In terms of illegal drugs, few have caused as much harm as fentanyl.
The powerful synthetic opioid has been responsible for about 266,000 deaths in the United States since 2021 and now drives roughly two-thirds or more of all overdose fatalities. The nation’s overdose death rate in 2023 was more than four times greater than it was in 1999—with the vast majority of that increase due to fentanyl.
“It's a drug that is incredibly cheap, far more cheap than heroin or cocaine or anything like that, and it's also about 50 times more potent than heroin,” said Jake Braun, a former White House official and the executive director of the Cyber Policy Initiative of the Harris School of Public Policy at the University of Chicago. “It's more like a poison really, because it's being cut into other drugs—but also more insidiously, into fake prescription pills.”
At a Dec. 3 session at the Keller Center, Braun and fellow former White House official Katie Tobin, now a lecturer at Harris, shared their experiences shaping the federal response to the fentanyl crisis in the Biden administration. The event, part of the Harris Policy Outlook series, was held in partnership with the Chicago Council on Global Affairs and examined the scope of the crisis, the role of foreign cartels and the federal government’s work to counter them.
In their conversation with the council’s event moderator Cécile Shea, Braun and Tobin traced how fentanyl moves through a global supply chain, starting with Chinese chemical manufacturers but otherwise dominated by Mexico’s Sinaloa Cartel. Because demand for the drug is low and most deaths come from accidental exposure, they argued, the U.S. must treat it as a supply-driven threat—one that intense, targeted pressure can make too costly for cartels to continue.
Tobin described regular, high-level diplomacy with the governments of both Mexico and Canada aimed at boosting anti-fentanyl work as a shared political priority.
“At a very high level, at like one level below presidential, you’re meeting on a monthly basis to deal with this existential challenge that’s confronting all of North America,” she said. “It’s a shared challenge, and not only do we need to deal with it in the continent, but all three countries need to be dealing with China as well.”
The growing reach of synthetic opioids
The business strategies of the Sinaloa organization, which has a stranglehold on parts of Mexico's northern borderlands, was a central theme of the policy event.
“The Sinaloa Cartel is a massive global enterprise bigger than a Fortune 50 company that can outfight the government of Mexico in certain places,” Braun said, adding the group was “armed to the teeth” with military-grade weapons.
He explained that while cannabis, cocaine, and heroin were formerly the biggest lines of enterprise for the cartel, the organization had adapted through the years to meet shifting demand for drugs in the U.S. Over more than two decades, this has centered on the opioid epidemic.
While counterfeit medications were previously just a small source of revenue for the cartels, Braun said, they quickly became a major line of business as the U.S. government began restricting prescription painkillers such as OxyContin.
Today, users seeking cheap pharmaceuticals online, even non-opioids such as Ritalin or Viagra, may instead get a lethal dose of fentanyl.
Tobin explained how the cartel behaves like a diversified corporation that leans on other revenue streams when one falters. When migrant crossings at the border—a key source of cash for cartels, which provide human trafficking—dropped sharply earlier this year, she said, criminal syndicates in northern Mexico reportedly saw an immediate decline in smuggling income.
To make back some of those lost earnings, they pivoted to high-ransom kidnappings.
“They will adjust very fast to make sure they keep their business going,” Tobin said.
Given the fluid nature of the syndicate’s illicit cashflows, Shea asked if law enforcement agencies were merely “playing whack-a-mole” in their attempts to suppress cartels.
Braun said this was true to an extent, but that the deadliness of the fentanyl industry relative to other cartel activities was too high not to act. He pointed to the efficacy of mass anti-syndicate operations in the past coordinated between federal agencies, military units and the intelligence community in forcing changes to cartel behavior—and said a similar level of “outsized heat” was necessary today.
“This isn’t a terrorist organization in the sense that it’s ideologically driven,” he said. “If we have outsized enforcement on the cartels, then we can degrade multiple lines of business, degrade their ability to make money in multiple areas, so that they say, ‘You know what, fentanyl is just too bad of a business for us to be in.’”
—For more on the subject, see Braun’s newly published book Fentanyl: Fighting the Mass Poisoning of America and the Cartel Behind It.
