For graphs and links, visit https://insightcrime.org/news/fentanyl-drives-us-opioid-market/

28 APR 2021
BY PARKER ASMANN AND STEVEN DUDLEY

Based on available data — as well as interviews with more than a dozen counterdrug officials, drug policy experts and academics — the deadly synthetic opioid fentanyl has displaced heroin as the leading driver of the ongoing opioid crisis in the United States and is contributing to a deadly scramble for market-control back in Mexico. In the second of this three-part series (read chapters one and three), InSight Crime explores these seismic shifts in the regional drug market.

It wasn't long after she'd been arrested that April Kelly told US prosecutors how she was able to move huge quantities of the synthetic opioid, fentanyl across the US-Mexico border. Kelly, a US citizen living in Tijuana, was at the San Ysidro border crossing, just south of San Diego, when her car was stopped by authorities. They discovered over 16 kilograms of methamphetamine, 17 kilograms of cocaine and 5.5 kilograms of fentanyl. She was arrested on the spot and prosecuted for drug trafficking.

Using the car was Kelly's biggest mistake. Normally she crossed on foot, fastening plastic bags filled with fake prescription pills to her. The pills were laced with fentanyl and fetched about $20 a pop on the open market. She could, she said, carry as many as 10,000 pills across per trip, or about $200,000 worth of drugs.

Her secret, she told authorities, was that she was obese and could hide the drugs around her stomach, where border agents were reluctant to look. If they did, she would throw a fit, she told investigators, and the officers would back off.

Her employers loved her, she added, and she claimed they'd hired numerous other obese women to follow her lead. She was so good that other organizations also employed her. In nine months, authorities say she moved 450,000 pills, or close to $5 million, just in fentanyl.

A Rising, Dominant Presence

Fentanyl is being found in record quantities throughout the United States. Meanwhile, fentanyl overdose deaths, after dropping briefly, are rising again at alarming rates.

Between October 2020 and early March 2021, US Customs and Border Protection (CBP) agents seized more than 2,500 kilograms of illicit fentanyl, a more than 300 percent uptick from the same time period the year before. The haul is also double the some 1,200 kilograms of heroin seized during the first six months of the fiscal year (which runs from October 1 to September 30).

Fentanyl, a synthetic opioid, is manufactured for a fraction of the price of heroin, and is close to 100-times stronger. Dealers regularly substitute fentanyl for heroin — as well as lace it into false prescription pills that resemble OxyContin, Xanax and Percocet, of the type Kelly was moving.

The potency of the drug has led to a spike in overdose deaths tied to synthetic opioids in the United States over the last five years. In 2019, the last year for which data from the Centers for Disease Control and Prevention (CDC) was available, there were more than 36,359 synthetic opioid overdose deaths driven largely by fentanyl, which accounted for around half of total overdose deaths. That same year there were 14,019 overdose deaths linked to heroin, continuing the downward trend the CDC has documented since 2016.

SEE ALSO: End of Heroin is Bad News for US Fentanyl Hotbeds

The Drug Enforcement Administration (DEA) is also taking note of fentanyl's increased threat. The agency's 2020 Drug Threat Assessment identified illicit fentanyl as being "primarily responsible" for fueling the ongoing opioid crisis in the United States. The majority of the DEA's 23 field divisions reported seeing "high availability" of the drug.

"As inexpensive, potent fentanyl continues to push into established heroin markets, fentanyl will augment, and in some cases supplant, white powder heroin in various domestic markets," the report stated.

The number of fentanyl samples agents sent to the National Forensic Laboratory Information System (NFLIS), for example, jumped from just 5,541 in 2014 to more than 100,000 in 2019. While still slightly lower than the number of heroin samples sent to the NFLIS for that year, the trend lines of the two drugs were clearly going in opposite directions.

"What we are seeing is that in most US drug markets where fentanyl was introduced, in three to five years, there's no longer any heroin," said Bryce Pardo, a drug policy researcher at the non-profit RAND Corporation. "Fentanyl has completely displaced heroin in some cases."

Pardo and numerous other drug researchers and counterdrug officials consulted for this story were reluctant to say definitively that fentanyl has topped heroin in terms of prevalence. And some researchers, such as the University of Maryland's Peter Reuter, who also works with RAND, said heroin remains atop the illicit opioid market, although synthetic opioids cause more deaths. But all of them said if it is not there yet, fentanyl is quickly moving in that direction.

"What is fascinating is how rapidly fentanyl spreads when it enters the market and how slowly it has percolated across the country," Reuter explained. Fentanyl entered as a cheaper substitute for heroin in markets east of the Mississippi River, but that has not happened in the western United States, where the drug has yet to take hold as it has on the East Coast.

That said, analysts can see the writing on the wall.

"Even if only 50 percent of heroin supply was replaced by [fentanyl and other synthetic opioids], it would represent a momentous change in global drug markets and challenge to drug policy," Pardo, Reuter and Jirka Taylor, another policy analyst at RAND, wrote in the International Journal of Drug Policy in its January 2021 issue.

Why Fentanyl Has Surged

The reasons for this surge — they and other experts and counterdrug officials say — are numerous. To begin with, the Mexican criminal organizations at the center of producing the drug — including in counterfeit pill form — have the infrastructure, the contacts and the personnel to mass-produce it. This is mostly due to their vast experience producing and transporting huge quantities of methamphetamine, the second-most consumed illicit drug in the United States behind only marijuana (whose legal status is in considerable flux throughout the country).

SEE ALSO: The United States is Now Meth Country

"Drug trafficking organizations already have the infrastructure in place for methamphetamine production, so it makes sense that they would also produce and import fentanyl to the United States on a large scale," said Jaime Arredondo, a professor at the Drug Policy Program at the Center for Economic Research and Teaching (Centro de Investigación y Docencia Económica — CIDE) in Aguascalientes, Mexico.

For this, they have capitalized on the relative ease with which they can obtain supplies of key precursor chemicals, initially from China and India, but increasingly from other places, as controls become tighter on Asian precursors and criminal organizations produce their own. In 2020, Mexican authorities reported a 486 percent jump in fentanyl seizures, from just 222 kilograms in 2019 to some 1,300 kilograms last year.

The markup from production to the point of sale is also enormous. One DEA source told InSight Crime that the Mexican criminal organizations can make fentanyl for as little as $180 per kilogram; they can sell this for $25,000 a kilogram at the US-Mexico border; those organizations can also cut that with other drugs to make eight kilograms, then sell each kilogram for as much as $60,000 in vibrant markets such as Massachusetts or Ohio. In other words, the markup can reach near 2,700 times the production price.

Delivery of fentanyl is also easier. As the Kelly case illustrated, the deadly opioid is moved in such small quantities that it is difficult to detect. The drug can also be purchased online and shipped directly to the consumer, often using the US Postal Service (USPS), which poses a unique problem for authorities given the sheer volume of parcels.

Kelly's experience also tells us a little about the evolving market. While there appear to be two dominant players in the Mexican drug market — the Sinaloa Cartel and Jalisco Cartel New Generation (Cartel de Jalisco Nueva Generación — CJNG) — there are also numerous smaller, independent producers and distributors that are moving significant quantities of the drug. Kelly, for example, was employed by two separate groups, illustrating the increasing number of players trying to take advantage of the surge in the use of fentanyl.

The battles in Mexico seem to reflect this atomization. In the central state of Zacatecas, for example, a five-way fight for control over a strategic trafficking corridor passing through the heart of the country is in part helping drive up rates of violence in an area not known for such power struggles.

An Inexact Science

While InSight Crime believes fentanyl is the dominant illicit opioid in the United States, based on the data cited above as well as numerous interviews with experts and law enforcement, determining just how widespread fentanyl use has become remains difficult.

Many places where it is prevalent do not have the wherewithal or the equipment to test for it. And the estimates are most likely significant undercounts. In 2019, for example, the US Department of Health and Human Services estimated that 10 million people used opioids, of which 269,000 of them used prescription fentanyl products.

However, by the government's own measures, the number of fentanyl users is likely much higher. Estimates of fentanyl use, according to the 2019 National Survey on Drug Use and Health, "may underrepresent people who used illicitly manufactured fentanyl [IMF] from clandestine laboratories and may not include those who used IMF mixed with heroin or sold as heroin [but contained only IMF]."

What's more, counterdrug officials contacted for this story say fentanyl use is quickly spreading west, far from its epicenter in New England. In San Diego, not far from where Kelly was crossing with her counterfeit pills, authorities announced fentanyl-related overdoses were three times higher through the first seven months of 2020 compared to 2019.

"There's no reason to doubt that we could see double the number of overdose deaths in the next few years if fentanyl spreads further," said Reuter.

There is some reason to believe this is already happening. Preliminary overdose data released by the CDC regarding FY2020 already indicates a stunning 29 percent increase in drug overdose deaths from FY2019, though all data have not been tallied. Most of that increase, experts say, is related to fentanyl use.

A senior DEA official told InSight Crime that fentanyl is spreading, and that agents are now seeing it in places like Arizona and California, which has raised concerns about its increased prevalence.

Meanwhile, stopping the flow of drugs along the US-Mexico border remains near impossible. In December 2019, a judge sentenced the 39-year-old Kelly to 14 years in federal prison on four drug charges. Federal prosecutors said the hundreds of thousands of fentanyl pills she smuggled over the border were destined for mid-level distributors in southern Arizona and California.

The multiple layers of trafficking groups likely haven't missed a beat since her arrest. Low-level smugglers like her are the most disposable link in the drug trafficking chain. What's more, US law enforcement officials says they are capturing more fentanyl powder again, as the trafficking groups shift back to moving large quantities in that form.

This gives them flexibility. Once in the United States, the criminal groups can process it — or allow local groups to process it — into the fake pharmaceutical pills, or they can mix it with other drugs like methamphetamine and cocaine.

Kelly told prosecutors before she was sentenced she'd also strapped powdered fentanyl to her back and taken a plane to Atlanta. To be sure, the same month Kelly was sentenced, CBP agents seized more than 100 pounds of fentanyl across the country. The seizures have not slowed since.