The opioid crisis in the United States is a multifaceted and long-standing epidemic, posing a threat not only to public health but also to the economy and national security. Opioid addiction has devastated communities across the country, resulting in a surge in overdose deaths and a strain on healthcare resources. This crisis has also had economic consequences, with lost productivity and increased healthcare costs estimated to cost the US economy billions of dollars. Moreover, the epidemic has implications for national security, with the potential for illegal drug trafficking and addiction to impact military readiness and threaten homeland security. Despite efforts to address the crisis, such as increased access to addiction treatment and expanded public education campaigns, the opioid epidemic remains a significant challenge facing the United States.

How did it get so bad?

The opioid crisis in the United States has reached catastrophic levels, claiming more than 1,500 lives each week due to drug overdoses. The COVID-19 pandemic has worsened the crisis as millions more Americans struggle with opioid addiction. The crisis started with the overprescription of legal pain medications, but has been exacerbated in recent years by an influx of cheap heroin and synthetic opioids, particularly fentanyl, supplied by foreign drug cartels. The issue has become so pervasive that it has not only affected public health but also the economy and national security. The cost of opioid misuse runs into tens of billions of dollars each year, impacting not only healthcare expenses but also the workforce.

To combat the opioid epidemic, the U.S. government has implemented various measures to reduce both foreign and domestic supplies of opioids. These efforts include limiting the number of prescriptions and providing counternarcotics assistance abroad. Meanwhile, officials have shifted from punishing drug users to treating them in an attempt to reduce demand. Other countries, such as Australia and Canada, are also experimenting with different policies to address the rising opioid use in their respective populations.

‍

What is the scale of the epidemic?

Since 1999, overdose deaths involving opioids have increased more than sixfold. In 2019, nearly fifty thousand people died from opioid overdoses, surpassing the number of U.S. military service members killed in the post-9/11 wars in Iraq and Afghanistan by more than seven times. Shockingly, according to provisional CDC data, the number of opioid-related overdose deaths shot up in 2020 to around seventy thousand and again in 2021 to eighty thousand. The opioid mortality rate has contributed to a historic decline in life expectancy in the United States since 2015, except for a brief reprieve in 2018-19.

The opioid epidemic started with the over-prescription of legal pain medications, but the problem has intensified in recent years with the influx of cheap heroin and synthetic opioids, especially fentanyl, supplied by foreign-based drug cartels. The correlation between the rise in opioid-related deaths and the volume of opioids prescribed is significant. Many users turn to heroin and other illegal drugs once they can no longer obtain enough of their prescribed drugs to keep pace with their developing addiction. The opioid crisis has not only caused the loss of lives but also significant economic damage and weakened the country's workforce.

In response, the US government has stepped up efforts to cut both foreign and domestic supplies of opioids by limiting prescriptions and providing counternarcotics assistance abroad. Officials have also attempted to reduce demand by focusing on treatment rather than punishment. Other countries with increasing opioid use, such as Australia and Canada, are experimenting with different policies. Nonetheless, it is clear that the opioid crisis remains a complex and pressing problem that requires a multifaceted approach.

Where are the heroin and fentanyl coming from?

The opioid crisis has also become a national security concern. Most of the heroin coming into the United States is cultivated on poppy farms in Mexico, with several major cartels controlling production and operating distribution hubs in major U.S. cities. Mexican cartels, which the DEA calls the “greatest drug trafficking threat to the United States” [PDF], typically smuggle narcotics across the U.S. southwest border in commercial and passenger vehicles and via underground tunnels. Large quantities of heroin are also produced in South American countries, particularly Colombia, and trafficked to the United States by air and sea. Although most of the world’s heroin comes from Afghanistan, only a small portion of the U.S. supply is produced there.

Most fentanyl in the United States is smuggled across the southern border, U.S. officials say. Although fentanyl coming directly from China—previously the dominant source—has significantly decreased since 2019, experts note that many drug shipments from China are merely being rerouted through Mexico. Mexican cartels will “almost certainly have the greatest direct impact” on the U.S. fentanyl market in the coming years, the DEA cautions.

What is the United States doing to restrict foreign narcotics?

Since 2007, the United States has provided Mexico with more than $3 billion in security and counternarcotics aid, including for police and judicial reforms, in a program known as the Merida Initiative. U.S. officials say the initiative led to the capture of some top cartel leaders, including Joaquin “El Chapo” Guzman, but Mexican President Andres Manuel Lopez Obrador has sharply criticized the agreement, and in 2021, the two countries announced a new bilateral framework for health and security cooperation. Through a similar partnership with Colombia, the United States provided almost $10 billion beginning in 2000; that program effectively drew to a close following the end to the civil conflict there in 2016.

The DEA has also coordinated efforts with China, the primary source of fentanyl in the United States in the mid-2010s. Amid sustained U.S. diplomatic pressure, Beijing made several moves to crack down on fentanyl production, culminating in a 2019 ban on the production, sale, and export of all fentanyl-related substances. Experts note, however, that Beijing’s cooperation has lessened as bilateral relations have strained.

‍