“We are losing an entire generation due to drugs,” said Michael Cole, the founder of Lauren’s Wish Addiction Triage Center, an organization named after the daughter he lost to a fentanyl overdose. Growing up in West Virginia, Lauren was a strong student, athletic, and kind to others. At 16 she became addicted to opioids. She died on July 9, 2020, at the age of 26.
Driven largely by fentanyl, drug overdoses are now the leading cause of death among Americans ages 18 to 45. In 2020, close to 92,000 Americans died of a drug overdose, but the number rose sharply during the pandemic and lockdowns. In 2021, life expectancy in the U.S. hit its lowest point in two decades. In 2022, there were 109,000 overdose deaths, according to provisional data from the Centers for Disease Control, with deaths from synthetic opioids up 80% over the same period and most of those attributable to fentanyl.
Other countries in the world don’t come close to America’s level of illegal drug consumption—or to its death tallies. The U.S. now consumes about 85% of all the world’s opiates. As a result, the rate of overdose deaths is around 20 times higher in America than the global average.
To understand how it is that a deadly and highly addictive poison has flooded the streets of American cities and small towns, one has to untangle the knot of connections linking Chinese drug manufacturers, Mexican cartels, and a homegrown culture of addiction that uses chemical remedies to treat economic and spiritual woes. That globalized and lethal supply chain, which is enriching criminal cartels while undoing the fabric of American life, is in part the result of shortcomings in U.S. policy, multiple former agents from the Drug Enforcement Administration told Tablet. According to them, the federal government failed to respond to repeated warnings about the coming fentanyl crisis, even as the casualties began to mount.
On Dec. 11, 2001, China was brought into the World Trade Organization—the culmination of a bipartisan commitment to free-market fundamentalism among America’s political and economic elite. In short order, China became the world’s factory, first developing into a regional and then international power, competing directly with the U.S. and Europe for commercial opportunities, patents, and political hegemony. No longer just a producer of cheap consumer goods, today China exports high level and strategic products like semiconductor chips, industrial chemicals, and pharmaceuticals to Western markets.
Derek Maltz, a former agent in charge of the Special Operations Division at the Drug Enforcement Administration who retired after working for the agency for 28 years, has long believed that China is the driving force behind America’s fentanyl crisis. 2005 and 2006 were marked by “a massive [number of] fentanyl deaths in the Midwest, but no one knew where it was coming from and who was producing it,” Maltz told Tablet. An investigation in partnership with the Mexican Authorities identified the lab in Mexico producing the fentanyl and shut it down. Then in 2007, more than $200 million was discovered in a house in Mexico City. DEA officials were surprised to learn that the Chinese national who owned the house was holding a Mexican passport and, according to Mexican authorities, had close ties with Sinaloa cartels. At that time the DEA did not conclude that Chinese criminals were involved in the production of fentanyl—only that the country was involved in the production of large amounts of precursor chemicals to assist the Mexican cartels in the production of methamphetamines. Maltz later became suspicious of China’s role in the fentanyl crisis in 2012, when Americans began dying of drug overdoses at an even higher rate. “I knew in my mind that there was a correlation between Chinese criminals and Mexican cartels,” he said.
More DEA investigations and raids found that various Mexican cartels were receiving the chemical component for their fentanyl labs—N-(1-Phenethyl-4-piperidyl) propionanilide citrate—directly from China. As their investigations developed, the DEA discovered that two main Mexican cartels, Sinaloa and Jalisco New Generation, were working closely with Chinese nationals to bring the chemicals to Mexico.
These investigations did not, however, disrupt the production labs in China or Mexico, nor did they slow the growing overdose epidemic in the United States. Even with Chinese nationals turning up in Mexico, it was difficult to prove the Chinese government had any direct involvement in the fentanyl trade. According to Paul Campo, a retired DEA official with 25 years of experience (he has since founded a consulting firm, Global Financial Consultants, which focuses on anti-money-laundering securities), few in the DEA recognized how bad the fentanyl problem was becoming. “When I was working cases in the early 2000s, we did not think initially that fentanyl was much of an issue, as it was produced, transported and sold legally to the U.S. for medicinal purposes,” he explained. “Furthermore, fentanyl was mixed into heroin, making it very hard to trace at the time.”
But the death count continued climbing, with limited federal government intervention. In 2014 and 2015, senior DEA officials tried to communicate the urgency of the issue to the Obama administration, and met with Eric Holder, then the U.S attorney general, telling him that the deadly issue would get worse if the government failed to take action. Increasing amounts of fentanyl—and increasingly strong product—was entering the country. “In Arizona alone,” Maltz said, “we went from zero in 2015 to seizing more than 25 million pills in 2022.” Much of that growth is the result of the Obama administration’s inaction. “As far as I’m aware, the Obama administration never pressured China,” Maltz said. It was only during Trump’s presidency in 2019 that China placed fentanyl and its analogues on a regulatory schedule, making them more difficult to produce and distribute. By then, however, it was too late: In 2022, over 50.6 million fentanyl-laced pills and 10,000 pounds of fentanyl powder were seized in the U.S. by the DEA—enough to kill every American citizen.
China’s chemical output has proven difficult to monitor. “It is almost impossible to see what is going on inside that country,” Maltz said. “Both the Mexican cartels and the Chinese government are very creative in countering our federal agencies.” Chinese traffickers are using various strategies to circumvent new regulations, including producing more chemical precursors (chemicals that are transformed into fentanyl), relocating some manufacturing to India, and rerouting precursor shipments through third countries. China’s weak supervision and regulation of its chemical and pharmaceutical industries also enable evasion and circumvention.
While tracking the chemicals coming from China to Mexico is difficult, tracking the vast sums of money being made by Mexican cartels in U.S. drug markets is even harder. By using complex Chinese financial technologies, mobile banking apps, and social media networks to evade authorities, money made by Mexican cartels often ends up washed and cleaned in China, and cooperation between the United States and China remains limited. U.S. law enforcement agencies have established working groups, conducted high-level meetings, and shared information with their Chinese counterparts—and this has led to the dismantling of a few illicit fentanyl networks—but it seems that it has hardly made a dent in the exportation of chemicals, which still flood America’s streets.
Since China’s government began monitoring fentanyl, however poorly, the amount of finished fentanyl (fentanyl that is fully produced) shipped directly from China to the United States has declined while the amount shipped from Mexico to the United States has increased. It is impossible, however, to know by how much. DEA officials believe that Chinese traffickers have shifted from primarily manufacturing finished fentanyl to primarily exporting fentanyl’s chemical ingredients to Mexican cartels, who manufacture the final product and then push it across the border.
Additionally, U.S. law enforcement has seen a growing trend of Chinese nationals in both Mexico and the United States working with Mexican cartels. As Chinese suppliers coordinate more with international partners, former and current members of the DEA are concerned that fentanyl, like almost every other product Americans consume, be it cars or pharmaceuticals or iPhones, has found success by globalizing its production chain.
Cartels have become skilled at producing and refining fentanyl. These cartels are also savvy and entrepreneurial—they were quick to understand how addictive and profitable fentanyl would be after observing the success of Oxycodone, which was foisted onto the general public by America’s pharmaceutical companies.
Fentanyl, like most synthetic drugs being produced in Mexico, is so cheap to make that almost anyone with a bit of startup money and can-do spirit can get into this new business venture. It is far cheaper (and therefore more profitable) to produce than other drugs: The opium needed to produce a kilogram of heroin, for instance, can cost producers as much as $6,000. The precursor chemicals to make a kilogram of fentanyl, meanwhile, costs $200 or less. With chemicals easily imported from China, a fentanyl entrepreneur only needs a pill press, protective gear, and a few underlings willing to risk their lives for money to create a fentanyl fiefdom. “What worries me is how proficient these cartels have become in synthesizing and producing these drugs,” Campo explained. “It is truly the devil’s work.”
Not only is it easy to produce, but it is also easy to hide. “We used to catch loads of fentanyl hidden in Lego box sets, or even inside coconut fruit containers,” Campo said. Now that so many small criminal organizations in Mexico are jumping into the frothy fentanyl market, it has become much harder. “This has created numerous independent groups who do not need powerful criminal syndicates to make and sell their product.”
San Diego has become the epicenter of the illegal fentanyl market. Last year alone, more than 5,000 pounds of fentanyl were captured by border authorities based in the city—more than 60% of the fentanyl apprehended nationally. This constitutes a small portion of what is actually being sold in America. Campo believes that barely 20% of the fentanyl that comes into the U.S. is seized by authorities. “In truth, no one really knows what the real number is. All we know is that even if 20% is captured each year, it is worth it. The cartels are making so much money on synthetic drugs.”
Romain Le Cour Grandmaison, a senior expert on transnational organized crime at the Global Initiative, believes it’s far less. “From our calculation, the U.S. authorities do not catch more than 10% of what is going through. It is so low because the drugs are hidden within legitimate containers and therefore integrated within legal goods.” This strategy makes it impossible for the authorities to check all containers, as it would seriously impair global trade. “Only 3% of containers around the world are checked by legal authorities,” Grandmaison explains. Countries cannot afford to do much more checking, as they would lose too much money by doing so.
The drug also moves fluidly across heterogeneous communities of the United States, making addicts of all kinds of Americans. This is both because of how powerfully addictive it is, but also because it’s now used to cut virtually every other drug on the market. A person who uses meth or heroin or cocaine might be taking fentanyl without realizing it, and can easily end up addicted to a drug that is profoundly lethal. A dose of 2 milligrams of the drug is enough to kill most users—an amount so minuscule that in a test tube it looks like a few grains of salt clinging to the glass. Crime labs now keep auto-injectors of Naloxone, the lifesaving opioid receptor antagonist, within reach in case their personnel are accidentally exposed to traces of the drug.
Yet fentanyl’s addictive qualities don’t explain why the European Union suffered only 6,400 overdose deaths in 2020 while the U.S., with a significantly smaller population, suffered more than 90,000. While the U.S. does prescribe and sell more synthetic drugs, that does not explain the uniquely American phenomenon of the overdose epidemic either.
One cause of the illegal drug crisis is America’s legal drug crisis. Opioid-based legal drugs have been pushed onto the general public for over a century, enriching pharmaceutical companies. From 1939 to 1959, drug sales rose from $300 million to $2.3 billion, with prescription drugs accounting for almost the entire increase. By 1969, prescription drugs made up 83% of consumer spending on pharmaceuticals. All of this has amounted to extraordinary profits for the pharmaceutical industry. In 2010, prescription drugs constituted $291 billion of business; in 2022, $424 billion. In 2017, 4.1 billion prescriptions were filled; in 2021, 4.69 billion. These profits have become a dependable form of tax revenue for the government.
In contrast, the European Union has far more stringent laws regarding the accessibility of opioid-based prescription drugs, and while American pharmaceutical companies lobbied doctors to prescribe these pills, EU doctors were directed to severely limit their use.
With illegal addictive drugs produced just over the border and legal addictive drugs pushed by domestic producers and pharmaceutical companies, Americans find themselves squeezed from both sides. The chains of production and supply that have contributed to unprecedented prosperity in the United States by relying on cheap labor and goods from Mexico and China, are hollowing America out from the inside, creating a permanent underclass of addicted citizens and a spiraling crisis of dependency and death.
This article has been updated to clarify comments made by Derek Maltz.
Jonathan Alpeyrie is a photographer whose work has appeared in Newsweek, The Boston Globe, Le Monde, Der Speigel, Le Figaro and The Atlantic. He has covered numerous conflict zones, in the Middle East and North Africa, the South Caucasus, Europe, North America, and Central Asia.