Enough fentanyl to kill you on the tip of a pencil

According to the UNODC: Opioids are a group of drugs comprising a range of substances, including opiates and their synthetic analogues. Opiates are the naturally occurring alkaloids found in the opium poppy and include morphine, codeine and thebaine. Their semi-synthetic derivatives include heroin, hydrocodone, oxycodone and buprenorphine. Opioids also include a range of synthetic or pharmaceutical opioids, such as methadone, pethidine, tramadol and fentanyl. The group also comprises a diverse group of chemicals – opioid receptor agonists – that were initially developed by pharmaceutical companies with the aim of producing more effective opioids for pain management, but were later discarded or considered unsuitable for further development. Many of those substances, also known as research opioids, novel synthetic opioids or NPS opioids, are considered to be more potent than morphine. Synthetic opioids and pharmaceutical opioids include tramadol methadone, pethidine, pentazocine and fentanyl, Among the opioids taken for medical and non-medical purposes are fentanyl and morphine. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

Some prescription opioids are made from the plant directly, and others are made by scientists in labs using the same chemical structure. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea. Opioids can also make people feel very relaxed and "high" — which is why they are sometimes used for non-medical reasons. This can be dangerous because opioids can be highly addictive, and overdoses and death are common. Heroin is one of the world's most dangerous opioids, and is never used as a medicine in the United States. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

Prescription opioids and heroin have similar effects, different risk factors Heroin and prescription opioid pain relievers both belong to the opioid class of drugs, and their euphoric effects are produced by their binding with mu opioid receptors in the brain. Different opioid drugs have different effects that are determined by the way they are taken and by the timing and duration of their activity at mu opioid receptors.

Common prescription opioids include hydrocodone (Vicodin) oxycodone (OxyContin, Percocet), oxymorphone (Opana), morphine (Kadian, Avinza), codeine and fentanyl.. These drugs are used for pain relief are generally safe when taken for a short time and as prescribed by a doctor, but they can be misused. People misuse prescription opioids by: 1) taking the medicine in a way or dose other than prescribed; 2) taking someone else's prescription medicine; and 3) taking the medicine for the effect it causes-to get high.

Prescription opioid pain medicines such as OxyContin and Vicodin have effects similar to heroin. Fentanyl and OxyContin are powerful prescription painkillers. They are more powerful than heroin and are becoming increasingly abused. Oxycontin is synthesized from a nonanalgesic in opium. When misusing a prescription opioid, a person can swallow the medicine in its normal form. Sometimes people crush pills or open capsules, dissolve the powder in water, and inject the liquid into a vein. Some also snort the powder.

Synthetic opiods include hydromorphone (Dilaudid), pethidine (meperidine , Demerol) and diphenoxulate (Lomotil). Lomotil is used as a combination drug with atropine for the treatment of diarrhea. It acts by slowing intestinal contractions; the atropine is present to prevent drug abuse and overdose. Dilaudids are very powerful and often used by junkies.


Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. It is a prescription drug that is also made and used illegally. Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects. In its prescription form, fentanyl is known by such names as Actiq, Duragesic, and Sublimaze. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59.8 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010. Fentanyl is addictive because of its potency.

When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops. The illegally used fentanyl most often associated with recent overdoses is made in labs. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.7

Fentanyl's effects include: extreme happiness, drowsiness, nausea, confusion, constipation, sedation, problems breathing and unconsciousness Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opioid receptors, which are found in areas of the brain that control pain and emotions.8 After taking opioids many times, the brain adapts to the drug, diminishing its sensitivity, making it hard to feel pleasure from anything besides the drug. When people become addicted, drug seeking and drug use take over their lives.

Fentanyl and Prescription Opioid Overdoses and Abuse

According to the World Drug Report 2018: “The non-medical use of prescription drugs is becoming a major threat to public health and law enforcement worldwide with opioids causing the most harm and accounting for 76 per cent of deaths where drug use disorders were implicated, according to the latest Fentanyl and its analogues remain a problem in North America. Accessibility of fentanyl medical use is vital for treating pain, but traffickers manufacture it illicitly and promote it illegal markets causing considerable harm to health. [Source: World Drug Report 2018,United Nations Office on Drugs and Crime (UNODC), June 26, 2018]

The increased availability of prescription opiods — as well as heroin — is associated with increased use and overdose From 1991 to 2012, opioid prescriptions dispensed by U.S. pharmacies more than tripled from 76 million to 255 million prescriptions. In parallel with this increase, opioid-involved overdose deaths more than quadrupled over the same period. Since then, opioid prescriptions have declined to nearly 143 million in 2020. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

Drug overdose deaths involving prescription opioid pain relievers have increased dramatically since 1999. Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59.8 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010. During the Opiod Crisis from 2006 to 2012, nearly 100,000 people died as a result of prescription-opioid-related overdoses.

Overdoses of fentanyl are especially tricky. Because many drug dealers mix the cheaper fentanyl with other drugs like heroin, cocaine, MDMA and methamphetamine to increase their profits, making it often difficult to know which drug is causing the overdose. Naloxone is a medicine that can treat a overdose when given right away. Fentanyl is stronger than other opioid drugs like morphine and might require multiple doses of naloxone.

According to the UNODC: In North America, the introduction of fentanyl and its analogues into the drug market has resulted in an unprecedented increase in opioid overdoses attributed to synthetic opioids. Earlier, the opioid epidemic in North America was characterized by cyclical waves of heroin use and non-medical use of pharmaceutical opioids although in recent years, the non-medical use of opioids and use of heroin has stabilized (in the United States). Fentanyls found on the illicit market are mainly used as adulterants in heroin or other drugs or sold as falsified pharmaceutical drugs, with the result that users are often unaware that they are consuming them. As a result, due to the unpredictability of the potency of the different fentanyls, many users end up with non-fatal or fatal overdose. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

The non-medical use of opioids is attributed to 12.9 million DALYs (healthy years of life lost due to disability and premature death), or 70 per cent of the total 18 million DALYs attributed to drug use disorders. The use of opioids also contributes to the majority of deaths attributed to drug use disorders and contributes significantly to the number of deaths attributed to liver cancer, cirrhosis and other chronic liver diseases resulting from hepatitis C, as well as to those attributed to HIV and AIDS. Heroin remains the opioid of major concern for the great majority of countries, but in some countries and subregions, the non-medical use of pharmaceutical opioids has triggered new health threats in the last few years and has come to be known as an opioid crisis.

Prescription Opioid Users

People who began using heroin in the 1960s were predominantly young men from minority groups living in urban areas. The epidemic of prescription opioid abuse has been associated with a shifting of the demographic of opioid users toward a population that is somewhat older (mean age at first opioid use, 22.9 years), less minority, more rural/suburban, with few gender differences among those who were introduced to opioids through prescription drugs. Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90 percent of respondents who began use in the last decade were white. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

Because heroin is often injected, the upsurge in use also has implications for HIV, hepatitis C (HCV), and other injection-related illnesses. Recent studies suggest that having used opioid pain relievers before transitioning to heroin injection is a common trajectory for young injection drug users with HCV infection. A study of new HCV infections in Massachusetts found that 95 percent of interview respondents used prescription opioids before initiating heroin.

With the increasing use of opioids, there has been a concomitant increase in the number of treatment admissions attributable to prescription opioids and heroin. The number of persons receiving substance use treatment for prescription opioids rose from 360,000 in 2002, representing 10.3 percent of the total treatment population, to 772,000 (18.6 percent) in 2014.

Celebrities Who Died From Prescription Opiod Overdoes

Tom Petty

Prince died of an accidental fentanyl overdose at age 57 in his home in Chanhassen, Minnesota, on April 21, 2016. Prosecutors have alleged that he believed he was taking Vicodin, but that his pills were laced with fentanyl. Prince suffered from severe pain and addiction in the years before his death, according to the Associated Press. [Source: Everyday Health]

The Australian actor Heath Ledger died on January 22, 2008, from the effects of a mixture of several prescription drugs, including oxycodone, hydrocodone, and diazepam, according to CNN. The 28-year-old, known for his portrayal of the gay cowboy in “Brokeback Mountain” and the Joker in The “Dark Knight”, reportedly had been using the drugs to deal with a busy schedule and lack of sleep.

Famed rock singer-songwriter Tom Petty died on October 2, 2017, from an accidental overdose of several painkillers, including fentanyl and oxycodone. The 66-year-old had gone through bouts of addiction over the years, but at the time of his death he was reportedly using painkillers to treat a fractured hip, among other issues, according to NBC.

Mac Miller, the American rapper, singer, and record producer and good friend of Ariana Grande died of an accidental overdose of fentanyl, cocaine and alcohol in 2018. He was 26 years old.

Fentanyl and Prescription Opiods Market

According to the UNODC: The ease and low cost of manufacture and easy accessibility of fentanyls make the illicit markets for those substances substantially more profitable for traffickers than the markets for other opioids, such as heroin. The large-scale manufacture of fentanyls for the illicit market emerged in the context of an absence of international regulations on tramadol and many fentanyl analogues and their precursors. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

The fact that the substances available on pharmaceutical markets can be misused interchangeably with those on the illicit market makes it increasingly difficult to prevent their misuse, especially when their use is seen in the context of medical use and is thus perceived to carry less stigma or is subject to less severe legal sanctions than other controlled drugs.

Some drug dealers are mixing fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose. [Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services]

Fentanyl is a widely abused drug in the U.S. but it is not so widely used outside the U.S. In the U.S. the DEA uses the term “prescription opiods”. Internationally, the UNODC uses term “pharmaceutical opioids”. More or less the two terms describe the same thing except pharmaceutical opioids includes codeine. According to the UNODC: “ With a total amount of 228 tons of pharmaceutical opioids seized, an all-time high was reached in 2019, exceeding the quantities of opiates (seized if converted into heroin equivalents: 96 tons of heroin, 26 tons of morphine and 73 tons of opium expressed in heroin equivalents. In the past five years, tramadol, an opioid not under international control, has accounted for nearly two thirds of the global quantities of pharmaceutical opioids seized.

In 2019, quantities of pharmaceutical opioids seized worldwide were of codeine (65 percent of the total), followed by tramadol (26 per cent) and fentanyl (2 per cent). A number of other opioids were seized in 2019, including methadone, various mixtures containing fentanyl, licit or pharmaceutical morphine, papaverine, pethidine, oxycodone, carfentanil, buprenorphine, hydromorphone, phenazocine, tapentadol, hydrocodone, diphenoxylate and pentazocine. In addition to a number of substances seized in previous years, including dextropropoxyphene, isomethadone, hydromorphine, trimeperidine, dihydrocodeine, apo-oxycodone, U-47700, nalbuphine, ethylmorphine and oxymorphone. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

Large Drug Companies Fueled Opiod Crisis in U.S.

oxycodone pills

The largest drug companies in the U.S. flooded U.S. markets with 76 billion prescription pain pills during the nation's opioid epidemic from 2006 through 2012, according to a Washington Post analysis of a government database. U.S. News and World Report reported: Examining recently released data from the Drug Enforcement Agency's Automation of Reports and Consolidated Order System – which shows a pain pill's route from manufacturer and distributor to a U.S. pharmacy – the Post found that the volume of oxycodone and hydrocodone pills tied to the companies increased by more than 50 percent during the seven-year period, from 8.4 billion in 2006 to 12.6 billion in 2012. During the same time frame, nearly 100,000 people reportedly lost their lives to a prescripton opioid-related overdose. [Source: Katelyn Newman, U.S. News and World Report , July 17, 2019]

Six companies – McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart – distributed 75 percent of the pills, according to the analysis, while three manufacturers – SpecGx, Actavis Pharma and Par Pharmaceutical – accounted for 88 percent of the supply. Purdue Pharma – often blamed for sparking the opioid crisis with its release of OxyContin in the 1990s and marketing of the drug – was ranked fourth among the manufacturers, supplying about 3 percent of the market.

"Those 10 companies along with about a dozen others are now being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids," according to the Post. "The companies, in turn, have blamed the epidemic on overprescribing by doctors and pharmacies and on customers who abused the drugs. The companies say they were working to supply the needs of patients with legitimate prescriptions desperate for pain relief." According to the analysis, the highest concentrations of pills per person per year were received in West Virginia, with 66.5; Kentucky, with 63.3; South Carolina, with 58; Tennessee, with 57.7; and Nevada, with 54.7.

Fentanyl Trafficking Into the U.S.

The flow of fentanyl into the United States in 2019 is more diverse compared to the start of the fentanyl crisis in 2014, with new source countries and new transit countries emerging as significant trafficking nodes. This is exacerbating the already multi-faceted fentanyl crisis by introducing additional source countries into the global supply chain of fentanyl, fentanyl-related substances, and fentanyl precursors. [Source: Fentanyl Flow to the United States Drug 2019] Enforcement Administration (DEA), January 2020]

Further, this complicates law enforcement operations and policy efforts to stem the flow of fentanyl into the United States. While Mexico and China are the primary source countries for fentanyl and fentanyl-related substances trafficked directly into the United States, India is emerging as a source for finished fentanyl powder and fentanyl precursor chemicals.

As Beijing and the Hong Kong Special Autonomous Region (SAR) place restrictions on more precursor chemicals, Mexican transnational criminal organizations (TCOs) are diversifying their sources of supply. This is evidenced by fentanyl shipments from India allegedly destined for Mexico. The flow of fentanyl to the United States in the near future will probably continue to be diversified. The emergence of India as a precursor chemical and fentanyl supplier as well as China’s newly implemented regulations have significant ramifications for how TCOs’ fentanyl and fentanyl precursor chemical supply chains will operate. Mexican TCOs are likely poised to take a larger role in both the production and the supply of fentanyl and fentanyl-containing illicit pills to the United States, especially if China’s proposed regulations and enforcement protocols are implemented effectively. Fentanyl production and precursor chemical sourcing may also expand beyond the currently identified countries as fentanyl lacks the geographic source boundaries of heroin and cocaine as these must be produced from plant-based materials

Global Fentanyl Trade

Fentanyl pills

According to the UNODC: In 2019, the largest quantities of fentanyls seized at the global level were of fentanyl, followed by mixtures of fentanyl and carfentanil, a substance that is 10,000 times more potent than morphine. The vast majority of the fentanyls (98 per cent) seized over the period 2015–2019 were intercepted in the Americas, almost all of them in North America. The proportions seized in Europe (1.3 percent, mostly in Eastern Europe) and Asia (0.4 percent, mostly in East and Southeast Asia) were comparatively very small. Although most of the increase in the amounts of fentanyls seized over the period 2010–2019 was reported in North America, the quantities of fentanyls seized in Europe and Asia also increased. In all regions, the quantities of fentanyl seized were larger than those of any fentanyl analogue. At the same time, the sizeable amounts of mixtures of fentanyl seized in 2019 suggest that the market may be increasingly diversifying in terms of fentanyl products. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

Most trafficking in fentanyls takes place from East and Southeast Asia to North America, including via Mexico Given the predominance of seizures in North America and according to United States authorities, international trafficking in fentanyls over the period 2015–2019 took place mainly from East and Southeast Asia (notably China) to North America, either directly, in small quantities, to the United States or to Mexico, in large quantities, and from there to the United States or to Canada for the domestic market and/or for onward shipment to the United States. These trafficking patterns seem to have changed, however, since the class scheduling of fentanyls in China in May 2019, which went hand in hand with a major crackdown on illicit fentanyl laboratories and sales sites in China, together with improved training for law. The fentanyl analogues 3-methylfentanyl, acetyl-alpha-methylfentanyl, ocfentanil and furanylfentanyl are not pharmaceutical drugs.

In recent years, the largest increases in the amounts of the various pharmaceutical opioids seized have been reported for fentanyl and its analogues. Compared with the previous year, the global quantities of fentanyls seized increased by more than 30 percent in 2018 and more than 60 percent in 2019. Moreover, the quantities of fentantyls seized in 2019 were almost 50 times larger than those seized in 2015 and more than 6,000 times larger than those seized in 2000. The largest quantities of fentanyl-type substances seized over the period 2010– 2019 were reported for fentanyl as such, followed by various mixtures containing fentanyl, 3-methylfentanyl, carfentanil, acetyl-alpha-methylfentanyl, ocfentanil.

As a result, of increased activity by enforcement officials and the installation of new screening equipment at postal facilities, the amount of illicit fentanyl and fentanyl analogues shipped by mail from China to the United States, which used to be a major route for high-quality fentanyls arriving in the United States, appears to have decreased dramatically, according to United States authorities. In 2018, direct shipments of fentanyl analogues to the United States by mail declined, in terms of quantities seized, by more than 50 percent following the scheduling of a number of fentanyl analogues in China in 2017 and 2018. Nonetheless, according to United States authorities, shipments of fentanyls from other countries (such as India) and/or of precursor chemicals for the clandestine manufacture of fentanyls from China and other countries to Mexico appear to have increased over the last two years. In fact, there is a potential risk that criminal groups operating in countries with a large and thriving pharmaceutical sector may become more involved in the clandestine manufacture of fentanyls. In September 2018, the Indian authorities reported a relatively large seizure of fentanyl destined for organized crime groups in Mexico that involved the arrest of a Mexican citizen. Moreover, United States authorities have reported the interception of mail shipments containing illicitly

China: A Major Source of Fentanyl and Fentanyl-Related Substances

Currently, China remains the primary source of fentanyl and fentanyl-related substances trafficked through international mail and express consignment operations environment, as well as the main source for all fentanyl-related substances trafficked into the United States. Seizures of fentanyl sourced from China average less than one kilogram in weight, and often test above 90 percent concentration of pure fentanyl. precursors. [Source: Fentanyl Flow to the United States Drug 2019] Enforcement Administration (DEA), January 2020]

On May 4, 2018, the Hong Kong SAR updated their drug law to control the fentanyl precursors 4-anilino-N-phenethyl-4- piperidine (ANPP) and N-phenethyl-4-piperidone (NPP) as well as the synthetic opioid U-47700. This matches China’s scheduling of ANPP and NPP on July 1, 2017. The move by the Hong Kong SAR is considerable, since synthetic opioids produced and shipped from China may transit the Hong Kong SAR en route to the United States.

Effective May 1, 2019, China officially controlled all forms of fentanyl as a class of drugs. This fulfilled the commitment that President Xi made during the G-20 Summit. The implementation of the new measure includes investigations of known fentanyl manufacturing areas, stricter control of internet sites advertising fentanyl, stricter enforcement of shipping regulations, and the creation of special teams to investigate leads on fentanyl trafficking. These new restrictions have the potential to severely limit fentanyl production and trafficking from China. This could alter China’s position as a supplier to both the United States and Mexico.

Vicodin pill

Fentanyl and Fentanyl-Related Substances from India

According to the UNODC: According to authorities in the United States, in September 2018, the Directorate of Revenue Intelligence of India, in cooperation with the Drug Enforcement Agency of the United States, dismantled the first known illicit fentanyl laboratory in India and seized several kilograms of fentanyl.a A close partnership was identified between an Indian and a Chinese national who worked in concert to obtain fentanyl precursor chemicals and manufacture fentanyl.b The operation had begun in China but later moved to India after the actors involved encountered difficulties obtaining precursor chemicals in China, possibly as a consequence of the previous announcement by China of the regulation of fentanyl precursors 4-anilino-N-phenethyl-4-piperidone (4-ANPP) and N-phenethyl-4-piperidone (NPP). Subsequent investigations also indicated that, in the meantime, chemists in India had developed the expertise to illicitly manufacture fentanyl without NPP and 4-ANPP. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

In 2017, the DEA provided information to India’s Directorate of Revenue Intelligence, resulting in the takedown of an illicit fentanyl laboratory in Indore, India in 2018. DEA reporting indicates an Indian national associated with the Sinaloa Cartel initially supplied the organization with fentanyl precursor chemicals, NPP and ANPP, after which a Chinese national also affiliated with the Sinaloa Cartel would synthesize the fentanyl and traffic it from India to Mexico. precursors. [Source: Fentanyl Flow to the United States Drug 2019] Enforcement Administration (DEA), January 2020]

Between February and March 2018, the India- and China-based suspects shifted their production from China to India, likely due in part to China’s regulation of ANPP and NPP. The organization likely transferred their production to India due to difficulties obtaining precursor chemicals in China and the increasing pressure from Chinese authorities on fentanyl manufacturing operations. This may serve as an important precedent, given China’s newly imposed restrictions on fentanyl and fentanyl precursors as a class. Fentanyl and fentanyl precursor trafficking from India to TCOs in Mexico or direct to the United States may be poised to increase if China-based traffickers work with Indian nationals to circumvent China’s new controls on fentanyl. In addition, in February 2018, India announced controls on the exportation of ANPP and NPP, similar to previous regulations enacted by China, which will likely result in stricter controls on these precursors.

In December 2018, the Mumbai Anti-Narcotics Cell (ANC) seized approximately 100 kilograms of the fentanyl precursor NPP and arrested four Indian nationals in Mumbai, India. India’s Narcotics Control Bureau (NCB) reported to DEA in April 2019 that the seizure was identified as NPP through forensic analysis at a state-run laboratory in India. According to the ANC, the NPP was destined for Mexico and deliberately mislabeled. This was the third seizure of a fentanyl-related substance or fentanyl precursor linked to Mexico in 2018, demonstrating growing links between Mexican TCOs and India-based fentanyl precursor chemical suppliers. Given the behavior of Mexican TCOs who obtain fentanyl precursors and finished fentanyl from China, it is highly likely the precursor chemicals purchased from India were to be used in the synthesis of finished fentanyl destined for sale in the United States.

Fentanyl from Mexico

Mexican TCOs are producing increased quantities of fentanyl and illicit fentanyl-containing tablets, with some TCOs using increasingly sophisticated clandestine laboratories and processing methods (i.e., laboratory grade glassware, unregulated chemicals, and industrial size tablet presses). DEA, working in conjunction with Mexican officials, has seized and dismantled numerous fentanyl pill pressing operations and fentanyl synthesis laboratories in 2018 and 2019, highlighting the role TCOs play in supplying the US fentanyl market. Fentanyl is smuggled across the U.S.-Mexico border in low concentration, high-volume loads, kilogram seizures often contain less than a 10 percent concentration of fentanyl. precursors. [Source: Fentanyl Flow to the United States Drug 2019] Enforcement Administration (DEA), January 2020]

TCOs are also increasingly producing wholesale quantities of illicit fentanyl pills and smuggling them into the United States. In December 2018, Mexican officials in combination with DEA authorities seized an illicit pill mill in Azcapotzalco, Mexico City. Law enforcement officials seized illicit fentanyl-laced oxycodone M-30 pills, suspected fentanyl powder, precursor chemicals and multiple other items related to the production of fentanyl-laced illicit pills. As with the Mexicali, Mexico fentanyl pill mill seized in September 2018, DEA reporting indicated the organization operating the pill mill in Mexico City is linked to the Sinaloa Cartel.

DEA reporting continues to indicate the Sinaloa and the New Generation Jalisco (Cártel de Jalisco Nueva Generación or CJNG) cartels are likely the primary trafficking groups responsible for smuggling fentanyl into the United States from Mexico. To date, the fentanyl synthesis and fentanyl pill production operations dismantled in Mexico have either occurred in territories controlled by these cartels or have had involvement by members/associates of these cartels. In addition, these TCOs are known to control the trafficking corridors in Mexico that connect to California and Arizona, indicating drugs passing through these associated areas would need to be approved by these organizations.

suspected fentanyl cutting table

Fentanyl Trafficking and the Mexican Cartels

According to the UNODC: Most fentanyl trafficking to the United States continues to be in the hands of organized crime groups involved in trafficking the drugs from Mexico to the United States. The main drug trafficking organizations involved include the Jalisco New Generation Cartel, which now operates in a close alliance with the Arellano Félix Organization (also known as the Tijuana Cartel) for such trafficking activities, and the Sinaloa Cartel. The Sinaloa Cartel and the Jalisco New Generation Cartel have previously been identified as the primary groups involved in trafficking fentanyls into the United States across the country’s south-western border but, according to United States authorities, both cartels are also heavily involved in the smuggling of a number of other drugs into the United States. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

To enable the import of fentanyl and/or of fentanyl precursors from Asia into Mexico, the control of the country’s Pacific ports is of key importance to traffickers. The Sinaloa Cartel is active in many of the country’s northern Pacific ports, while the Jalisco New Generation Cartel is active in several of the country’s southern Pacific ports. This is of importance because Mexico continues to be a major transit country for fentanyls, as well as a source country for illicit fentanyl and fentanyl-laced falsified tablets destined for the United States market, according to United States authorities.

In addition to seizures of fentanyl in territories under the control of the Sinaloa Cartel and the Jalisco New Generation Cartel, seizures of fentanyl are also concentrated along the border between Mexico and the United States, in particular along the stretch between Mexico and the states of California and Arizona that is controlled by the Sinaloa Cartel and the Arellano-Félix Organization, which has an alliance with the Jalisco New Generation Cartel, as well as on the east coast of the United States, most notably in the north-eastern states, around the Great Lakes and in some parts of the Midwest. The number of opioid-related deaths in the United States involving fentanyl is also highest around the Great Lakes, the north-east and parts of the Midwest.

Fentanyl Production and the Mexican Cartels

According to the UNODC: A comparison of fentanyl seizures made at the south-western border of the United States with those made in other parts of the country revealed that, despite the identification of some fentanyl pill mill laboratories in Mexico, most fentanyl contained in wholesale-level shipments does not contain mixtures of other drugs, suggesting that most of the mixing of fentanyl with heroin and other illicit drugs continues to take place in the United States, not Mexico. [Source: United Nations Office on Drugs and Crime (UNODC), World Drug Report 2021]

According to authorities in the United States, most of the fentanyl synthesis and fentanyl tablet production operations dismantled in Mexico to date have occurred in territories controlled by the Sinaloa Cartel.a For example, in November 2017, Mexican authorities seized a fentanyl laboratory in Culiacán, the state capital of Sinaloa and the home base of the Sinaloa Cartel. In September 2018, counter-narcotics authorities of Mexico and the United States seized a laboratory in Baja California, Mexico, that was manufacturing fentanyl and carfentanil, arresting two suspected associates of the Sinaloa Cartel. In September 2018, police in the border city of Mexicali raided a clandestine fentanyl laboratory and detained two suspects, including a Russian passport holder, underlining the international dimension of such activities. In December 2018, the Office of the Attorney General of Mexico reported the dismantling of a clandestine fentanyl laboratory in Mexico City, which was also equipped with an automated pill press.d Mexican law enforcement authorities also seized and dismantled clandestine fentanyl pill-milling operations in 2018, one of which was responsible for producing carfentanil-laced tablets. Another laboratory, dismantled in December 2018 by Mexican law enforcement agencies in Azcapotzalco, Mexico City, apparently produced fentanyl-laced oxycodone tablets.

In April 2019, Mexican authorities reported the dismantling of a clandestine fentanyl laboratory in Culiacán,e seizing not only fentanyl tablets but also several containers that contained heroin.f In June 2019, authorities reported the dismantling of a clandestine laboratory in Nuevo León that had been used for the manufacture of chemical precursors of fentanyl and possibly also the manufacture of fentanyl itself. At the same time, significant quantities of fentanyl continue to be smuggled into Mexico for re-export to the United States. In January 2019, the Ministry of Public Security reported the interception of shipments of fentanyl from China and Hong Kong, China, at Mexico City International Airport. In August 2019, the Ministry of Naval Affairs announced a major seizure of powdered fentanyl, which had originated in Shanghai, China, and was headed to Culiacán, by the Mexican navy and customs enforcement personnel at the Lázaro Cárdenas seaport. The latest significant seizure was in February 2021, when the Mexican military seized over 100,000 fentanyl tablets (together with over 2.5 tons of methamphetamine) from a vessel near the coast of the north-western state of Sinaloa.

Image Sources: 1) DEA (Drug Enforcement Administration); 2) Normal Museum; 3) Wikimedia Commons

Text Sources: 1) “Buzzed, the Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy” by Cynthia Kuhn, Ph.D., Scott Swartzwelder Ph.D., Wilkie Wilson Ph.D., Duke University Medical Center (W.W. Norton, New York, 2003); 2) National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services; 3) United Nations Office on Drugs and Crime (UNODC) and 4) National Geographic, New York Times, Washington Post, Los Angeles Times, Wikipedia, The Independent, Times of London, The New Yorker, Time, Newsweek, Reuters, Associated Press, AFP, , Lonely Planet Guides, and various books and other publications.

Last updated April 2022

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