Fentanyl is a highly potent synthetic piperidine opioid primarily used as an analgesic (pain medication). It is 30 to 50 times more potent than heroin and 50 to 100 times more potent than morphine. Its primary clinical utility is in pain management for cancer patients and those recovering from painful surgeries. Fentanyl is also used as a sedative. Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose. Fentanyl works by activating μ-opioid receptors. Fentanyl is sold under the brand names Actiq, Duragesic, and Sublimaze, among others.
Fentanyl is contributing to an epidemic of synthetic opioid drug overdose deaths in the United States. From 2011 to 2021, deaths from prescription opioid (natural and semi-synthetic opioids and methadone) per year remained stable, while synthetic opioid (primarily fentanyl) deaths per year increased from 2,600 overdoses to 70,601.
Since 2018, fentanyl and its analogues have been responsible for most drug overdose deaths in the United States, causing over 71,238 deaths in 2021. Fentanyl constitutes the majority of all drug overdose deaths in the United States since it overtook heroin in 2018. The United States National Forensic Laboratory estimates fentanyl reports by federal, state, and local forensic laboratories increased from 4,697 reports in 2014 to 117,045 reports in 2020. Fentanyl is often mixed, cut, or ingested alongside other drugs, including cocaine and heroin.
Fentanyl has been reported in pill form, including pills mimicking pharmaceutical drugs such as oxycodone. Mixing with other drugs or disguising as a pharmaceutical makes it difficult to determine the correct treatment in the case of an overdose, resulting in more deaths. In an attempt to reduce the number of overdoses from taking other drugs mixed with fentanyl, drug testing kits, strips, and labs are available. Fentanyl's ease of manufacture and high potency makes it easier to produce and smuggle, resulting in fentanyl replacing other abused narcotics and becoming more widely used.
Fentanyl is contributing to an epidemic of synthetic opioid drug overdose deaths in the United States. From 2011 to 2021, deaths from prescription opioid (natural and semi-synthetic opioids and methadone) per year remained stable, while synthetic opioid (primarily fentanyl) deaths per year increased from 2,600 overdoses to 70,601.
Since 2018, fentanyl and its analogues have been responsible for most drug overdose deaths in the United States, causing over 71,238 deaths in 2021. Fentanyl constitutes the majority of all drug overdose deaths in the United States since it overtook heroin in 2018. The United States National Forensic Laboratory estimates fentanyl reports by federal, state, and local forensic laboratories increased from 4,697 reports in 2014 to 117,045 reports in 2020. Fentanyl is often mixed, cut, or ingested alongside other drugs, including cocaine and heroin.
Fentanyl has been reported in pill form, including pills mimicking pharmaceutical drugs such as oxycodone. Mixing with other drugs or disguising as a pharmaceutical makes it difficult to determine the correct treatment in the case of an overdose, resulting in more deaths. In an attempt to reduce the number of overdoses from taking other drugs mixed with fentanyl, drug testing kits, strips, and labs are available. Fentanyl's ease of manufacture and high potency makes it easier to produce and smuggle, resulting in fentanyl replacing other abused narcotics and becoming more widely used.
However, fentanyl has become the most common drug linked to overdoses in the United States, prompting the Centers for Disease Control and Prevention (CDC) to call it the «third wave» of the opioid epidemic. Fentanyl is relatively inexpensive to produce, and its high potency helps to expand supply, making it attractive to the illicit market. Illegal fentanyl is usually in powder form or pressed into fake tablets that look similar to prescription opioids. It may also be mixed with other drugs, such as heroin, to increase efficacy and reduce cost.
President Donald Trump used the drug trade issue as an argument for imposing duties on goods from Mexico, Canada and China. Official administration documents state that «the flow of smuggled drugs, such as fentanyl, through illicit channels has created a national emergency, including a public health crisis». Tariffs on goods from Mexico and Canada were temporarily lifted for 30 days on the condition of increased border controls, but 10% duties on Chinese goods began in early February.
Most medical fentanyl is imported into the U.S. from China, shipped directly in finished form. At the same time, illegal shipments originate in China, starting with direct shipments to the U.S. and then becoming disparate streams. There is currently no evidence that legal fentanyl is illegally entering the black market. The main shipments of precursors for the production of illegal fentanyl are sent from China to Mexico, where laboratories use them to make the final product, which is then shipped across the border to the United States.
Mexican cartels use well-established trafficking routes, often through legal ports, using U.S. citizens as mules.
According to U.S. Customs and Border Protection, about 22,000 pounds of fentanyl were seized along the nation's borders in FY 2024. Nearly all of this volume (about 97%) was seized along the southwest border, with a significant portion — more than half — seized in Tucson, Arizona, and about 30% seized in San Diego, California. In contrast, only a few dozen pounds of fentanyl were seized along the northern border with Canada, due to the fact that the illicit networks in Canada have little connection to the U.S. market.
While seizures of illegal fentanyl have increased in recent years, there is evidence that the supply of the drug is changing. The epidemic remains dynamic and the market can respond quickly to changes in supply and demand, which has long been the case.
According to the CDC, the first wave of opioid overdoses began in the 1990s with the widespread availability of prescription painkillers. This year, Purdue Pharma and its owners, the Sackler family, reached a multibillion-dollar settlement in thousands of lawsuits alleging that the drug OxyContin caused the massive opioid addiction crisis in the United States.
Since 2010, there has been a sharp increase in heroin overdoses, which the CDC considers the second wave of the epidemic. However, since about 2013, synthetic opioids, primarily fentanyl, have taken center stage.
Overdose deaths peaked during the COVID-19 pandemic, when the number of deaths reached about 115,000 for the year, the CDC estimates. Synthetic opioids, primarily fentanyl, were largely to blame for these cases, accounting for about two-thirds of all deaths.
Since the beginning of last year, however, death rates have begun to decline. While fentanyl remains the leading cause of fatalities, the data shows a 22% decrease in the death rate compared to last year. In the 12 months ending in August, about 58,000 deaths related to synthetic opioids were recorded.
Some experts suggest that a «fourth wave» of the epidemic is underway, characterized by more frequent mixing of illicit fentanyl with other drugs, particularly stimulants, creating particularly dangerous situations. While opioid deaths are declining, there has been an increase in overdose deaths from cocaine and stimulants such as methamphetamine, according to preliminary data from the CDC.
Experts believe that the rapid decline in mortality cannot be attributed to a single factor; rather, it is the result of comprehensive efforts and measures taken in recent years.
Changes in supply began long before the tariff sanctions were imposed. In November, the U.S. Drug Enforcement Administration noted that the number of lethal doses of fentanyl in tested samples was down from the previous year. About 50% of pills tested by the agency contained lethal doses of fentanyl — down from 70% a year earlier.
Drug tests at the Forensic Science Center showed a slight decrease in the average concentration of fentanyl in powder, though the changes were small amid high variability in supply.
Under Joe Biden's presidency, the Department of Health launched a national overdose prevention strategy focused on harm reduction — with test strips to detect fentanyl, antidote medications and safe injection sites, as well as prevention programs, treatment and rehabilitation.
An in-depth trend analysis by experts at the University of North Carolina, led by Nabarun Dasgupta, found that the number of non-fatal overdoses has also dropped significantly, and that these trends are consistent at the state level — all evidence of an emerging overall trend.