Domestic and International Dimensions of the U.S. Fentanyl Crisis

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Flickr photos of this briefing for download can be found here: 240215 DCFPC On-the-Record Briefing on the Domestic and International Dimensions of the U.S. Fentanyl Crisis with Brookings Institution’s Dr. Vanda Felbab-Brown. | Flickr

THE WASHINGTON FOREIGN PRESS CENTER, WASHINGTON, D.C.

MODERATOR:  Good morning and welcome to the Washington Foreign Press Center.  My name is Leah Knoble, and I am the moderator for today’s briefing.  Today, it is my pleasure to introduce Dr. Vanda Felbab-Brown who is Senior Fellow of Foreign Policy at the Brookings Institution’s Strobe Talbott Center for Security, Strategy, and Technology and the Director of the Initiative on Nonstate Armed Actors.

Today, Dr. Felbab-Brown will be discussing the domestic and international dimensions of the U.S. fentanyl crisis.  This discussion’s on the record, and we will post a transcript and video of the briefing on our website fpc.state.gov later today.  And a reminder that remarks of today’s briefing do not represent the views of the United States Government.

For the journalists joining us on Zoom, please take a moment now to rename yourself in the chat window with your name, outlet, and country.  And I would now like to invite Dr. Felbab-Brown to share some opening remarks.

MS FELBAB-BROWN:  Well, thank you very much for joining me today.  I very much welcome this opportunity to speak about fentanyl, a devastating public health crisis in the United States but more broadly in North America with a substantial potential of spreading around the world.

Fentanyl today is killing more Americans than – between the age of 18 and 49 – than any other public health issues.  We’ve seen death rates of about 300 Americans daily.  But as I mentioned, this situation is not just confined to the United States.  Fentanyl is a very significant challenge in Canada as well, and it is a very significant and spreading challenge in Mexico.  Even though the Government of Mexico claims that there is no fentanyl produced in Mexico or no fentanyl used in Mexico, autopsies by NGOs in the northern part of Mexico, for example, recently showed that at least one-third of corpses that were brought to morgues on which autopsies were conducted had fentanyl present in their bodies.

In this context of a very significant public health crisis, no doubt one of the most serious ones – and not just between this 18 to 49 age group; we also seeing extraordinary death rates on fentanyl related causes for Americans over 50 and 65, something that is very unprecedented in drug markets – there are some good news.  Let me start with basic approach of the U.S. Government, which is a whole-of-government approach on fentanyl that is most welcome, and I would hope over time to see that expanded into a whole-of-government approach on organized crime groups that bring in fentanyl but that oftentimes are poly-crime entities.

Certainly, the two principal backers of supply to the United States, the Sinaloa Cartel and Cartel Jalisco Nueva Generación are deeply involved in the variety of other illegal economies.  They’re also taking over legal economies in Mexico.  And their counterparts are delivering precursor chemicals from China.  Chinese criminal networks are also often poly-crime entities.  So a whole-of-government approach against these organizations, not against just the specific substance, would perhaps further advance U.S. policy.

And then lastly, you have registered some very good news in what’s happening in supply side.  Namely, after several years of a hiatus of U.S.-China cooperation, the United States has been able, through very effective diplomacy, to resurrect cooperation with China.  There have been several aspects to that.  In November during the summit between President Xi and President Biden, China announced that it was now committed again to cooperating with the United States on halting – on reducing the flow of precursor chemicals from China.  This is very welcome news.

For several years, we have had no meaningful cooperation with China, and China would say that the problem of fentanyl use in the United States is that of U.S. doing.  Now, China has recognized its responsibility.  It has taken some actions.  It has sent notices to Chinese industry, Chinese chemical-pharmaceutical industry, to – that it will be monitoring and acting against precursor flows.  It has taken down some websites selling precursor flows.  It has perhaps taking further actions against some companies.  The robustness of that is yet to be seen,  something to be watched in 2024.

How did we get to this moment, where cooperation with China has been restarted?  Well, I think there are two dimensions to it.  One is the basic geostrategic picture with both China and the United States realizing that after several years of significantly intensified tensions between the two countries it was important to put a ceiling underneath the freefall of the relationship.  And they judged that counternarcotics cooperation was one fruitful aspect – one fruitful venue to stabilize the relationship.

But second was the role of U.S. diplomacy, highlighting to Chinese officials how significant the issue was and how much the United States was prioritizing it.  This has had multiple dimensions to it.  China was placed in the fall of 2023 on the so-called majors list.  That’s a list of countries that are of major concern to the United States for illicit narcotics.  That was a big blow to China’s reputation that prides itself on being the world’s tough drug cop.  The United States also was able to create a global coalition against the threat of synthetic drugs that was launched in July of 2023.  About 90 countries joined, yet China abstained. was not interested.  And once again, it realized that its reputation was significantly at stake.  So between the U.S diplomacy and both countries hoping to stabilize the relationship, we now have the beginning the launch of new cooperation, yet to be seen in 2024 and beyond how strong it is.

I’d like to make a few words, however, about Mexico.  Mexico is our neighboring country; it is our partner.  It’s a country where communities, families live on both sides of the border.  It is more than just our neighbor; it is part of the North American community.  Yet unfortunately, we have had also very inadequate and still deeply troubling lack of cooperation from Government of Mexico in terms of acting against cartels like Sinaloa and Jalisco and in terms of stopping the flows of fentanyl to the United States.

First of all, over many months the top levels of the Mexican Government has been denying that any fentanyl is synthesized in Mexico; something I certainly don’t believe; something that the United States Government – for which I don’t speak – does not believe in its reports.  Moreover, to the extent the Mexican Government has acted against synthetic labs, destroyed synthetic labs, they – which it claims are for producing methamphetamine, not fentanyl, there have been important investigative reports by Reuters showing how the data is manipulated, cooked by the Mexican Government and significantly overstates the actions that are in fact taken.

More broadly, in my extensive research Mexico over many years, including over many months last year, I have seen a government that is not willing to confront the cartels in the context where criminal groups are increasing their territorial power, the power over populations, the takeover of legal economies and impact even institutions.

Now, this is, of course, taking place in the very difficult context of migration, where migration imposes a straitjacket on U.S. policy.  Certainly the failure to have a meaningful immigration reform that would reduce the flow of people who are undocumented to the United States, it’s a major source of outrage for the Mexican Government in being able not to act on criminality that is so deeply threatening the United States and that is even more deeply threatening Mexico and Mexican people.

MODERATOR:  Thank you.  We will now take some questions.  For those of you in the room, if you have a question, please raise your hand and wait to be called on.  Please also state your name and media outlet before your question, and project so we can hear you well.  A reminder for journalists joining us via Zoom:  Please be sure your screenname includes your name, outlet, and country.  Click on the raised hand icon to indicate if you have a question and please turn on your video, if you’d like.

We’ll start by taking any questions from journalists in the room.  Okay.  Seeing none right now, please raise your hand if you have a question and you’re joining us via Zoom.

Okay.  We’ll start with a pre-submitted question, actually.  So could you please expand upon opioid and fentanyl use outside of the United States?  Are the same transnational crime networks at play that are trafficking the drugs through the United States?

MS FELBAB-BROWN:  So the most extensive documented misuse of fentanyl is in Canada and to a lesser extent in Mexico.  When I say to a lesser extent in Mexico, it’s not perhaps because there is less use of fentanyl in Mexico, but because it’s less documented.  As I mentioned, the Government of Mexico has been in denial that there is any production and use of fentanyl in Mexico.  Consequentially, there has been very limited collection of information data about what is happening with use.

To the extent that the data has been done, it’s been done by it’s by done by nongovernment entities mostly and has found significant use and major threat in certainly northern Mexico, where these studies have been conducted.  So in places like Tijuana or Ciudad Juárez, fentanyl is deeply spreading and spread already across local drug markets.  And certainly what we see with drug groups historically and (inaudible) today is that they often pay their local dealers, they often pay their allies, their partners in kind.  They find it much more convenient to pay in drugs rather than to pay in cash.  This then creates domestic markets.  This has set off a major methamphetamine epidemic in Mexico and this is likely why we are seeing fentanyl spreading significantly in northern Mexico.

The second country affected is, of course, Canada, where opioid epidemic use are very significant and fentanyl is a very significant component of that, including in places that have highly advanced harm-reduction policies, such as in British Columbia, in Vancouver.

Outside the North American space, we have seen limited instances.  There is an established fentanyl market in Europe, in Austria, that has been in existence for over 20 years.  About a decade, decade a half ago, there were instances of fentanyl popping up in the northern – in the Nordic countries, but police officials there, law enforcement at the time was able to stamp it out very quickly.

In the past three, four years, we have seen instances of fentanyl popping up in Western Europe.  But perhaps the more concerning drug there is another type of synthetic opioid and synthetic class of opioids, and that’s nitazenes, that seem to be what is more threatening in Western Europe right now than fentanyl class of synthetic opioids.  That might change.

We have also seen instances of fentanyl in Argentina, Brazil, various reports of fentanyl supply in Colombia, efforts by criminal groups in Colombia to divert fentanyl from legal medical use for the illegal market.  All of these are so far limited.

But let me add one important element here:  Fentanyl and a lot of the modern drugs – synthetic drugs – that are emerging around the world, like nitazenes, are very dangerous drugs not simply because of the enormous potency, their high chance of resulting in lethal overdose or dramatic and often horrific morbidity, but they are also driven by suppliers.  These drugs are not drugs that consumers start asking for.  In the United States, fentanyl was introduced by suppliers – first Chinese criminal networks, Chinese producers, later on Mexican cartels.

Mexican cartels are now starting to operate in Europe.  They have established methamphetamine markets there.  We see big rise in meth use in places like Germany, France, Spain.  It is only a matter of time before they start introducing fentanyl into those markets as well.

As to Asia, the claim is that we have not seen the spread fentanyl in Asia.  Nonetheless, there is also very inadequate collection testing.  So when drugs are seized, they’re often not testing for fentanyl or other types of synthetic opioids.  When someone overdoses, they are not necessarily testing for synthetic opioids of any kind.  So the picture is not as clear.  The data is not as strong.

Australia and New Zealand are another market where I think there is a high potential for fentanyl emerging.  There are many reasons with – they’re highly valuable markets with high profit margins.  We see again not just the Chinese criminal networks that have long been dominant actors in methamphetamine there, but also now Sinoa Cartel and Jalisco Nueva Generación trying to penetrate those markets, bringing in cocaine, bringing in meth, and those established channels provide ample opportunities for spreading synthetic opioids.

And final word here:  Synthetic drugs overall, and particularly synthetic opioids, whether they are of the nitazene class or the fentanyl class, provide enormous advantages to smugglers.  They are so potent that very small amounts are sufficient to supply markets and very small amounts of precursors are sufficient to produce these drugs.  So they present enormous advantages from a smuggling perspective vis-a-vis plant-based drugs like cocaine and heroin, and that is the reason why we are seeing a synthetic drugs revolution sweeping global markets.

MODERATOR:  Our next question is from Ralph Gore with Free Eurasia Media: “In addressing the fentanyl crisis, what specific bipartisan strategies and legislative actions are being considered by the – by Congress to curb the flow of illicit fentanyl from China and Mexico, and provide robust support for community-based treatment and prevention programs, recognizing the multifaceted nature of the opioid epidemic?”

MS FELBAB-BROWN:  So let me start with the domestic use.  The United States fortunately has made great progress in how it thinks about users.  For decades, the United States erroneously treated users as villains.  Often it would imprison people for nonviolent drug use.  That has caused a whole variety of devastating cascade effects, whether on public health, the health of communities, families, as well as on the criminal justice system.

There is more and more recognition and embrace of the idea that substance use disorder is a chronic illness and then it requires treatment and support, both effective psychosocial treatment as well as access to insurance that can cover, medical coverage.  There is more push for the medical profession to recognize substance use.  We now have drugs that – like buprenorphine that reverse overdose that the United States criminalized for decades.

The reason why we have the ability to reverse so many overdoses is because of buprenorphine.  So last year some 70,000 Americans died as a result of fentanyl; 110,000 Americans – that is in 2022 – 110,000 Americans overall.  The actual number of overdoses was significantly higher, and fortunately those devastating death rates are so low because of drugs like buprenorphine that can reverse overdose.  And so the United States moving to allowing that at state level, at community level, at a federal level, has been big progress.

Even so, we are still in a situation where only 13 – 1-3 – percent of people with substance use disorder who want to seek treatment are able to do so.  Often people who are able to seek some treatment will run into obstacles with with insurance that stops covering it in a matter of weeks for what needs to be lifelong medical psychosocial support.  So progress on the domestic side on how we think about substance use, a very long way to go yet.

On the international side, there are challenges, including what’s happening with U.S. Congress.  The polarization of politics in the United States is being dramatically manifested with what’s happening with the budget, with the inability of U.S. Congress to fund the government for anything but short periods of time.  And that has dramatic repercussion for the ability to stem the flow of fentanyl to the United States.

The Republican side is often complaining that the U.S. southern border is open, undefended, unsecure.  It is the case that legal ports of entry are the predominant venue though which fentanyl comes in.  It’s being brought in by trailer trucks and personal vehicles, the vast majority of which are driven by U.S. citizens and having U.S. license plate.  Migrants are very small percentage, in the single digits, of carrying fentanyl.  By and large, they do not.  This is not the way fentanyl enters the United States.

Yet we are in a situation where only some 2 percent of cars can be inspected for carrying contraband in legal ports of entry.  Yes, you did not mishear me: 2 percent.  The numbers of trailer trucks is higher; somewhere between 20-30 percent are being inspected, but vastly inadequate.  The Biden administration has for some years now been asking Congress to pass a budget that would allow the installation of screening equipment that would allow the number of vehicles screened to go up to 70 percent for trailer trucks and for personal vehicles to go to about 40 percent.  Still far from hundred, but far better than 2 and 20-30 kind of ratio.  Yet the Republican side has not been willing to pass even that very simple technical measure.  So the polarization of politics is having significant impact on how we can respond effectively to supply side.

That said I think it’s very appropriate that the Congress has been concerned about supply from China, that the Congress has been concerned about supply from Mexico.  Many hearings have been held about those two issues.  Again, the inability to pass meaningful immigration reform is a key vulnerability for U.S. supply side efforts because it gives this preponderant leverage to the Government of Mexico and allows it to ignore its own responsibilities toward its citizens and its responsibilities toward the United States in acting against criminal groups.

MODERATOR:  We have one more question on Zoom.  Andres, would you please ask your question?

QUESTION:  Hi, here I am.  Thank you very much.  You mentioned that there are records of fentanyl use in Argentina and Brazil.  Are you referring only to consumption, or there is some type of production also?  And how risky is it for consumption and eventually production to grow in Argentina, Brazil, and those other South American countries?

MS FELBAB-BROWN:  So actually – thank you, Andres – we only have evidence of fentanyl seizures in Argentina and Brazil.  So we do not know whether those were meant for use.  We certainly don’t have any record of evidence of production.  What appears to be the case is that the fentanyl entered from somewhere else, or to the extent that it was produced, still on a small level.  But again, there is often a significant lack of data.  The level of investigation, monitoring, data, testing in Brazil and Argentina and in other parts of Southern Cone and Latin America more broadly are insufficient to develop a big picture.

What we are not seeing yet is significant death rates.  If all of a sudden there were significant death rates in the drug market, that would likely stimulate more testing for wider set of substances, not just cocaine, crack cocaine, (inaudible) basuco, the drugs that are widely used in Latin America.  So we would probably – if consumption was taking off, we would probably be seeing greater lethality.

Nonetheless, the fact that it is not happening now does not mean that it will not come.  Certainly the Mexican cartels are present across the Americas.  Their competition among each other, the bipolar war in which they are involved, is one of the important causes of stimulating violence from Ecuador to Costa Rica to Chile.  They are increasingly looking at connections to Asian markets, which makes even Pacific ports in the Southern Cone of very high interest.  And high possibility that they will start bringing – using fentanyl.

There’s also the possibility, of course, that other groups, such as Primeiro Comando da Capital, the Brazilian powerful organized crime group PCC, will start competing or will attempt to be competing with the Mexican cartels by diversifying into fentanyl as well.  Right now, PCC is primarily focused on cocaine supply, of course, to Southern Cone and through West Africa into Europe.  In Europe, cocaine is still the dominant drug the – that has not yet plateaued off, but in a matter of time, the chances that fentanyl will spread into Latin America, into other parts of the world is very substantial in my view.  It’s just much more convenient for smugglers to move the amount of fentanyl that it takes to supply a market than amount of cocaine or heroin.

But the lag that we are seeing, it’s not at all unusual.  We often see in drug markets these lags that are essentially driven by supply.  Back in the 1980s, cocaine, crack cocaine were spreading in the United States.  They were the dominant drugs.  There was plenty of cocaine in Latin America in the Andes to be supplying Europe at the same time; yet, Europe for another decade and a half was simply consuming heroin.  Traffickers were simply interested in moving heroin.  All of a sudden come in 1990s, Latin American traffickers along with Italian drug – organized crime groups decide to be bringing cocaine into Europe and cocaine takes off and is the predominant – becomes the most active drug.

Why was there this decade and a half of lag?  It essentially has to do with the entrepreneurship innovation of the drug trafficking groups and not with anything that came out of policy or user preferences.  So – and I’m not at all surprised that we are seeing these gaps in the spread of fentanyl.  In my view, it will come, and it’s part and parcel of synthetic drugs, whether it’s methamphetamine, fentanyl, or weaker versions like Captagon just emerging in every market around the world.

MODERATOR:  We’ll take another question from Zoom.  Marco, could you please introduce yourself and your outlet?

QUESTION:  Thank you for this opportunity.  This is Marco Berdazzi from Il Foglio in Italy.  I wanted to ask you if – you were mentioning cocaine before, and of course a good – an important part of the fight against cocaine and other drugs in the past was also related to education.  I was wondering if you have any suggestion about what the U.S. Government should do in terms of education, public campaign, communication campaigns in order to do – to sensibilize the public opinion about this tragedy?  Is it enough for what has been done so far or do you think you need more from the point of view of education and communication?

MS FELBAB-BROWN:  I mean, so certainly providing accurate information, accessibly making it available is very important.  The United States Government has had various policies, one of which is a pill can kill, where what we have seen is that users, people with substance use disorder in the United States, are seeking out OxyContin on the illegal market and instead end up being given fentanyl or some combination of fentanyl with another drug and overdose.  One of the reasons why fentanyl and synthetic opioids are so different also is that literally one pill can kill.  So your typical teenager starting to experiment with drug is a problem, but if one pill – one product, which they get (inaudible) sufficient to kill them, then it’s very different type of problem than what we are seeing with cocaine or heroin market.  So, yes, there is certainly the need and importance of spreading information.

It’s becoming more challenging in the U.S. as we are now seeing the mixing of Xylazine, which is an animal tranquilizers used in veterinarian medicine, to be mixed into fentanyl and other drugs.  This is spreading particularly on the East Coast.  It’s – the wave of – the emergence, the path of Xylazine is mimicking the early stages of fentanyl about a decade ago with some of the same hotspots.  And one of the big issues is whether law enforcement, policy awareness – some policy can halt it from spreading westward.

What is so bad about Xylazine – and here is again where education comes in – is that not only it causes horrific morbidities such as necrotic tissues and amputation potentially, but it also is not responsive to buprenorphine, to the medication that’s used for reversing overdose.  So if Xylazine and other type of tranquilizers, other type of drugs like nitazenes start being mixed into drugs, the death rates can escalate even beyond the current awful levels.  So informing users is important.

But I would say that the – that we really need to go beyond information and allowing pill testing is a significant element.  Users often do not know what they are given.  So, again, they think they’re buying Oxy, they end up with fentanyl.  They think they are buying – perhaps they’re aware they’re buying fentanyl; they end up with a mixture of fentanyl and Xylazine. There are have been pilot efforts to allow for testing.  It’s hardly 100 percent proof.  It’s – users will sometimes despite knowing what it’s in it still use.  They might seek a greater high.  But nonetheless it’s better than not having information as to what they are actually buying.

And there is a related component which is law enforcement.  I think there are opportunities to think about how to penalize and prioritize acting against dealers and suppliers who knowingly provide different kind of drugs or who knowingly give people fentanyl without telling them there’s fentanyl in it.

MODERATOR:  This ends the Q&A portion of today’s briefing.  Dr. Felbab-Brown, do you have any final remarks you’d like to share?

MS FELBAB-BROWN:  Thank you.

MODERATOR:  Thank you.  This concludes our briefing.  I want to give a special thanks to our briefer for sharing her time with us today and to the journalists who joined us.  Thank you.