Fentanyl and Opioid Policy

Overdose deaths rose for two decades, first from prescription painkillers, then heroin, and from about 2014 from illicitly made fentanyl, a synthetic opioid 50 times stronger than heroin. Annual overdose deaths peaked at about 110,000 in 2022 and 2023, most involving fentanyl, much of it made in Mexico from chemicals shipped from China and smuggled mostly through legal ports of entry. Deaths then fell sharply, to about 81,000 in 2024 and about 70,000 in 2025, with fentanyl deaths down 22 percent in 2025.

Responses span many agencies. The DEA and FBI pursue traffickers, Customs and Border Protection screens cargo, and the Office of National Drug Control Policy coordinates strategy. In 2025 the government designated major cartels as foreign terrorist organizations, imposed tariffs on China, Mexico, and Canada citing fentanyl, signed the HALT Fentanyl Act permanently placing fentanyl-related substances in Schedule I, and in December 2025 designated illicit fentanyl a weapon of mass destruction. Starting in September 2025, the military struck dozens of boats it said were carrying drugs in the Caribbean and Pacific.

Treatment and prevention expanded too: the overdose reversal drug naloxone became available over the counter in 2023, doctors no longer need a special waiver to prescribe the addiction medicine buprenorphine, and states received about 50 billion dollars from settlements with opioid makers and distributors. Experts credit some mix of treatment, naloxone, changes in the drug supply, and enforcement for the decline. The boat strikes drew criticism from lawmakers of both parties and legal experts who questioned their legal basis, while supporters said cartels are waging war on Americans.