The black legend of fentanyl, the drug that triggers tensions between Mexico and the US

From unknown drug to public enemy number one.

Fentanyl has monopolized the last chapters of the war against drug trafficking in Mexico and the United States.

More potent, cheaper and harder to detect, this synthetic drug is behind an epidemic-tinged public health crisis, killing tens of thousands of Americans each year, according to official data.

Nine out of ten seizures are made on the southern border, and Washington has increased pressure on the Mexican government to do more to curb the illegal trade.

Amid criticism from the most recalcitrant conservative sectors in the US and clashes with the DEA, President Andrés Manuel López Obrador this week proposed banning fentanyl for medical use as one of the possible solutions.

“I am going to ask Mexican doctors and scientists to analyze the possibility that we can replace fentanyl for medical purposes with other pain relievers to stop using it,” López Obrador said at his press conference last Wednesday.

“You have to see that possibility,” he added.

His proposal has aroused a strong debate about the scope and effectiveness of this measure in the fight against opioid addiction that is hitting the region, especially the United States.

"It doesn't go that way," summarizes Raúl Martín del Campo, director attached to the National Institute of Psychiatry and former member of the United Nations International Narcotics Control Board (INCB).

"The president's intention is not bad, but I don't know if he was given bad advice or if he got confused because the problem is complex," adds the specialist.

Martín del Campo explains that each country informs the UN of how much fentanyl it will need for medical use and that each year it also reports how much it ended up being used in the treatment of patients, either as an analgesic or anesthetic.

In 2021, for example, Mexico told the INCB that it used 4.6 kilos of the substance for medical use and that same year, seizures of illegal fentanyl exceeded more than 1,850 kilos, according to data from the Ministry of National Defense.

The specialist cites this data to underline that the black market and the legal consumption of fentanyl follow completely separate lines.

"They have nothing to do with it," settles the expert, "narcos have the possibility of manufacturing their own fentanyl, they do not need to steal the one for medical use."

Raúl Martín del Campo during the presentation of a UN report on narcotics, on March 10, 2023.Alex Cruz (EFE)

Security experts maintain that there is no evidence that there was a “leakage” from the pharmaceutical market for fentanyl to fuel illicit demand for the drug, as other opioids did in the late 1990s. “The problem of illegal fentanyl, produced or trafficked from Mexico —there is a discussion about how much is produced, but it is certainly trafficked—, it is not a problem of diversion from the pharmaceutical market”, agrees analyst Alejandro Hope.

“The problem is the illegal import of finished products or precursors from Asia.

All of this is illegal, since its entry into Mexico.

In other words, if you close the key to legal importation, you do nothing to this illegal importation of finished product or precursors that is already taking place”, he affirms.

“The only thing you achieve is taking away a therapeutic alternative from doctors and patients, many of whom do need it.

This combines a maximum of ineffectiveness with a maximum of cruelty, ”he adds.

Anatomy of the illegal fentanyl market

The opioid crisis hits the United States.

But the problem is not new.

The crisis has had three waves in the last 30 years.

The first began when the big pharmaceutical companies pushed for painkillers to be prescribed indiscriminately and with the consent of the health authorities.

Since the late 1990s and early 2000s, prescriptions have been the gateway for thousands of chronically ill patients to become addicted to synthetic drugs such as oxycodone, known as Oxy or OxyContin by its trade name.

The second wave came a decade later and was marked by a skyrocketing demand for heroin as the door to prescription drugs closed.

The third wave, the current one,

It happened when the cartels realized the enormous business opportunity that existed in manufacturing false or adulterated versions of these opioids.

Fentanyl completely revolutionized drug trafficking: it is used to cut cocaine, to modify heroin, to make "pirate" pills and to adulterate crystal, as has been documented by Clara Fleiz, a researcher at the National Institute of Psychiatry.

The perverse thing about this latest wave is that people who use drugs often think they are taking one drug, when in fact they are giving them another that is much more aggressive and lethal.

“Many do not know what they are consuming,” laments Fleiz, a member of the opioids working group at UNAM's Global Studies Seminar.

Political scientist Zara Snapp points out that fentanyl is an easier drug to traffic compared to others, given its characteristics: it is more potent —it is 50 times stronger than heroin and 100 times stronger than morphine— and therefore , the doses that are moved are in very small sizes, while the gains are huge.

“We know that there is a great demand from our neighboring country, we know that there is that profit by non-state groups and I have no doubt that Mexico is participating in the illegal fentanyl market, either by producing or as a transit country for fentanyl. fentanyl done”, affirms the specialist in drug policy.

An agent of the Attorney General's Office among dozens of packages of fentanyl and methamphetamine seized in Tijuana, in October 2022.Salwan Georges (Getty Images)

How lucrative is the fentanyl business?

Martín del Campo affirms that producing and transporting a kilo of the drug costs the cartels $1,000, but the profits are around $1.5 million.

“It's as if I asked you for an investment peso to start a business and I promised you 1,500 in profits,” he says.

How dangerous is consumption?

Three grams can be lethal for an average person, according to US authorities.

“The United States is currently, yes, in the midst of an overdose crisis over the adulteration of this market.

That is the reality of them ”, complements Snapp.

Lately, and in order not to give in to excessive criticism from the United States, López Obrador assured that the drug is not produced in the country, although these affirmations have been refuted by US officials, politicians, academics and by the discovery of clandestine laboratories in operations of his government.

The president qualified later that it does occur, but only in the "die-cutting" of pills.

The president's narrative has been reinforced by the Foreign Ministry, which ensures that Mexico is a country of "final conditioning" of the product ("

), which is something like “pastillado”, but that the drug is not synthesized in the country, a position disputed by analysts.

The criminal dynamics of the last decades point to a fact that is repeated over and over again: the drug traffickers are where the business is.

More and more is known about how fentanyl finds its way onto the US market.

Cartels are increasingly turning to precursors, which are the substances used to make fentanyl.

Martín del Campo affirms that many drug traffickers go to pharmaceutical companies in India and China to buy the chemical compounds, which are often not regulated or prohibited.

For this reason, so-called

platforms are used , which give their users anonymity, or are even obtained from ordinary Internet pages.

US intelligence points out in a report published in February that many laboratories also use false labels or say that the compounds are going to be used for a different purpose.

"Is it national production or is it pure and simple smuggling of finished products in other countries," summarizes Hope.

Specialists warn that the doses are so small that many arrive by parcel or regular postal service.

It is increasingly common for drug users and producers to

and have access to substances.

In a January 2018 photo, a van stopped by authorities near Ensenada with 45.5 kilograms of fentanyl.AP

Despite the fact that they star in far fewer headlines, the precursors are key to the business and the difficulty of eradicating it.

Due to international pressure, in 2019 China began to regulate the sale of 50 substances that are used as precursors, but there are another 150 related to fentanyl that have escaped regulation.

In addition, there are more and more types of fentanyl from the mixtures that are experimented on the illegal market.

Martín del Campo points out that in 2014 only five types of fentanyl were known and that there are now more than 50. Instead, there are only four types of fentanyl for medical use.

Just this week three precursors were added to the United Nations blacklist: norfentanil, 4-AP and 1-boc-AP.

Medical use and illegal consumption in Mexico

Due to its potency, legal fentanyl is used as anesthesia in complex surgeries or surgeries that take several hours.

It is also common in palliative care, in pain management, and in patients who are, for example, in intensive care and need to be sedated to withstand medical procedures.

It has been used for decades.

It was created in 1960 and approved for administration in the United States in 1968. Martín del Campo indicates that legal production has been declining in recent years, partly due to the stigma of the drug.

“There is a kind of demonization of

fentanyl, when in reality it is irreplaceable in some treatments because such powerful substances are needed,” he comments.

Fleiz has documented for years the use of synthetic drugs in Mexico, especially in the northern states of the country, where the trafficking routes pass.

Since 2019, she had shown that fentanyl was consumed in the country, despite the fact that the Mexican authorities maintain that the demand in the country is practically non-existent.

In the vast majority of cases, these were users who were addicted to other drugs, such as coke or heoin, or who had tried it in the United States, although it is increasingly common for people to seek to buy fentanyl directly.

"A few years ago, people didn't know about it, now there's already a demand for it," says the specialist, who admits to being surprised at the speed with which consumption has spread in recent years.

The two main forms of consumption among users are injecting and inhaling it.

People pulverize a pill, put the dose on a spoon, and dilute it to put it into a syringe, similar to heroin but without the need to heat the spoon.

Sometimes the pill is simply pulverized into a small aluminum square and inhaled or smoked, Fleiz explains.

A laboratory technician tests an Aderall pill purchased at a pharmacy in Cabo San Lucas, Mexico, which is adulterated with fentanyl, on January 27, 2023.Wally Skalij (Getty Images)

In Mexico there is a significant underreporting of the use of this and other drugs, but the levels of use of fentanyl do not reach, by far, what is seen in the United States or Canada.

Snapp argues that President López Obrador's approach is contradictory because he tries to "solve" the crisis that the US is going through when in Mexico fentanyl addiction is far from being comparable.

“In Mexico we do not have a wide consumption of injecting drugs: it is around 150,000 people throughout the country and is mainly concentrated in five cities in the north.

So, we are transferring a fear, a fear, a misinformation from the United States to the Mexican context, when our problem is quite different ”, he explains.

Fleiz, on the other hand, sees that the signs that consumption is increasing in Mexico are increasingly evident, from the notes that arrive from the border to the reports from the centers where addictions are treated.

Many times, consumption did not attract attention because it occurred among people living on the streets or other vulnerable groups.

But the profile of the consumer is increasingly broad.

The US authorities targeted presentations such as the so-called "rainbow fentanyl", which is shaped like colored candies.

Last July, for example, six minors had to be hospitalized in Tijuana for an overdose of fentanyl.

"We have to approach it as a social and health problem, and I think that many times everything is diluted in the political discussion," says the specialist.

“We have time to prevent, before it is a tragedy in our country as well”, she affirms.

As the proposal to ban medical fentanyl is the topic of the week, medical specialists see a world turned upside down.

Precursors continue to receive insufficient attention and remain widely available.

On the other hand, the main antidote against overdoses, naloxone, continues to require a prescription, despite the fact that there is an initiative in Congress to change that situation.

Methadone, which allows people to gradually wean off synthetic drugs, also requires a prescription and has also received no attention from lawmakers.

A Homeland Security Investigations Agency agent leaves the scene of a fentanyl overdose case he investigated, in San Diego, on Nov. 10, 2022.Salwan Georges (Getty Images)

The political inertias are too strong.

Bilateral tensions surrounding the fentanyl crisis have been increasing over the weeks.

The kidnapping of four US citizens —and the murder of two of them— on March 6 in Nuevo Laredo, Tamaulipas, by a cartel has raised bilateral tension to levels that already have a hint of diplomatic conflict.

In the US, the most extremist politicians have proposed that their Army intervene in the fight against the cartels that traffic fentanyl, a proposal that has been interpreted from Mexico as interference in the internal affairs of the country and, ultimately, as a threat of foreign invasion, a sensitive issue in the historical relationship of both countries.

The truth is that fentanyl has not managed to escape the familiar narrative of the war on drugs: between a country with enormous demand that claims to be “poisoned” by the Mexican cartels and another that is tired of its neighbor not recognizing its part of the problem.

The US has made fentanyl its main crusade of the century.

The reproaches about who is more guilty emerge.

The bilateral dialogues remain open, despite the media controversies.

The discussion has stalled and has entered a loop.

There is no talk, at least in public discussion, of standardizing customs regulations, of increasing information and intelligence exchanges, of leaving behind prohibitionist schemes (especially when they do not make sense), of attacking financial structures, of tackling the impunity, to guarantee access to treatment or palliative care.

As has happened so many times before, we are not talking about people, but about substances.

When the subject of fentanyl comes up, there is talk of who has done more and who has done less.

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