107,622 died of drug overdoses in the U.S. in 2021.
Fentanyl was responsible for two-thirds of those deaths.
The number of Americans killed by the drug has jumped 94 percent since 2019.
On average, one person dies of a fentanyl overdose in the United States every seven minutes.
Fentanyl kills more people than automobile accidents.
Overview: From Mexican labs to U.S. streets, a lethal pipeline
Fentanyl’s catastrophic surge came after the Drug Enforcement Administration cracked down on the excesses of the U.S. opioid industry. Millions of Americans who had become addicted to prescription pain pills suddenly found them difficult or impossible to get.
Mexican cartels stepped in to fill the vacuum. Traffickers, who relied for decades on plant-based drugs such as heroin, cocaine and marijuana, are now using chemicals in clandestine laboratories to manufacture fentanyl powder and pills to meet the ever-increasing demand in the United States.
Fentanyl is 50 times more potent than heroin, and its compactness makes it far easier to smuggle. The synthetic opioid is so powerful that a year’s supply of pure fentanyl powder for the U.S. market would fit in the beds of two pickup trucks.
In a seven-part investigation, The Washington Post traced the synthetic-drug crisis from the back alleys of Tijuana, Mexico, to official Washington and from warehouses in northern Mexico to neighborhoods in Utah, Colorado and San Diego.
As fentanyl trafficking boomed, U.S. counternarcotics cooperation with Mexico deteriorated. U.S. border authorities are now overwhelmed, and, since July, the volume of fentanyl seized coming across the Mexico border each month has doubled from earlier in the year.
Despite record numbers of American deaths, federal officials have been slow to react. The DEA said it is now taking direct aim at the cartels and the epidemic.
Shifting operations
Early shipments of illicit fentanyl came from China, much of it ordered through the dark web and concealed in small parcels sent through the mail.
Mexican cartel chemists learned to make fentanyl themselves, quickly replacing China as the main source of the drug and operating on a much larger scale, according to the DEA.
It takes months and acres of land to grow and process poppy into opioids, but fentanyl can be manufactured in a small lab with relatively accessible chemicals. The entire process to a finished product can take just a few days.
Seizing the precursor chemicals that traffickers need is extremely difficult. Many are used to make basic goods, such as medicines, pesticides and soap.
The vast majority of fentanyl seizures occur at U.S.-Mexico border crossings in California and Arizona.
The cartel transportation networks use the U.S. interstate system to reach wholesale markets in Los Angeles, Las Vegas, Chicago and East Coast cities, where street-level drug dealers take over.
Increasing demand
U.S. health officials do not have reliable estimates of the number of fentanyl users or recent deaths in the country. Key monitoring programs that could have alerted authorities to the increased flow of fentanyl were defunded by the federal government just as the drug was hitting U.S. streets.
Since the early 2000s, three waves of the opioid epidemic — fueled first by prescription pain pills, then by heroin and now by illicit fentanyl — have taken the lives of nearly three-quarters of a million Americans. The damage to U.S. communities cost the economy $1.5 trillion in 2020 alone, according to a congressional analysis.
U.S. drug agents say it has been nearly impossible to stop fentanyl trafficking. Border authorities can screen only a small fraction of the more than 219,000 vehicles crossing from Mexico each day.
Fentanyl seizures at the southern border have skyrocketed since 2016
The vast majority of fentanyl seized at the southern border is confiscated at ports of entry, primarily in San Diego and southern Arizona.
U.S. law enforcement agencies are on pace to confiscate more than 23,000 pounds of fentanyl powder this year, up from 4,000 pounds in 2018, according to a Post analysis of the latest government data. The number of fentanyl tablets seized is projected to reach 35 million, up from 289,000 in 2018.
At the southern border, U.S. authorities have seized an additional 16,200 pounds of fentanyl through the first 11 months of 2022, an analysis of the most recent Customs and Border Protection data shows. In November, the agency seized 2,900 pounds of fentanyl at ports of entry along the southern border, the highest monthly total ever, an amount that easily eclipses what the agency confiscated during the entirety of 2018.
Cascading failures
President Donald Trump told Americans that a wall along the border with Mexico would stop the torrent of drugs. But nearly all the fentanyl entering the United States passes through official border crossings — not through the deserts and mountains.
Successive administrations failed to deploy technology to detect the drugs.
The surge of fentanyl into the United States has been exacerbated by a breakdown in the U.S.-Mexico drug war partnership. After taking office in 2018, Mexican President Andrés Manuel López Obrador rejected the security agreements that had underpinned anti-drug cooperation for a decade, saying that approach intensified violence in Mexico.
“Mexico needs to do more. We believe that they can do more,” DEA Administrator Anne Milgram told The Post. “We think it’s vitally important that Mexico work on these issues as tirelessly as we do.”
Congress commissioned an extensive report, published in February, which determined that progress against fentanyl would be achieved only by pairing enforcement with a reduction in U.S. demand.
“Without a major shift in U.S. policy, more American sons and daughters, brothers and sisters, neighbors and friends will perish.”— Feb. 2022 Congressional Report
Mass overdose deaths
Fentanyl is eclipsing heroin and prescription pain pills as the go-to opioid.
Drug dealers in the United States have been spiking drugs with fentanyl to boost potency and get more customers hooked. Many users have no idea. New or infrequent opioid users are at a far greater risk of fatally overdosing.
Today, the drug cartels also are churning out counterfeit oxycodone pills masquerading as what was once the most sought-after pain pill on U.S. streets — Mallinckrodt Pharmaceuticals’ baby blue 30 mg tablets known as blues or M-30s.
Batches of “rainbow” tablets have been seized on U.S. streets and on the border in recent months. Narcotics agents think the colors are meant to signal that the pills contain fentanyl.
The epidemic has hit the young with alarming speed and disproportionately killed Blacks and Native Americans in recent years. In 2020, overdose death rates increased 44 percent for Black people and 38 percent for Native Americans.
More people are overdosing in groups because of fentanyl’s potency.
In Colorado, five friends died in an apartment in February after using cocaine they did not know was spiked with fentanyl. At the time, it was the largest reported mass fatal overdose in the nation.
As police raced to uncover who supplied the drugs, the answers they would find underscore the challenge of holding dealers accountable for the deaths of their customers.
About this story
Reporting by Nick Miroff, Scott Higham and Steven Rich. Mary Beth Sheridan, Meryl Kornfield and Sari Horwitz also contributed to this report. Photography by Salwan Georges. Videos by Erin Patrick O’Connor and Luis Velarde.
Design and development by Tyler Remmel. Additional design and development by Allison Mann, Laura Padilla Castellanos and Rekha Tenjarla. Graphics by Júlia Ledur. Data analysis by Steven Rich. Video graphics by Sarah Hashemi.
Editing by Gilbert Dunkley, Chiqui Esteban, Christian Font, Meghan Hoyer, Jai-Leen James, Jessica Koscielniak, Jeff Leen, Thomas LeGro, Jordan Melendrez, Robert Miller and Martha Murdock.
Additional support from Steven Bohner, Matthew Callahan, Sarah Childress, Sarah Dunton, Jenna Lief, Osman Malik, Monika Mathur, Angel Mendoza, Sarah Murray, Ben Pillow, Sarah Pineda, Andrea Platten, Kyley Schultz, Casey Silvestri, John Taylor and Mael Vallejo.
Data for graphics is from the U.S. Drug Enforcement Administration and U.S. Customs and Border Protection.
Cartel RX
In a seven-part investigation, The Washington Post followed the fentanyl epidemic from Mexican labs to U.S. streets.
Methodology
The Post analyzed data from a range of sources to measure the rise of fentanyl in the United States and Mexico. Among other topics, reporters compiled data on drug seizures, overdose deaths and reversals, border crossings and fentanyl potency.
The data was collected from more than three dozen federal, state and local sources across the United States and Mexico. For example, for the count of overdose deaths in the United States, The Post used mortality data from the Centers for Disease Control and Prevention. To measure data seizures along Route 15 in Mexico, reporters standardized multiple datasets from agencies including the Secretaría de la Defensa Nacional, Fiscalía General de la República, Secretaría de Marina and the Guardia Nacional.
Reporters made open records requests in both countries, retrieved data from government websites to create data sets and obtained and analyzed seizure data from High Intensity Drug Trafficking Areas, run by the White House’s drug czar, by submitting a detailed research proposal to gain access.
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