From unknown drug to public enemy number one. Fentanyl monopolized the final chapters of the war on drug trafficking in Mexico and the United States. More powerful, cheaper and harder to detect, this synthetic drug is behind an epidemic public health crisis that officials say is killing tens of thousands of Americans every year. Nine out of 10 seizures occur on the southern border, and Washington has increased pressure on the Mexican government to do more to curb the illegal trade. Faced with criticism from the most recalcitrant conservative sectors in the US and clashes with the DEA, this week President Andrés Manuel López Obrador proposed banning fentanyl for medical use as one of the possible solutions. However, the proposal raises doubts among experts, who insist that the measure would not be effective in fighting organized crime and could create more health problems than it solves.
“I will ask Mexican doctors and scientists to examine the possibility that we can replace fentanyl for medical purposes with other painkillers to stop using it,” López Obrador said at his press conference last Wednesday. “You have to see that possibility,” he added. His proposal has sparked heated debate about the scope and effectiveness of this measure in the fight against opioid addiction afflicting the region, particularly the United States. “It doesn’t work like that,” says Raúl Martín del Campo, director of the National Institute of Psychiatry and former member of the International Narcotics Control Board (INCB) of the United Nations. “The President’s intention is not bad, but I don’t know if he was badly advised or if he was confused because the problem is complex,” adds the specialist.
Martín del Campo explains that each country reports to the UN how much fentanyl it needs for medical purposes, and each year also reports how much fentanyl ended up being used in treating patients, either as an analgesic or an anesthetic. In 2021, for example, Mexico told INCB it had used 4.6 kilos of the substance for medical purposes, and in the same year seizures of illegal fentanyl exceeded 1,850 kilos, according to the Defense Ministry. The specialist cites this data to underscore that the black market and legal use of fentanyl follow entirely separate lines. “They have nothing to do with it,” the expert notes. “Narcos have the opportunity to produce their own fentanyl, they don’t have to steal it for medical purposes.”
Raúl Martín del Campo presenting a UN report on narcotics on 10 March 2023. Alex Cruz (EFE)
Safety experts claim there is no evidence that there has been any “leakage” of the pharmaceutical market for fentanyl to fuel illicit demand for the drug like other opioids did in the late 1990s: “The problem of illicit fentanyl, the manufactured or traded from Mexico —there’s debate about how much is being produced, but it’s certainly being traded—it’s not a pharmaceutical market distraction issue,” agrees analyst Alejandro Hope.
“The problem is the illegal import of finished products or preliminary products from Asia. All of this has been illegal since entering Mexico. In other words, if you close the key to legal imports, do nothing about this illegal importation of finished or intermediate products that is already taking place,” he affirms. “The only thing you can achieve is to take away a therapeutic alternative from doctors and patients, many of whom need it. It combines maximum inefficiency with maximum cruelty,” he adds.
Anatomy of the Illicit Fentanyl Market
The opioid crisis hits the United States. But the problem is not new. The crisis has had three waves in the last 30 years. The first began when big pharma pushed to prescribe painkillers indiscriminately and with the approval of health authorities. Since the late 1990s and early 2000s, prescriptions for thousands of chronically ill patients have been the gateway to addiction to synthetic drugs such as oxycodone, known by its trade names as Oxy or OxyContin. The second wave came a decade later and was marked by skyrocketing demand for heroin as the door to prescription drugs closed. The third wave, the current one, occurred when the cartels recognized the huge business opportunity in manufacturing fake or adulterated versions of these opioids. Fentanyl has completely revolutionized the drug trade: it’s used to cut cocaine, modify heroin, make “pirate” pills, and adulterate crystal, as documented by Clara Fleiz, a researcher at the National Institute of Psychiatry.
The perverse thing about this recent wave is that people who use drugs often think they are taking one drug when in fact they are giving them another that is far more aggressive and deadly. “Many don’t know what they’re consuming,” said Fleiz, a member of the opioid working group at UNAM’s Global Studies Seminar.
Political scientist Zara Snapp points out that fentanyl’s properties make it an easier drug to handle compared to others: It’s more potent – it’s 50 times stronger than heroin and 100 times stronger than morphine – and hence the doses are staggered in very small sizes while the wins are huge. “We know there’s a lot of demand from our neighboring country, we know there’s this profiteering from non-governmental groups, and I have no doubt that Mexico participates in the illicit fentanyl market, either through production or as a transit country for fentanyl, fentanyl done,” affirms the drug policy specialist.
An agent for the attorney general’s office among dozens of packages containing fentanyl and methamphetamine seized in Tijuana in October 2022. Salwan Georges (Getty Images)
How lucrative is the fentanyl business? Martín del Campo asserts that it costs the cartels $1,000 to manufacture and ship a kilo of the drug, but the profit is around $1.5 million. “It’s like I asked you for an investment peso to start a business and promised you 1,500 in profit,” he says. How dangerous is consumption? According to US authorities, three grams can be deadly for an average person. “The United States is currently, yes, in the midst of an overdose crisis over the adulteration of this market. That’s the reality of them,” adds Snapp.
Not wanting to give in to excessive criticism from the United States, López Obrador recently assured that the drug is not manufactured in the country, although these claims have been refuted by US officials, politicians, academics and by the discovery of secret laboratories in his government’s operations. The President later qualified it as occurring, but only when “punching” pills. The President’s narrative was reinforced by the State Department ensuring Mexico is a country of “final conditioning” of the product (“fill and finish”), which is something like the “pastillado”, but that the drug is not synthesized in the country, a position disputed by analysts. The criminal dynamics of the last few decades point to a fact that is repeated over and over again: the drug dealers are where the business is.
More is becoming known about how fentanyl is making its way into the US market. Cartels are increasingly turning to precursors, i.e. the substances used to manufacture fentanyl. Martín del Campo confirms that many drug traffickers go to pharmaceutical companies in India and China to buy the chemical compounds, which are often unregulated or banned. For this reason, so-called dark web platforms are used, which grant their users anonymity or are even obtained from ordinary websites. The US Secret Service, in a report released in February, points out that many labs are also using false labels or saying the compounds should be used for a different purpose.
“Is it national production or is it just smuggling finished products to other countries,” summarizes Hope. Specialists warn that the doses are so small that many arrive by parcel or regular mail. It is becoming increasingly common for drug users and manufacturers to click on and access substances.
In a January 2018 photo, a van was stopped by authorities near Ensenada with 45.5 kilograms of Fentanyl.AP
Despite the fact that they appear in far fewer headlines, the progenitors are key to the business and the difficulty of eradicating them. In 2019, due to international pressure, China began to regulate the sale of 50 substances used as precursors, but there are another 150 fentanyl-related substances that have evaded regulation. Also, there are more and more types of fentanyl in the mixes being tried on the illicit market. Martín del Campo points out that in 2014 only five types of fentanyl were known and that there are now more than 50. Instead, there are only four types of fentanyl available for medical use. Just this week, three precursors were blacklisted by the United Nations: norfentanil, 4-AP and 1-boc-AP.
Medicinal use and illicit consumption in Mexico
Due to its effectiveness, legal fentanyl is used as an anesthetic in complex surgeries or surgeries lasting several hours. It is also common in palliative care, pain management and in patients who are in, for example, intensive care units and need to be sedated to withstand medical procedures. It has been used for decades. It was developed in 1960 and approved for administration in the United States in 1968. Martín del Campo points out that legal production has declined in recent years, partly due to the drug’s stigma. “There’s a sort of demonization of fentanyl when in fact it’s irreplaceable in some treatments because of the need for such powerful substances,” he comments.
Fleiz has been documenting the use of synthetic drugs in Mexico for years, particularly in the northern states of the country through which smuggling routes lead. There has been evidence of fentanyl being used in the country since 2019, although Mexican authorities claim that demand in the country is virtually non-existent. The vast majority of cases have involved users who have been addicted to or tried other drugs such as cola or heoin in the US, although it is becoming more common for people to want to buy fentanyl outright. “You didn’t know that a few years ago, but now there’s a demand,” says the expert, who is surprised at how quickly consumption has spread in recent years.
The two main forms of consumption among users are injecting and inhaling. People powder a pill, put the dose on a spoon, and then dilute it to put it in a syringe, much like heroin but without the need to heat the spoon. Sometimes the pill is simply pulverized into a small aluminum square and inhaled or smoked, Fleiz explains.
A lab technician tests an Aderall pill adulterated with fentanyl purchased at a pharmacy in Cabo San Lucas, Mexico, on January 27, 2023. Wally Skalij (Getty Images)
In Mexico, use of these and other drugs is severely underreported, but levels of fentanyl use fall far short of what is observed in the United States or Canada. Snapp claims that President López Obrador’s approach is contradictory because he’s trying to “solve” the crisis the United States is going through when Mexico’s addiction to fentanyl is anything but comparable. “In Mexico we don’t have a large use of injecting drugs: it’s around 150,000 people across the country and it’s mostly concentrated in five cities in the north. So we’re transferring a fear, a fear, a misinformation from the United States to the Mexican context, even though our problem is quite different,” he clarifies.
Fleiz, on the other hand, sees signs of increasing use in Mexico becoming clearer, from notes pouring in from the border to reports from drug treatment centers. Oftentimes, use went unnoticed because it occurred among people living on the streets or other vulnerable groups. But the consumer’s profile is widening.
The US authorities targeted dosage forms such as the so-called “rainbow fentanyl”, which is shaped like colorful candies. Last July, for example, six minors in Tijuana had to be hospitalized for an overdose of fentanyl. “We have to tackle it as a social and health problem, and I think that everything is often watered down in the political discussion,” says the expert. “We have time to take precautions before a tragedy occurs in our country,” he says.
With the proposal to ban medicinal fentanyl the topic of the week, medical professionals see a world turned upside down. Precursors continue to receive insufficient attention and are still widely used. On the other hand, the primary antidote to overdoses, naloxone, continues to be available by prescription, despite an initiative in Congress to change this situation. Methadone, which allows people to gradually wean off synthetic drugs, also requires a prescription and has also been ignored by lawmakers.
A Homeland Security Investigation Agency agent exits the scene of a fentanyl overdose case he is investigating in San Diego on November 10, 2022. Salwan Georges (Getty Images)
Political inertia is too strong. Bilateral tensions surrounding the fentanyl crisis have increased in recent weeks. The kidnapping of four US citizens – and the killing of two of them – on March 6 in Nuevo Laredo, Tamaulipas, by a cartel has raised bilateral tensions to levels that already have tinges of diplomatic strife. In the US, the most extreme politicians have proposed that their army intervene in the fight against the cartels that trade in fentanyl, a proposal interpreted by Mexico as interference in the country’s internal affairs and ultimately a threat of foreign invasion, a sensitive issue in the historical relations of both countries.
The truth is, fentanyl hasn’t managed to escape the well-known drug war narrative: between one country in huge demand that claims to be “poisoned” by the Mexican cartels and another that’s fed up with being Neighbor does not recognize his part in the problem. The US has made fentanyl its most important crusade of the century. The allegations of who is to blame emerge. Despite the media controversy, the bilateral dialogues remain open. The discussion has stalled and gotten into a loop.
At least in the public debate, there is no talk of unifying customs regulations, increasing the exchange of information and intelligence, leaving behind prohibition schemes (especially when they make no sense), attacking financial structures, tackling impunity, guaranteeing access to treatment or palliative care . As so often, we are not talking about people here, but about materials. When it comes to fentanyl, people talk about who did more and who did less.
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