The Pain Pill – Fentanyl and opioid crisis in the US

Over 100,000 individuals died of an overdose last year in the United States alone, with fentanyl being the predominant drug.

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Girish Linganna
Girish Linganna
Girish Linganna is a Defence & Aerospace analyst and is the Director of ADD Engineering Components (India) Pvt Ltd, a subsidiary of ADD Engineering GmbH, Germany with manufacturing units in Russia. He is Consulting Editor Industry and Defense at Frontier India.

In recent years, the debilitating opioid epidemic that has plagued the United States for decades has become even more lethal due to the increasing availability of fentanyl. This potent synthetic opioid is 50 times more potent than heroin. The United States has the highest rate of opioid-related deaths per capita globally, and fentanyl poisoning is the primary cause of death for Americans aged 15 to 44.

Illicit fentanyl Trade

According to the CDC (Centers for Disease Control and Prevention), fentanyl is cheaper to manufacture and distribute than opiates derived from poppies, despite having a potency level that is fifty times higher than heroin. Due to its low production cost and ubiquitous availability, it is increasingly being added to the supply of more expensive street drugs, such as heroin, cocaine, and illegally produced counterfeit prescription pills. The high potential for physical and psychological dependence and the extreme potency of fentanyl have contributed to increased opioid-related accidental overdoses and poisonings.

Figures derived from the Congressional hearings and CDC state that the United States has the highest rate of opioid-related fatalities per capita today, with a rate that is more than five times the global average for economically developed nations. Poisoning by fentanyl is the primary cause of death for Americans aged 15 to 44. Over 100,000 individuals died of an overdose last year in the United States alone, with fentanyl being the predominant drug.

Ingestion of counterfeit prescription pills containing fentanyl, such as OxyContin, Percocet, Adderall, or Xanax, has significantly increased poisoning deaths among adolescents. Statistically, populations who identify as white or Native American and are unemployed, disabled, uninsured, incarcerated, or impoverished have greater opioid overdose death rates than those who do not share these characteristics.

Nearly all illicit fentanyl ingested in the United States is produced in Mexico by transnational criminal organisations, specifically the Sinaloa and New Generation Jalisco cartels, and smuggled into the country by American citizens through official ports entry. According to data from the U.S. Sentencing Commission, most of those convicted of drug trafficking are American, more than ten times as many as illegal immigrants.

Virtually all illicit fentanyl produced in Mexico originates from Chinese precursor chemicals. Chinese companies sold fentanyl and precursor chemicals (which are not dangerous on their own) to U.S. and international customers for years. In 2019, at the behest of the U.S. government, China classified fentanyl and certain base chemicals as Schedule I narcotics and outlawed their export. Since then, China’s exports of fentanyl and related chemicals to the United States have nearly ceased. However, precursor chemicals continue to be diverted and smuggled into Mexico, where they are processed into fentanyl before being trafficked into the United States.

What actions is Congress taking? 

The illicit fentanyl trade results from the Food and Drug Administration’s (FDA) regulatory failings dating back to the 1990s. The FDA is a federal agency within the U.S. Department of Health and Human Services tasked with protecting public health by requiring drug manufacturers to demonstrate that their products are safe and efficacious before being sold. Due to conflicts of interest, the FDA failed to evaluate and classify OxyContin (extended-release oxycodone) as an addictive narcotic in 1995. Therefore, Purdue Pharma was legally permitted to aggressively and falsely market OxyContin, a highly addictive prescription opioid, as a non-addictive analgesic to physicians and patients nationwide. These dubious OxyContin sales generated billions in profits for Purdue.

Following a sharp increase in reported cases of opioid-related overdoses, the FDA began to revise OxyContin’s regulatory labelling and examine prescribing practices until 2001. Nevertheless, the demand for analgesics was established. The prescription opioid crisis of the 1990s gave way to the heroin epidemic of the 2000s. The opioid epidemic is currently in its third phase. To operate the highly lucrative clandestine fentanyl trade, drug cartels are capitalising on the depressed economic conditions in Mexico, the enormous demand for opioids in the United States, and the low production costs and low barrier to entry in the market for synthetic drugs.

Three federal laws were enacted between 2016 and 2018 to enhance treatment and reform opioid prescribing policies. However, the FDA has never been held accountable for the regulatory errors and negligence that led to this ongoing public health emergency. While criminalisation, border security, and treatment currently dominate the conversation regarding solutions to the deadly fentanyl epidemic, Since the 118th Congress convened on January 3, five bipartisan bills to enhance FDA regulatory oversight have been introduced. These bills include Ensuring the FDA Fully Examines Clinical Trial Impact and Vitalness before Endorsement (EFFECTIVE) Act, FDA Accountability for Public Safety Act, Changing the Culture of the FDA Act, Protecting Americans from Dangerous Opioids Act and Ensuring the FDA Fully Examines Clinical Trial Impact and Vitalness before Endorsement (EFFECTIVE) Act. The Center for International Policy has also recorded the introduction of sixty bills and resolutions pertinent to the illegal fentanyl trade. 


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