IT was around 2:45pm last month on September 15 that paramedics answered an emergency call at the Divino Nino nursery in the Bronx area of New York City. There they found one-year-old Nicholas Dominici, a two-year-old boy, and an eight-month-old girl unconscious and unresponsive. Another ill child had already been taken to hospital by his parents. 

Nicholas Dominici had been at the nursery for only a week when he and the other children were exposed to the drug fentanyl. In a subsequent search, police later found bags of the synthetic opioid hidden beneath a rug and trap door in the children’s play area.  

Last week, Felix Herrera Garcia, the husband of the nursery’s owner, became the fourth person charged in the case with conspiracy to distribute narcotics resulting in death. 

Fentanyl and death, it seems, go almost hand in hand in today’s United States. Over the last decade, the drug, which is 50 times stronger than heroin, has become the leading cause of death among young Americans and linked to more than ­two-thirds of the record 109,680 overdose deaths in the US last year. 

It’s estimated that more than 600,000 Americans and Canadians have died of an opioid overdose since 1999 and ­modelling data suggests that 1.2 million more could die by the end of this decade. 

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Given such potency, fentanyl kills long-time users and new users alike. ­According to health officials, young people, many of them experimenting with drugs for the first time, have little tolerance of synthetic opioids.  

Victims often believe they are ­ordering heroin, cocaine or painkiller tablets from drug dealers on social media, not ­knowing the products are mixed with deadly ­fentanyl. There are other ­unsuspecting victims too, as in the case of the children at the Divino Nino nursery.  

US federal mortality data show that ­fentanyl-related deaths among infants and toddlers are rising sharply. ­Losing a child has become a devastating ­consequence of the addiction for many parents ­using ­fentanyl who leave the drug within reach of youngsters. 

Such is the scale of the worst drug crisis in US history that not only has it become a major killer, but a drag on the American economy, a threat to national security and a significant factor in deteriorating US relations with China and Mexico.

The extent of the problem is now so all-pervasive that tackling it is already a ­major campaigning issue impacting the upcoming 2024 US presidential election. So what happened to spark this epidemic, who are the criminal cartels that now ­exploit it and what can we expect next of its impact? 

The National: Many victims of fentanyl overdoses don't realise other drugs are being laced with the productMany victims of fentanyl overdoses don't realise other drugs are being laced with the product

According to Patrick Radden Keefe, a staff writer at The New Yorker and author of Empire of Pain: The Secret History Of The Sackler Dynasty, the answer to the first of these questions lies with Purdue Pharma, a pharmaceutical company that began to sell the powerfully addictive ­opioid painkiller OxyContin back in the late 1990s. 

Of the massive revenues it generated, some $13bn was paid to the company’s previously low-profile owners, members of the Sackler family, a trio of ­brothers, two of whom acquired the ­company in 1952. For the brothers and their ­descendents, ­Purdue yielded vast profits from the ­opioid painkiller.  

“The prescription blizzard will be so deep, dense and white,” Keefe recounts one of those descendants prophetically saying at the launch party for ­Oxycontin. And so it proved true as other drug ­manufacturers followed Purdue’s lead.  

By 2010, when OxyContin was reformulated to make it more difficult to abuse, many Americans who were already ­addicted switched and illicit fentanyl ­displaced legally prescribed painkillers.  

But if big pharmaceutical ­companies and negligent doctors were in part ­responsible for setting the demand for opioids into motion, then it was Mexican and other drug cartels that ­exploited the surge, first with heroin and then synthetic fentanyl.  

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For just as user habits changed, so too did Mexico’s illegal drug trade adapt in the shift from plant-based drugs towards synthetics, creating a new, simplified and highly profitable arm of the illicit ­business that involved fewer workers and lower costs. 

Fentanyl production is simpler than heroin because it is entirely synthetic and doesn’t require cultivating the ­poppies needed for heroin. For the cartels, large seizures at the Mexico-US border or raids on labs can quickly be offset without having to wait to harvest crops or pay farmers. 

Experts agree it is also much less ­expensive to make. Where the plant-based opium needed to produce a ­kilogram of heroin can cost producers about $6000, the precursor chemicals to make a ­kilogram of fentanyl cost $200 or less, ­according to a US bipartisan report on synthetic opioids last year. 

“Synthetic opioids offer economic and tactical advantages that allow criminals to vastly outpace enforcement efforts,” the report concluded.  

Writing in the Financial Times (FT) ­recently, Christine Murray, the ­newspaper’s Mexico and Central America correspondent, detailed just how difficult it is to stop the supply at Mexico’s ­largest port Manzanillo, one of the key entry points for chemicals from China that are used to make fentanyl.  

Every day at this Pacific coast hub, the port handles some 9500 ­containers, some 30% of Mexico’s maritime ­imports. In such a vast cargo, Mexico’s customs ­authorities have their work cut out ­trying to find the tiny amounts of input ­chemicals needed to make fentanyl. 

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Further complicating their task is the sheer variety of precursors that can be used to make fentanyl and other ­illicit drugs. Most such precursors also have legitimate uses – including for ­medical research – and are perfectly legal to sell, making up part of the booming transnational trade. 

As researchers at the Rand ­Corporation which helped compile the US ­bi-partisan report have established, all the ­fentanyl needed to supply the US for one year weighs the equivalent of five tonnes and would easily fit into one lorry. It’s a comparatively small load compared to the 125 tonnes for heroin and even more for cocaine.  

“It’s not a needle in a haystack, it’s the hole in the needle in the haystack,” ­Peter Reuter, public policy professor at the ­University of Maryland told the FT. 

With business savvy and growing ­power in Mexico, the Sinaloa and rival Jalisco cartels dominate the market for supplying fentanyl to the US.  

The two pre-eminent cartels are named for their respective strongholds in states on Mexico’s Pacific Coast. Sinaloa is a decades-old criminal organisation ­deeply embedded in the economy, politics and culture of Mexico’s wild northwest, analysts and officials say. Jalisco, to the south, is relatively new, and has violently challenged Sinaloa for market share. 

The National: Many victims of Mexico's drug dealing cartels have been found in clandestine gravesMany victims of Mexico's drug dealing cartels have been found in clandestine graves

“It’s definitely become a big driver of violence in Mexico,” says Falko Ernst, senior Mexico analyst at the International Crisis Group.

“It’s a huge cash cow for those who have access to it,” Ernst told the FT. 

But at its roots, this multi-million-dollar operation is low-tech. From porches and shacks within their remote strongholds, Mexico’s Sinaloa and Jalisco employ fentanyl “cooks” as part of their globe-spanning production line manufacturing the cartels’ highly profitable export. No one knows how many crude labs there are which can be set up inexpensively and quickly, torn down and moved or abandoned to evade security forces.  

One Mexican cook who spoke to ­reporters from the Wall Street Journal (WSJ) said he makes up to $2500 a week running his one-man 10-by-10-foot lab. 

Once produced the drugs are ­transported across the Mexico-US land border by “mules”, who are often ­American women, according to a recent US indictment. Some are flown over in private planes. The fentanyl is then ­distributed using similar US networks as for other drugs. 

And it is here that the blame game that is politics comes into play with fentanyl becoming not only a threat to US ­national security but a significant factor in ­deteriorating relations between ­Washington, Beijing and Mexico City.  

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Speaking before the Senate Foreign Relations Committee earlier this year, Dr Rahul Gupta, director of the White House’s Office of National Drug Control Policy, made clear the findings of the US International Narcotics Control Strategy Report (INCSR) released in March 2023. 

“Criminal elements, mostly in the ­People’s Republic of China, ship ­precursor chemicals to Mexico, where they are used to produce illicit fentanyl,” Gupta told the committee before going on to ­underline that the American authorities identified Mexico “as the sole significant source of illicit fentanyl and fentanyl analogues ­significantly affecting the United States”. 

Just as this opioid epidemic has grown, so too has its role in American politics.

Where once it brought ­Republicans and Democrats together, as ­overdose deaths continue to climb, the ­discourse around ­fentanyl has become much more ­politicised. At times it has ­become less aligned with reality as House ­Republicans’ border oversight ­hearings have regularly invoked the ­smuggling of fentanyl across the ­US-Mexico border alongside migration ­issues. 

For the administration of US ­president Joe Biden, the grim overdose death ­statistics remain a real concern as it ­struggles  to contain a crisis it vowed to end during the 2020 election campaign. 

Certainly, there’s no doubt that since taking office the Biden ­administration’s ­efforts are visible and have won praise from healthcare experts for shifting away from criminalising drug users and ­focusing instead on expanding ­treatment for people suffering from ­opioid use ­disorder as well as information ­campaigns. This though has not stopped the fentanyl crisis from impacting the forthcoming presidential election next year. 

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As with Donald Trump and the ­Mexico border wall, Republican leaders like ­Florida Governor Ron DeSantis – a 2024 presidential hopeful – have blamed ­immigrants for drug trafficking. In that sense, fentanyl has become the ­Republicans’ new “wall” against Mexico.

On the wider US foreign policy front – Mexico aside – China too has come ­under intense US criticism. With ­relations ­between the two nations already soured, some had hoped that fentanyl control was one area in which Washington and ­Beijing might find common ground ­outside rival areas such as trade and technology. But the signs are not good.  

While America says China needs to do more to curb transnational supplies of both precursors and fentanyl itself, the Chinese state media continues to ­insist that “the fentanyl crisis in the US is ­demand driven”, primarily by “the users themselves”. 

Part of the problem, say analysts like Vanda Felbab-Brown – an expert on ­international crime at the ­Brookings ­Institution – is that China “sees its ­counternarcotics enforcement, and more broadly its international law enforcement ­cooperation, as strategic tools that it can instrumentalise to achieve other ­objectives.” 

The bottom line, says Felbab-Brown, is that “fentanyl stands apart from ­other ­domains of policy, because people are ­dying daily ... this is not a delayed threat, this is an immediate life-or-death situation.” 

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And on that note of immediate threat, US Secretary of State Antony Blinken has warned that Europe must wake up to the threat of synthetic opioids. It’s a view shared by Ylva Johansson, the EU’s home affairs commissioner. 

“When I talked to Secretary Blinken, he put it like this on synthetic drugs: ­‘Either it’s a problem that you have, that you don’t know that you have, or either it’s a problem that you will have’,” Johansson said in an interview with Politico magazine last month.

The US wants to act as the canary in the coal mine, she said, “so that others won’t have the same problem as they had”. 

Johansson also warned that the ­ capacity to produce fentanyl in the EU and across Europe as a whole “is here, we have it”. 

She highlighted how the moment ­organised crime see a rise in demand, production could multiply very quickly indeed.

Already, a total of 434 illicit ­synthetic drug production ­laboratories were ­dismantled in the EU in 2021, ­according to the European Drug ­Report – ­reinforcing ­Johansson’s view that ­Europe has to be “very vigilant and very ­prepared”.  

Right now, the skyrocketing death rate in the US – equivalent to one American overdosing every five minutes – and the $1.5 trillion annual cost to the economy is ­forcing a national debate about how to solve what is now a public health ­emergency.

Faced with a similar prospect, Europe would be wise, it seems, to take heed of the warnings Johansson has highlighted.