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The Fentanyl Crisis, Explained

Why the fentanyl epidemic is different from America’s past drug crises

February 2024


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If you’re of a certain age, the storyline of the typical anti-drug ad is probably burned into your brain.

Someone gives into peer pressure or curiosity and tries drugs for the first time. It seems harmless enough.

Pretty soon, addiction takes hold and they’re on a sharp downward spiral, losing money, jobs, and friends.

Then they bottom out. Maybe end up on the streets. Maybe in jail. Maybe dead.

Those ads were … a little over the top. OK, way over the top. And, as a result, most of us tuned out the most hysterical warnings about drugs a long time ago.

Which … is a little bit of a problem. Because these days, one drug in particular … may actually justify the hysteria.


Less than one in 100,000. That’s how many Americans died from drug overdoses annually in the years between 1945 and 1966. i

Now, maybe you’re thinking “Yeah, but how many people were doing hard drugs back then.”

So, the overdose rate at the height of the crack epidemic? Three in 100,000.ii

And then … things started to change.

Between 1990 and 2000, the death rate doubled. Then doubled again between 2000 and 2010. Then tripled between 2010 and 2020.iii In 2021, over 111,000 people died from overdosing — almost as many as died from homicide, suicide, and car accidents combined.iv

What changed? Well, the statistics tell the story: In 2021, 2/3 of those overdose deaths were caused by synthetic opioids like fentanyl.v

Every overdose death is a tragedy. But in this new era, the story of those tragedies often don’t follow the same plotline they used to.

In past drug crises, overdose deaths tended to come at the end of long, desperate struggles with addiction. But because fentanyl is so potent — 50 times stronger than heroin, and 100 times stronger than morphinevi it has a much greater likelihood of killing even an infrequent user with any given use. And what compounds the danger is how often fentanyl slips undetected into all kinds of other drugs.

Much of the “heroin” sold on the street is actually fentanyl. Fentanyl is often added to cocaine or even passed off as it. Many varieties of illegal pills are just pressed fentanyl. And too often users won’t know until it’s too late.

But why would fentanyl be getting into the supply of other drugs in the first place? The answer to that question is at the very heart of the fentanyl epidemic: Not only is fentanyl incredibly potent, but it’s also incredibly cheap — which means more money for drug dealers who substitute it for more expensive substances.vii

The reason fentanyl is so cheap is also the reason it’s now so abundant. In the past, there were physical factors limiting the supply of illegal drugs. If you were in the cocaine or heroin business, you were limited by the amount of land it took to grow your supply. There were limits to how potent a drug you could grow. And the physical size of it made it more likely that you’d get caught by law enforcement at some point.

But with synthetic opioids, all that work can get done in the lab — hardly any physical footprint, you can design the drug to be as potent as you want, and much less chance of getting caught.

So, for drug traffickers, fentanyl is fantastic. Cheaper. Easier. And so addictive you almost guarantee yourself repeat customers.

So, what can we do to combat this crisis? The most straightforward step is making sure that more Americans know just how great the risks associated with fentanyl are. After that … it gets tougher.

First, there’s the issue of dealing with the people responsible for supplying the drugs. We know where the problem is coming from. As of just a few years ago, estimates were that as much as 90 percent of the world’s fentanyl was coming out of China.viii But in 2019, Beijing declared that it would start cracking down on the drug trade — which doesn’t mean what it sounds like.

Today, the fentanyl trade is primarily being run by Mexican cartels — who get all the materials they need for the drugs from Chinaix … in return for which the cartels work with Chinese money laundering operations.x

And the story gets even murkier than that, because, thanks to legal loopholes, a lot of fentanyl money is actually laundered right here in the United States too.

In 2017, for example, the Justice Department brought charges against two Chinese nationals who were shipping drugs to 37 different states through a shell company … run out of Massachusetts.xi The trend grew so bad that it led Treasury Secretary Janet Yellen to declare that America had become perhaps the best place in the world to hide and launder dirty money.xii

So, step one: start by cleaning up our own contributions to the problem.

Then there’s the hardest question: How do we help the people already caught in addiction?

Some of the common answers don’t solve as many problems as we’d hope.

Providing drug users access to Naloxone, a medication that can reverse overdoses, for example, helps prevent deaths at locations where it’s handed out, but does nothing to help the same person the next time they use. As a result, research shows that it’s often little more than the difference between overdosing today or overdosing tomorrow.xiii

Research on the strategy of giving drug users clean needles suggests that while it may be successful at reducing things like HIV infection, it actually seems to increase the overdose rate.xiv

The data does, however, point to one tool that’s more effective: getting users treatment that includes medication that calms the craving for opioids. While about half of users still relapse, that’s still potentially millions of lives changed. One study estimated that there are about 7.6 million Americans who suffer from an opioid abuse disorder, but only about one million receiving medication-assisted treatment. xv

America has never seen a drug crisis quite like this before — one where even a casual user could face as much threat of an overdose as the most serious addict.

Will we figure out how to deal with it? We’ll have to. Because the consequences of failure would be too terrible to bear.


  1. Long-Term Trends in Deaths of Despair — U.S. Congress, Joint Economic Committee
  2. Ibid.
  3. Ibid.
  4. “How To Think About the Drug Crisis” (Charles Fain Lehman) — National Affairs
  5. Drug Overdose Death Rates — National Institute on Drug Abuse
  6. Fentanyl Facts — Centers for Disease Control and Prevention
  7. Facts About Fentanyl — United States Drug Enforcement Administration
  8. “Mexico’s Role in the Deadly Rise of Fentanyl” (Steven Dudley, et al.) — Wilson Center, Mexico Institute
  9. China Primer: Illicit Fentanyl and China’s Role — Congressional Research Service
  10. Ibid.
  11. Two Chinese Nationals Charged With Operating Global Opioid and Drug Manufacturing Conspiracy Resulting in Deaths — U.S. Department of Justice
  12. Remarks by Secretary of the Treasury Janet L. Yellen at the Summit for Democracy — U.S. Department of the Treasury
  13. “How To Think About the Drug Crisis” (Charles Fain Lehman) — National Affairs
  14. "Syringe Exchange Programs and Harm Reduction: New Evidence in the Wake of the Opioid Epidemic" (Analisa Packham) — Journal of Public Economics
  15. “How To Think About the Drug Crisis” (Charles Fain Lehman) — National Affairs


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  1. U.S. Congress, Joint Economic Committee
    Long-Term Trends in Deaths of Despair
  2. National Affairs
    “How To Think About the Drug Crisis” (Charles Fain Lehman)
  3. National Institute on Drug Abuse
    Drug Overdose Death Rates
  4. Centers for Disease Control and Prevention
    Fentanyl Facts
  5. United States Drug Enforcement Administration
    Facts About Fentanyl
  6. Wilson Center, Mexico Institute
    “Mexico’s Role in the Deadly Rise of Fentanyl” (Steven Dudley, et al.)
  7. Congressional Research Service
    China Primer: Illicit Fentanyl and China’s Role
  8. U.S. Department of Justice
    Two Chinese Nationals Charged With Operating Global Opioid and Drug Manufacturing Conspiracy Resulting in Deaths
  9. U.S. Department of the Treasury
    Remarks by Secretary of the Treasury Janet L. Yellen at the Summit for Democracy
  10. Journal of Public Economics
    "Syringe Exchange Programs and Harm Reduction: New Evidence in the Wake of the Opioid Epidemic" (Analisa Packham)

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