – even as S. authorities seized more than 77 million fentanyl pills and nearly 12,000 pounds of fentanyl powder in 2023, the most fentanyl seized by the U.S. in a single year.
  • With overdose deaths increasing by more than 500% since 1999, this growing public health crisis has massive economic costs. In 2020 alone, the opioid epidemic cost the United States a record of nearly $1.5 trillion, or 7% of our GDP that year.
  • There is widespread appreciation for the need to address this issue. Over 60% of Americans consider the misuse of synthetic drugs and opioids to be a major public health emergency.

The Global Connection

There is a significant and dangerous international component to the rise of synthetic drugs. The harm caused by drug trafficking contributes to and compounds many ongoing global crises, from instability and violence to environmental degradation and human rights by worsening health outcomes, fueling corruption, and weakening the rule of law – requiring strong global cooperation to mitigate its impacts. Today, the global fentanyl crisis has cemented itself as a critical component of geopolitical competition, cooperation, and U.S. foreign policy to build healthier, more stable, and prosperous communities around the world.

  • International Production. Much of the supply of synthetic drugs and illicit opioids are manufactured abroad, predominantly through international supply chains from Mexico and China. 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. The most recent estimates suggest that more than 90% of fentanyl in the U.S. is manufactured with precursor chemicals produced in China.
  • Transnational Crime. Most of the synthetic drugs in the United States are produced or supplied by Mexican-based transnational criminal organizations. Criminal organizations that manufacture and traffic synthetic drugs often engage in other types of transnational criminal activities – such as human trafficking and weapons dealing – exploiting gaps in the global system as some governments move to restrict precursor chemicals or the drugs themselves.
  • Global Drug Use. Global trends of synthetic drug use, addiction, and overdose are also staggering. One in every 17 people worldwide had used a drug in 2021, 23% more than a decade earlier. More specifically, it is estimated that 36 million people around the world use methamphetamine or other synthetic drugs annually, according to the United Nations.
  • Low-income communities around the world are also impacted by the illicit drug trade. According to the most recent United Nations World Drug Report, these communities “suffer from the violence and insecurity fueled by drug trafficking, as well as from insufficient access to and availability of controlled medicines.” With limited access to sustainable employment, vulnerable communities are more easily lured into illicit drug production and trafficking.


U.S. Investment and Action to Combat the Growing Crisis
The U.S. government is working with international partners to galvanize greater global attention, policy prioritization, resources, and impact aimed at stemming the flow of illegal synthetic drugs around the world. U.S. diplomatic, development, and economic assistance complements domestic efforts to curb this crisis – helping to uplift communities by strengthening law enforcement of counternarcotics, supplying addiction treatment, countering corruption, and educating on the harm’s illicit opioids present. And yet, even as greater attention and action is taking place, the crisis is far from abated and much more is needed to strategically maximize U.S. development and diplomacy resources and to spur Congressional commitment and action.

Leveraging America’s Diplomatic Toolkit to Curb the Production of Synthetic Opioids

  • Following diplomatic action by the State Department, China agreed to designate the entire class of fentanyl-related substances as Controlled Substances in a meeting with former President Trump in December 2018. As a result, individuals manufacturing or trafficking fentanyl are subject to “maximum penalties” under Chinese law. In September 2019, the Trump Administration secured additional commitments from China to expand law enforcement cooperation on fentanyl trafficking, strengthen detection capabilities, and launch joint investigations with the U.S. on traffickers and manufacturers.
  • In December 2021, the Biden Administration issued an Executive Order (EO) declaring that the synthetic drug crisis “constitutes an unusual and extraordinary threat to the national security, foreign policy, and economy of the United States” and empowered the State Department to impose sanctions on “foreign persons involved in the global illicit drug trade.”
  • Not long after the EO, the Administration released its inaugural National Drug Control Strategy. While the Order is predominantly domestic in focus, the Strategy underscored how the State Department “leads the United States government’s efforts to reduce the production of drugs outside the United States” and called on the Department to continue leverage the UN Commission on Narcotic Drugs “to promote U.S. drug control priorities and hold our international partners accountable for their responsibility to help stem the flow of illicit synthetic drugs.
  • In 2023, the State Department launched the Global Coalition to Address Synthetic Drugs, a U.S.-led international effort to combat the threats posed by synthetic drugs. To date, 151 countries and 14 international organizations are participating in the Global Coalition, working to speed up the global response to the rise in synthetic drugs threats. China, however, has abstained from joining the group.
  • At the first Cities Summit of the Americas in April 2023, the City of Denver’s Office of the Medical Examiner and the U.S. Department of State’s Bureau of International Narcotics and Law Enforcement Affairs signed a Memorandum of Understanding (MOU) on Combatting Fentanyl. This agreement will bolster forensic capacity throughout the Americas to support the early detection of fentanyl use and other synthetic drugs as well as identify drug trends.
  • In September 2023, China was added to the U.S. list of the world’s major illicit drug-transit or drug-producing countries. Shortly after, in November, the S. and China agreed to restart counternarcotic cooperation. Following the agreement, U.S. officials traveled to Beijing in January 2024 to launch the U.S.-PRC Counternarcotics Working Group, an important mechanism to strengthen bilateral communication, policy, and law enforcement on counternarcotics efforts.

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

  • The Department of State’s Bureau of International Narcotics and Law Enforcement Affairs and the U.S. Agency for International Development (USAID)’s Anti-Corruption Center are the lead U.S. agencies for implementing assistance to Mexico and other countries in the region to stem the illegal flow of synthetic drugs around the world. These investments aim to improve Mexico’s capacity to detect and seize illicit drugs and precursor chemicals. Since 2018, Mexican security forces have increased fentanyl seizures by 520% – though significant work remains to control the crisis.
  • The State Department’s embassy and country teams are an important element in advancing U.S. government activities – including law enforcement and intelligence activities through the Department of Justice (DOJ) and the Drug Enforcement Agency (DEA) – to combat transnational crime and the illicit flow of fentanyl into the U.S. Without strong State Department-led country teams, international efforts to reduce synthetic drugs production and trafficking would be significantly limited.
  • Launched in 2007, the Merida Initiative was a State Department and USAID managed package of U.S. security, antidrug, and rule of-law assistance to Mexico to fight critical organizations and their cross-border drug trafficking operations. In 2021, the S.-Mexico Bicentennial Framework for Security, Public Heath, and Safe Communities replaced the Merida Initiative and focuses more on driving economic development and addressing the root causes of crime and drug addiction in both countries. In March 2023, the U.S. and Mexico announced “phase two” of the framework, focused on combatting fentanyl production and arms trafficking. At the 2023 U.S.-Mexico High Level Security Dialogue, U.S. officials highlighted an increase in arrests, indictments, and confiscations for arms and fentanyl trafficking.
  • In February 2020, the Trump Administration released its Southwest Border Counternarcotics Strategy. The strategy was an important marker in articulating the government’s efforts to counter illicit drug trafficking. It focused on “countering criminal networks, strengthening interdiction and law enforcement capabilities, and targeting drug transportation routes and modalities in order to aggressively reduce illicit drugs crossing the Southwest Border.”
  • In December 2023, the Treasury Department’s Office of Terrorism and Financial Intelligence launched the Counter-Fentanyl Strike Force to better leverage and coordinate Treasury’s resource and expertise to combat the domestic and global dimension of illicit fentanyl trafficking.
  • At the recent annual meeting of the N. Commission on Narcotic Drugs (CND) in March 2024, Secretary Antony Blinken launched a new collaborative effort with the United Nations Office on Drugs and Crime and Meta, Snap, and other technology companies to disrupt synthetic drug activity online and better educate users about its risks. Additionally, it was announced that the U.S. is dedicating unprecedented resources to tackling demand for synesthetic drugs to strengthen public awareness, health interventions, and services to prevent and reduce drug use, overdoses, and other harms, alongside measures to prevent, to detect, and stop the illicit manufacturing and trafficking of drugs.

Congressional Action

Congress is also working in a bipartisan manner to ensure the U.S. continues to lead global efforts to curb the devastating impacts of the global fentanyl crisis.

  • Signed into law in December 2022 as part of the FY23 National Defense Authorization Act, the bipartisan Fighting Emerging Narcotics through Additional Nations to Yield Lasting (FENTANYL) Results Act requires the State Department to prioritize efforts to combat international synthetic drug trafficking. Specifically, it authorizes two State Department programs to build foreign law enforcement capacity to detect synthetic drugs and to carry out an international exchange program for drug demand reduction experts.
  • In March 2023, Representatives Joe Neguse (D-CO) and Darrell Issa (R-CA) relaunched the Bipartisan Fentanyl Prevention Caucus to combat the nationwide spike in fentanyl-related overdoses and educate Members of Congress of the ongoing threat that the global drug crises poses to communities across the U.S.
  • In February 2024, a bipartisan majority in the Senate passed the Fentanyl Eradication and Narcotics Deterrence (FEND) Off Fentanyl Act as part of the national security supplemental. This legislation declares fentanyl trafficking a national emergency and sanctions transnational criminal organizations and drug cartels engaged in international drug trafficking.
  • Recognizing the urgent threat posed by fentanyl and other illicit synthetic drugs, the FY24 International Affair Budget includes $125 million to counter fentanyl and other narcotics trafficking. Additional funding is also provided to support programs that advance “a comprehensive approach to combating synthetic drugs” – including the establishment of a task force in the Indo-Pacific to combat fentanyl trafficking and other criminal activities.
  • The Administration’s FY25 International Affairs Budget Request proposes a 58% increase compared to FY23 enacted levels for International Narcotics Control and Law Enforcement (INCLE) funding to stem the flow of synthetic drugs like fentanyl. The State Department’s Bureau of International Narcotics and Law Enforcement Affairs manages this funding and develops policies and programs to combat international narcotics and crime.

Combatting the Rise of Fentanyl and Synthetic Drugs through U.S. Foreign Policy

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