The National Threat from Fentanyl: Our Country’s Drug Overdose Crisis


Drug overdose deaths have risen steeply throughout the United States. Data from the Centers for Disease Control and Prevention (CDC) indicates that overdose deaths remain historically high and are continuing their upward trajectory. CDC estimates that there were over 110,000 overdose deaths in 2022, up from approximately 109,000 in 2021. Illicit fentanyl is at the forefront of this public health crisis. Of these drug-related overdose deaths, the majority involved this lethal substance. Fentanyl has become one of the single largest threats Americans have ever encountered. Highlighting the severity of this national threat, fentanyl has become the leading cause of death for Americans ages 18-45, claiming more lives than suicide, COVID-19, or automobile accidents in this age group.

CDC has a continuously updated dashboard that can be accessed for current information on drug overdose deaths at
CDC also has an online dashboard to track non-fatal drug overdoses that can be accessed at

The chart below, from CDC’s Drug Overdose Dashboard, shows the rise in overdose deaths that began to surge around the time of the COVID-19 pandemic in 2020.

Fentanyl Production and Trafficking

The majority of the fentanyl in the United States is mass-produced by transnational criminal organizations operating in Mexico using China-sourced precursor chemicals.  The two cartels thought to be primarily involved in the production and trafficking of fentanyl into the United States are the Sinaloa Cartel and Cartel Jalisco Nueva Generación (CJNG). Fentanyl is primarily entering the United States via the southern border, seized by law enforcement as kilogram bricks of fentanyl powder and in bulk quantities of counterfeit pills.

Fentanyl in the Drug Supply

Fentanyl has changed the drug threat environment to such an extent that the use of almost any illicit drug could potentially expose an individual to this deadly substance. At the retail level, drug dealers sell fentanyl powder and fentanyl-laced pills and also mix fentanyl with a variety of drug types such as heroin, cocaine, and methamphetamine. Sometimes drugs sold as heroin, cocaine, or methamphetamine are found to contain just fentanyl or fentanyl mixed with xylazine (an animal tranquilizer).

Fentanyl-Xylazine Drug Mixtures

  • In April of 2023, fentanyl mixed with xylazine was declared by the Office of National Drug Control Policy (ONDCP) as a national emerging drug threat. Because xylazine does not respond to life-saving Narcan since it’s not an opioid, fentanyl-xylazine mixtures are contributing to the rise in deaths nationally.

  • In July of 2023, ONDCP released a National Response Plan to reduce the currently rising threat from fentanyl-xylazine drug mixtures in the United States.

Click below to read the White House’s press release: National Response Plan to Address the Emerging Threat of Fentanyl Combined with Xylazine.


White House Press Release on Emerging Drug Threat from Fentanyl-Xylazine Mixtures

 Click below to read the National Response Plan. 


Fentanyl Adulterated or Associated with Xylazine Response Plan


Click to learn more about national strategies to combat the fentanyl crisis in America.


Commission on Combating Synthetic Opioid Trafficking: Final Report, February 2022


Click below to learn about the Drug Enforcement Administration’s One Pill Can Kill Campaign.

DEA’s One Pill Can Kill Campaign

Click to read DEA's public safety alert.

DEA’s Public Safety Alert: 7 of 10 DEA Tested Pills Contain a Lethal Dose of Fentanyl,totals%20of%2058%20million%20pills