Fighting Opioids – International Solutions to an American Epidemic

6 minutes read time
An arrangement of pills of the opioid oxycodone-acetaminophen.
An arrangement of pills of the opioid oxycodone-acetaminophen.

Fighting Opioids – International Solutions to an American Epidemic

The opioid epidemic and its mortality rates in the United States are alarming -- in 2015, there were 52,404 drug overdose deaths and 33,091 involved the use of opioids. The situation is only getting worse, with drug overdose deaths in 2016 estimated to be 64,000. That’s 175 deaths every day.  

Posters comparing lethal amounts of heroin, fentanyl, and carfentanil, are on display during a news conference about the dangers of fentanyl, at DEA Headquarters in Arlington VA. (AP Photo)

The rise in overdose deaths is largely due to the proliferation of illicitly made fentanyl, a highly potent synthetic opioid, and fentanyl analogs.  Fentanyl is 50 times more potent than heroin -- as little as two milligrams is potentially lethal -- and it is often added to heroin, an organically grown opioid, without the user knowing it. Criminals are rapidly creating fentanyl variants, making them extremely difficult to regulate. And to make matters worse, fentanyl can easily be sent in the mail or sold online without detection.

Both heroin and fentanyl largely originate beyond our borders and are major revenue sources for transnational criminal organizations (TCOs). Specifically, most heroin in our nation comes from Mexico and most fentanyl originates in China. This cross-border, foreign relations dimension means international cooperation is critical to finding a resolution. 

The Department of State is using all of our available tools and partnerships around the world to address this top Administration priority. The bureau where I work, International Narcotics and Law Enforcement Affairs (INL), is keenly focused on opioids. We work closely with our counterparts in Mexico and China, as well as with international organizations, to stop these drugs from reaching our borders, and to reduce drug demand at home and abroad.

A Mexican law enforcement officer pets a canine that is trained to detect narcotics.

United States and Mexico cooperate closely to counter narcotics trafficking. INL programs in Mexico have expanded Mexican law enforcement’s capacity to interdict drugs, eradicate opium poppy before it can be harvested and processed into heroin, dismantle TCOs, and disrupt their illicit proceeds. For example, INL provides training and equipment to Mexican authorities to improve security along their border with the United States and at other Mexican land, air, and sea ports. Such equipment was used in a substantial interdiction last August, when Mexican officials seized 140 pounds of material containing fentanyl and nearly 30,000 fentanyl-laced counterfeit pills from the bottom of a tractor trailer near the Arizona border. Additionally, INL provided Mexico over 500 canines trained to detect narcotics, currency, and explosives. INL is also helping to bring TCOs to justice through trainings designed to strengthen Mexican justice sector institutions, including its investigators, forensic labs, prosecutors, courts, and prisons. However, we must continue to deepen cooperation and intensify efforts, particularly to curtail production and interdict shipments of heroin bound for the United States. By working together we can disrupt the rapidly increasing flow of heroin north as well as the drug proceeds and firearms from the United States that fuel cartel power and violence in Mexico.

On March 17, UN Commission on Narcotic Drugs member states voted unanimously to mandate countries to control the source chemicals used in illicit fentanyl production.

Across the Pacific, the Department of State works with China, the primary global source of fentanyl, to keep synthetic drugs from entering the United States. Since 2015, in response to concerns raised by the Department of State, China has proactively implemented national controls on 138 synthetic drugs abused in the United States. 

This includes collaboration earlier this year to establish new controls on carfentanil and four other dangerous fentanyl analogues. According to the Drug Enforcement Administration, these new controls have resulted in a significant reduction of these drugs in the United States. Drugs from China are often mailed to the United States. To help stop these illicit shipments, China is also providing increasing amounts of advance electronic data for international mail, which is used by U.S. Customs and Border Protection to target packages. In the next few weeks, the Department of State, and the Department of Justice will participate in a recurring experts-level Counternarcotics Working Group meeting with China to further expand this cooperation.

On the global stage, our support to the United Nations Office on Drugs and Crime (UNODC), the UN Commission on Narcotic Drugs (CND), and the International Narcotics Control Board (INCB) has paid dividends. Just last week, on October 18, the INCB announced new binding international controls over the two major ingredients, or precursors, of illicitly produced fentanyl. INL led a robust diplomatic campaign to advocate for this important UN action that makes it more difficult for criminals to produce deadly synthetic opioids, and ultimately helps save American lives.  

Beyond this supply-side work, INL’s international drug demand reduction training team has developed scientifically-grounded, evidence-based prevention and treatment curriculum to prevent drug use and treat addiction, which can help address the domestic opioid crisis. These initiatives can lower the demand for drugs fueling violent narcotrafficking. Several other INL-funded demand reduction tools and research developed globally are being adopted by U.S. state and local prevention and treatment professionals.  

President Donald Trump speaks during an event to declare the opioid crisis a nationwide public health emergency at the White House, October 26, 2017.

Over 2.4 million Americans are struggling with opioid addiction across all levels of society, in every region. In this brave new world where drug traffickers are taking advantage of new ways to move and sell their product, and where criminals are rapidly developing new and increasingly powerful synthetic drugs, the Department of State is focused on the international dimensions of this epidemic. We are committed to using our diplomatic and programmatic tools, working both bilaterally and in the multilateral arena to fight this crisis. This grave challenge requires our urgent attention, and we will do everything we can to keep deadly illicit opioids from entering U.S. communities.

About the Author: Elizabeth Liu serves as Public Affairs Officer in the Bureau of International Narcotics and Law Enforcement Affairs' Office of Policy, Planning, and Coordination at the U.S. Department of State.

Editor's Note: This entry also appears in the U.S. Department of State's publication on