Fentanyl has become one of the leading causes of death in the United States, an issue in the presidential campaign and the subject of significant diplomatic efforts by the Joe Biden administration.
Secretary of State Antony Blinken and other top officials traveled to Mexico this week, in part to discuss strategies to stem the flow of fentanyl across the border. Here we have some key facts about a drug that is reducing life expectancy in the United States and is playing a role in the country’s politics.
What is fentanyl?
It is an incredibly powerful synthetic opioid. As a pharmaceutical product, it is safely used every day as an anesthetic in operating rooms across the country and as a prescription pain reliever. But like heroin and other opioids, it can be very addictive. Fentanyl can be produced entirely in a laboratory, unlike opioid drugs like heroin, which are derived from poppy plants.
Since 2015, fentanyl and other closely related drugs have gradually displaced heroin and other opioids in American illicit drug markets, leading to a rise in addiction and overdose deaths.
The many types of fentanyls have different strengths and characteristics, but they typically take the form of white powders that can be compressed into pills, mixed with other drugs, or sold alone. One gram of fentanyl is about 50 times more potent than pure heroin. Some fentanyl drugs are even stronger. Carfentanil, a drug associated with clusters of fatal overdoses, is estimated to be 100 times stronger than fentanyl itself, according to the Drug Enforcement Administration (DEA).
How many people die from this cause?
Overdose deaths have been rising in the United States for decades, but the emergence of fentanyl has caused a striking increase, accounting for the vast majority of overdose deaths in recent years.
Because fentanyl is so potent, even experienced drug users can overdose if they make small dosing errors, or if a batch includes a stronger version than usual.
People who do not normally take opioids can also easily overdose. Overdoses among adolescents have duplicate in the last decade; many have taken fentanyl pills that they believed contained a different drug, such as Xanax, Percocet, or oxycodone.
Many fatal overdoses also involve more than one drug, including mixtures of fentanyl and xylazine, an animal sedative, or methamphetamine, a stimulant. Some of those cases involve intentional use, but others may be the result of small amounts of fentanyl being mixed with other drugs without the users knowing.
How does it compare to other causes of death?
In terms of mortality, the current fentanyl crisis dwarfs any other drug crisis in American history.
In a recent presidential debate, Nikki Haley, the former governor of South Carolina, said fentanyl had killed more Americans than the Vietnam, Iraq and Afghanistan wars combined. This is true. About 77,000 Americans died from overdoses of synthetic opioids like fentanyl in the 12-month period ending in April of this year, according to provisional calculations from the Centers for Disease Control and Prevention. In 2022, the most recent year with complete data, this figure was around 74,000. Those three wars killed just over 65,000 Americans combined.
By comparison, about 55,000 Americans died in 1972 in car accidents, the year with the highest number of such deaths. Around 49,000 people died from firearms in 2021 (including suicide), the year with the highest number of such deaths.
Fentanyl alone has become a leading cause of death in the United States. It was responsible for a third of deaths among Americans ages 25 to 34 in 2022, according to a Times analysis of CDC mortality data.
How is it different from the opioid crisis?
The fentanyl crisis is, in many ways, simply the latest wave of an opioid crisis that began with the overprescription of painkillers in the 1990s. Prescription pills gave way to heroin in the 2010s, quickly followed by an influx of fentanyl and other synthetic opioids a few years later. As fentanyl came to dominate the illicit drug market, completely replacing heroin in many places, overdose deaths skyrocketed.
Public health officials and politicians of both parties often used the term opioid epidemic. But Republican politicians are increasingly mentioning fentanyl specifically, an acknowledgment of its increased presence in causing harm.
Where does fentanyl come from?
Most of the fentanyl sold in the United States comes from Mexico, where drug cartels synthesize it from chemical precursors believed to come from factories in China. Some fentanyls are also shipped directly from China to the United States.
Fentanyl in the medical system is produced in government-regulated factories, but a small portion of that supply reaches illicit drug markets.
Because fentanyl is so concentrated, it is easier to smuggle than heroin. Drug traffickers can import small packages of pure drugs into the United States, where they are then divided and redistributed among street dealers. Sometimes drugs are also imported in pill form or other forms ready for sale on the street.
How does fentanyl get to the United States?
Most fentanyl from Mexico is smuggled through legal ports of entry on the southern border in cars and cargo trucks, and is not usually carried by migrants seeking humanitarian aid in the United States and turned over to agents. of the Border Patrol after crossing illegally into the country.
Customs agents in Laredo, Texasrecently found more than 5,000 pounds of materials used to make fentanyl.
What is the government doing in the face of this crisis?
During Donald Trump’s administration, Congress passed a law that imposes more regulations on prescription opioids and provides grants to states to help combat the epidemic. The government also reached agreements with China to reduce the manufacturing of certain fentanyls, a policy that some researchers believe which has limited the supply of some of the most potent forms of the drug.
The Biden administration has implemented additional policies since taking office. Congress recently passed legislation making it easier for doctors to prescribe buprenorphine, a drug that helps people recover from opioid addiction. The government has expanded federal funding for so-called harm reduction approaches to addiction issues, such as needle exchanges and the distribution of drugs that can reverse overdoses.
The departments of Homeland Security and Justice have also increased law enforcement operations targeting fentanyl production and smuggling. The Biden administration recently imposed sanctions on 28 individuals and organizations, including a China-based network involved in the production and distribution of fentanyl precursors. It also imposed sanctions on members of the Sinaloa cartel, one of the largest Mexican traffickers of fentanyl to the United States. In September, Mexico extradited a leader of the Sinaloa Cartel To united states.
Josh Katz is the graphics editor at The Upshot, where he covers a variety of topics related to politics, law and culture. He is the author of Speaking American: How Y’all, Youse, and You Guys Talk, a visual exploration of American regional dialects. More by Josh Katz
Margot Sanger-Katz is a national correspondent and writes about health services for The Upshot. She previously was a reporter at National Journal and The Concord Monitor and an editor at Legal Affairs and the Yale alumni magazine. More by Margot Sanger-Katz
Eileen Sullivan writes about the Department of Homeland Security with a focus on immigration and law enforcement. More by Eileen Sullivan