Unpacking the U.S. fentanyl crisis ahead of the presidential election

The fentanyl crisis sweeping across the U.S. has intensified ahead of the upcoming presidential election in November. In recent years, fentanyl deaths have surged, and the drug has claimed the lives of more than 100,000 Americans in the past year. 

Republican presidential candidate Donald Trump has used the issue to call for harsher border restrictions and blames his likely opponent, Kamala Harris, for the crisis at the U.S.-Mexico border. In an interview with Fox News on July 24, Trump and his running mate, JD Vance, implied that the bulk of fentanyl is being smuggled over the border by undocumented immigrants and called for the death penalty to be used against convicted drug traffickers. 

On the other side of the political divide, President Joe Biden has called for more significant penalties for drug traffickers and stricter controls on pill presses being imported into the country. 

This explainer unpacks the statistics behind the fentanyl crisis and some of the widespread misinformation and otherwise questionable narratives being spread in the lead-up to the elections. 

What is fentanyl?

Fentanyl is a powerful synthetic opioid that was first developed in 1959 and introduced in 1960 as an intravenous anesthetic. It has been approved by the Food and Drug Administration (FDA) for relief from severe, ongoing pain and use as an anesthetic. It is approximately 100 times more potent than morphine and 50 times more potent than heroin. 

Medicinal fentanyl comes in the form of transdermal patches, lozenges, and injections. Illicit fentanyl is available in both powder and pill form. It is often cut into counterfeit pills and other illicit drugs like heroin to enhance their effects and bring down the cost of production. According to the U.S. Drug Enforcement Administration (DEA), just two milligrams of fentanyl – equivalent to 10 to 15 grains of table salt – is considered a potentially fatal dose. 

Fentanyl is cheaply made in laboratories and is easily transported, making it particularly attractive to the illicit drug trade. 

What does fentanyl do?

Fentanyl binds to the body's opioid receptors, which control pain and emotion. It produces effects such as relaxation, drowsiness, dizziness, and euphoria. 

The drug's potency makes it particularly easy to overdose on. Overdose can lead to respiratory depression, resulting in slowed breathing and, ultimately, respiratory failure, which leads to losing consciousness. Other symptoms of overdose include chest pains, slowed breathing, a blue complexion, seizures, coma, and death. 

Naloxone is a medication that can be administered to a person who is experiencing a fentanyl overdose. The medication temporarily reverses the effects of an opioid overdose by blocking the effects of the opioid and restoring normal breathing to a person whose breathing has slowed or stopped. 

There have been misleading reports on both social media and traditional media of police officers overdosing either from accidentally touching or inhaling fentanyl. However, experts have said that the risk of overdose through this type of accidental contact is very low. In a press statement, the State of Maryland's Department of Health said "it would take 14 minutes of constant exposure on the palms of the hands" to overdose from prescription fentanyl patches, and overdosing through exposure to fentanyl powder would take much longer and require a larger surface area. Similarly, it would take 200 minutes of exposure to industrial levels of fentanyl to overdose through accidental inhalation. 

How much fentanyl is in the U.S.?

Given the illicit nature of the trade, it is difficult to estimate how much fentanyl is in the country reliably. Further complicating the issue is the amount of fentanyl found cut into other counterfeit drugs like heroin, ecstasy, and cocaine, as well as the amount of counterfeit pills with fentanyl, which is often only detected through testing. According to the DEA, laboratory testing indicates that seven in 10 pills seized by them contain lethal doses of fentanyl. 

Available statistics indicate that the amount of fentanyl seized by U.S. authorities has sharply increased over the years. According to the U.S. Customs and Border Protection, fentanyl seizures have increased by over 860 percent between 2019 and 2023.

In a press release published by the DEA on May 9, seizures of fentanyl powder have doubled in the past two years, while seizures of fentanyl pills have tripled since 2021. Approximately 13,176 kilograms of fentanyl powder were seized in 2023. Law enforcement reported seizing over 115 million pills containing fentanyl, including illicit counterfeit pills meant to resemble prescription pills like benzodiazepine and oxycodone. This is a dramatic increase from the 49,657 pills containing fentanyl that were seized in 2017. 

Graph showing the increase in the number of fentanyl-laced pills seized by U.S. law enforcement since 2017. (Source: U.S. National Institute on Drug Abuse)

Fentanyl-related arrests have also increased. According to the Department of Justice, the DEA had over 5,600 arrests for fentanyl in 2023, up from 3,138 arrests in 2021. 

How many deaths are attributed each year to fentanyl? 

The claim that fentanyl is the leading cause of death for people aged 18-45 in the U.S. has been repeated on social media and by prominent politicians since at least 2022 and even by government agencies like the DEA. And in his Fox News interview, Trump claimed that 300,000 to 350,000 Americans die each year from fentanyl.

However, the mortality data shows a more complex picture. Statistics from the Centers for Disease Control and Prevention (CDC) indicate that heart disease is the leading cause of death. CDC lead mortality statistician Dr. Bob Anderson told Logically Facts, "We do not rank drug overdoses specifically as a leading cause of death. Drug overdoses are counted across several categories that are used for ranking, including unintentional injuries (unintentional drug overdoses), suicide, and homicide."

He explained that in 2022, unintentional injuries were the leading cause of death for ages 15-44. Within unintentional injuries, drug poisoning made up 67 percent of the deaths for persons aged 25-34 and 73.4 percent for persons aged 35-44. He added that fentanyl deaths were categorized under "other synthetic opioids" and accounted for 95 percent of deaths under this category. 

Statistics from the CDC indicate that as of January 2024, 104,551 people in the U.S. died from drug-related deaths within the 12-month period. Fentanyl and other synthetic opioids were responsible for approximately 70 percent of these deaths. 

The rate of drug overdose deaths has significantly increased over the years. According to the CDC, the rate of drug overdose deaths has increased from 8.2 deaths per 100,000 in 2002 to 32.6 in 2022 – an increase of almost 300 percent. Drug overdoses have now become one of the leading causes of injury and death in adults. 

Much of the focus on social media and traditional media has been on teenagers and young adults who have died of fentanyl overdoses. This includes public health campaigns targeting youth, such as Expect Fentanyl, an Oregon state campaign launched on May 7, 2024, aimed at educating Portland youth aged 13-20 on the dangers of fentanyl.

However, CDC data indicates that in both 2021 and 2022, overdose rates were higher among adults aged 35-54 years. The rates decreased for adolescents and adults aged 15-34 between 2021-2022 but increased for older adults in the same period. The largest percentage increase was recorded in adults aged 65 years and older. 

Graph showing the rate of drug overdose for adults in the U.S. aged 15 and older by age group. (Source: CDC)

Dr. Joseph Palamar is an associate professor in the Section on Tobacco, Alcohol, and Drug Use in the Department of Population Health at NYU Langone. He told Logically Facts that the data is complicated by those who knowingly and unknowingly use fentanyl.

"A lot of younger people, at least less than 30 [years old] in those poisonings, they're almost all unintentional poisonings," he explained. "You get someone in their early twenties, who tries it, you know, they're trying to find a Xanax or an Adderall or whatever. And they buy it illegally and they poison themselves," he explained.

However, exact figures are difficult to find in part because of the lack of easily accessible information on fentanyl use. 

Where does fentanyl come from, and how is it getting into the U.S.?

In his televised interview with Fox News, Trump claimed that "almost 100 percent" of fentanyl arriving at the U.S.-Mexico border is from China. He further discussed mass deportations as a potential answer, implying that fentanyl is largely smuggled in by undocumented immigrants. Posts on social media have since repeated his claims, essentially blaming what they perceive as an "open border policy" under the Biden administration as the cause behind the spike in fentanyl. 

X posts repeating Trump's claim that fentanyl is largely smuggled into the country by undocumented immigrants (Source: X/Composite by Logically Facts)

Trump's team also set up a now-defunct website, bidenbloodbath.com, which shared erroneous statistics on fentanyl deaths and migrants moving across the border. The website has since been rebranded to harrisbloodbath.com, but at the time of writing, it was not live and accessible. 

A 2019 explainer by the DEA indicates that fentanyl is manufactured in both China and Mexico. China is the primary source of fentanyl and fentanyl precursor chemicals, which are either directly shipped to the U.S. or sent to Mexico to be manufactured into fentanyl pills and powder. India has also become a source of fentanyl precursor chemicals. 

Research by the Cato Institute indicates that the majority of fentanyl is smuggled into the U.S. through legal ports of entry by U.S. citizens. In 2022, 89 percent of convicted fentanyl drug smugglers were U.S. citizens, as U.S. citizens are less likely to be searched by border officials. In comparison, just 0.009 percent of people stopped by border patrol for illegally crossing were found with any fentanyl on them. They also found that closing borders exacerbated the problem, as suppliers prioritized fentanyl over other illicit drugs like heroin because it is easier to smuggle. 

Palamar told Logically Facts that drug dealers can smuggle in fentanyl and fentanyl precursors directly into the U.S. through mail services and by communicating with suppliers using encrypted social media networks. Many of these groups are not associated with larger, hierarchical cartels. 

"What [law enforcement] are seeing now is a lot of semi-independent groups just pushing their own product within their own area," he explained. 

"You get these young people who want to create a business to make easy money, and they'll find a way to get fentanyl FedExed to them from Mexico, wherever. They might sell it online, or in person, however they do it. And technology makes everything harder for law enforcement. And it makes it easier to buy and sell illegal products."