On July 27, the head of the U.S. Drug Enforcement Administration (DEA) Anne Milgram testified in the U.S. Congress in the periodic hearing on “Drug Enforcement Administration Oversight.” Far from a canned pro-forma event, Administrator Milgram’s written and oral testimony and her exchanges with Members of Congress provided fascinating insights both into the substance of the China-Mexico-United States drug trade and the Mexican cartels, as well as to recent very significant and positive changes to DEA’s policies.
Not all of these points are new, but in their pithy and explicitly stated form, they are worthwhile to reiterate and consider. In this series, I pull out some of these key takeaways and (highlighted them in Italics to distinguish them from my own commentary), reflect on them and draw implications. In this first piece in the series, I look mostly at the big picture of U.S. consumption and the way synthetic drugs are altering global drug markets. In my next blog, I will dissect what the Administrator Milgram’s statements tell us about the operations of the Mexican cartels in Mexico, the United States, and around the globe. In following pieces, I will analyze the revealed big changes in the DEA’s policies and suggest further policy recommendations.
Let’s start with the fundamental in Administrator Milgram’s testimony: The most lethal drug epidemic ever in history, fentanyl is the “leading cause of death for Americans between the ages of 18 to 45”.
Yet the death rate doesn’t start and the age of 18 or end at the age of 45. Stunningly, unlike other drugs, fentanyl and other synthetic opioids, not including methadone, have also ramped up the death rates of those over 65, doubling them in just one year from 2019 to 2020 and quadrupling them over the past twenty years as Keith Humphreys and Chelsea Shover showed in a recent paper. Fentanyl is not just killing population subgroups, it is hitting the U.S. population overall. On a personal note, a friend who is a student in a prominent Washington metro high school and a colleague’s daughter attending another top-level DC metro school each had three or four high school friends and acquaintances die of fentanyl-linked overdose during the past school year. The death rate is awful, the devastation of the families profound, and the trauma extends across the entire school population.
Fake prescription pills laced with fentanyl are a key culprit in the death rate. Milgram stated that “DEA lab testing reveals that 6 out of 10 of these fentanyl-laced fake prescription pills contain a potentially lethal dose.”
That’s a stunning proportion. Essentially, drug traffickers – at the wholesale level the Sinaloa Cartel and Cartel Jalisco Nueva Generación as Milgram stated repeatedly throughout her testimony – and their subsidiaries, such as smaller Mexican criminal groups licensed by the two big cartels to press pills are indifferent to the fact that they will kill off more than half of their customers. As the U.S. Department of Justice indictments of the Chapitos had already revealed, with extraordinary brutality and a lack of restraint, the Chapitos simply count on generating new addicts faster than killing them off.
The volume of the fake prescription pills is also significant: In 2022, Milgram stated, “DEA seized more than 58 million fake pills containing fentanyl, and 13,000 pounds of fentanyl powder, equating to nearly 400 million deadly doses of fentanyl,” enough to kill every single person in the U.S. population.
We don’t know, of course, what proportion of the volume flowing in these seizures amount to. It could be that although massive in size, the seizures still capture only a small portion of the fentanyl volume coming in. Certainly, there is no lack of fentanyl on U.S. streets.
But it would be erroneous to suggest that consequently seizures don’t matter. The more deadly pills are removed, the smaller the chance that more people will die. This is especially true about fake prescription pills laced with fentanyl: many users who ended up dying thought they had acquired oxycontin: these may be older people trying to deal with arthritis pain, or teenagers beginning to experiment with drugs.
Seizures – and more broadly the disruption of supply – are not the only tool, and need to be supplemented with the wide availability of treatment, including methadone maintenance, and harm reduction measures, such as safe-use sites and drug testing availability. But disrupting supply is important.
Hence the lack of meaningful cooperation on the part of China — the principal source of precursor chemicals, and Mexico where fentanyl is overwhelmingly synthetized, is egregious.
As Keith Humphreys, Jonathan Caulkins, and I argued in a 2018 Foreign Affairs article, synthetic drugs, and uniquely synthetic opioids, are highly attractive to drug traffickers: Their production is simple, cheap, and easy to hide and does not require control over territories and hence standing armies. The extraordinary weight-per-potency ratio of synthetic opioids also makes transportation much more simplified, with only small fractions of precursors and finished fentanyl having to be smuggled among legal cargo in personal vehicles or trailer trucks or by tunnels, boats, or drones.
DEA Administrator Milgram’s testimony gave us concrete cost-revenue numbers: “It costs the as little as 10 cents to produce a fentanyl-laced fake prescription pill that is sold in the United States for as much as $10 to $30 per pill.”
The price markup is not all profits. The cartels still need to spend money on fighters to control transportation routes in Mexico and smugglers and halcones, on bribery, equipment and vehicles. But even in as violent and contested drug market as Mexico, the expenditures are smaller than in the international trafficking of plant-based drugs.
During the Q-and-A period with Members of Congress during the hearing, Milgram repeatedly emphasized that the only constraint on how much fentanyl the Mexican cartels can produce is the amount of precursors chemicals they can obtain. Overwhelmingly, Milgram added, they purchase these chemicals from China where two kilograms of fentanyl precursors from which 1.75 million lethal doses of fentanyl can be made can be purchased for only $1,000.
Yet stopping the flow of precursors for synthetic drugs is very difficult for structural and geopolitical reasons. On the structural side, altering the chemical signature of a drug just enough to evade detection and production, sale, and transport restrictions is easy. Milgram described in her written testimony how Chinese suppliers precisely do that to deliver precursors to Mexican cartels.
An even bigger problem is that an increasing array of precursors for fentanyl and methamphetamine have such widespread use in the legal chemical, agricultural, and pharmaceutical industries for legitimate purposes and are most unlikely to be scheduled, i.e., restricted, in their production, transportation, and sales. The widespread availability and use and the lack of scheduling indeed make controls very difficult. China has repeatedly used this argument to suggest it holds no responsibility for or cannot do anything about the flow of precursors from China.
But that is not fully true. First of all, just like the United States, China could prosecute Chinese sellers that knowingly sell precursors and fillers to the Mexican cartels, with the full knowledge they will use them for the production of illegal drugs. The United States recently indicted several Chinese companies and individuals for such knowing complicity, detailing how they provided advice to the Mexican cartel cooks on how to produce fentanyl.
China reacted according to script, not accepting responsibility and minimizing the role of Chinese criminal actors. Instead, it suggested that “Washington should stop using the fentanyl crisis as a pretext to impose sanctions on Chinese companies,” and blamed U.S. demand.
But when it serves China’s own interests, Beijing finds a way to act. China itself has come down hard at various times on Chinese chemical companies and traders supplying precursors to actors like the United Wa State Army in Myanmar for meth production. Even though these chemicals are also dual-use and non-scheduled, Chinese authorities engaged the producers to implement tighter control and provide tipoffs so China could better tackle its own growing and devastating meth use problems.
As I discussed in my March Congressional testimony on China’s role in the fentanyl trade and in a May Foreign Affairs article on China’s and Mexico’s willful lack of cooperation with U.S. counternarcotics efforts, China instrumentalizes its counternarcotics and law enforcement cooperation and subordinates it to its geostrategic interests. With countries which China wants to court and entice into its orbit, it increases law enforcement cooperation and even becomes willing to take limited steps against Chinese criminal groups that otherwise provide a variety of services to the Chinese government and Communist Party. To countries with whom relations deteriorated, such as the United States or Australia between 2017 and 2022, China denies law enforcement cooperation.
And as a rule of thumb, China tends to reject its responsibility in a variety of illegal economies and problematic activities, such as illegal logging and fishing or sex or wildlife trafficking, both in terms of demand and the role of Chinese criminal groups. It likes to define itself as the world’s toughest cop, particularly on drugs, and blame other countries for their enforcement failures. In this vein, China has repeatedly told Mexico that precursor smuggling was the problem of corrupt and inadequate Mexican law enforcement in ports. Thus, President Andrés Manuel López Obrador’s impromptu plea to China in April for counternarcotics cooperation was bound to fail in its amateurish form. López Obrador’s blatantly false claim that no fentanyl is produced in Mexico, contradicted by his own prior words, only made it easier for the Chinese government to dismiss the request.
With the United States, China suspended meaningful, if always limited, law enforcement cooperation in 2020 as relations between the two countries deteriorated to a level of tension unseen in years. China announced that it was ending cooperation in 2022 in retaliation for then Speaker of the House Nancy Pelosi’s visit to Taiwan.
In recent weeks, as the Biden administration has sought to halt the slide in U.S.-China relations, it has hoped that some counternarcotics cooperation with China could be restarted. In his June visit to China, Secretary Anthony Blinken sought the restarting of a U.S.-China counternarcotics working group. (Its prior versions were at times mostly platforms for mutual recriminations.) And Administrator Milgram stated in her testimony that in recent weeks, “the DEA had productive engagements with Chinese counterparts in Beijing.” But the road to necessary and meaningful collaboration has yet to climb a very tall mountain.
In July, the United States took further steps up that road by launching The Global Coalition to Address Synthetic Drug Threats. 80 countries, including Mexico, joined a first virtual meeting that laid out broad principles and began thinking through the agenda and organization of subgroups. But although, unsurprisingly, little policy substance came out of this first summit, China was caught off guard diplomatically, having decided not to attend.
China tends to be very active in global drug diplomacy, and often excels in it. It has built up influence in global and regional bodies such as the International Narcotics Control Board and the United Nations Office on Drugs and Crime. It will likely work to shape to its interests this new Global Coalition on Synthetic Drug Threats. It is thus very important that the Coalition demands meaningful accountability and cooperation from China. Building up a subgroup of countries in Southeast Asia and the Pacific that are experiencing massive flows of methamphetamine produced from Chinese precursors and supplied by Chinese criminal networks would be a useful next step. China cares about the sensitivities of those countries and has moved toward a greater willingness to satisfy their counternarcotics demands.
Ultimately, the basic approaches to counter fentanyl flows and meth flows are the same, and the meth diplomacy in Southeast Asia can and should be enlarged into overall synthetic drugs diplomacy. After all, the deadly fentanyl epidemic will not stay confined to Canada, Mexico, and the United States; and it will come to the Asia-Pacific region as well as other parts of the world.
* Vanda Felbab-Brown is a senior fellow in the Center for 21st Century Security and Intelligence in the Foreign Policy program at The Brookings Institution in Washington, DC. Twitter: @VFelbabBrown
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