Unregulated fentanyl in North America
A trilateral perspective
More than 1.1 million people in the United States have died from opioid overdoses since 2000. In Canada, over 50,000 lives have been lost to opioid-related overdoses since 2016. Meanwhile, in Mexico, homicide—mostly committed with illegally trafficked firearms—is the leading cause of death among men aged 15 to 44. These overlapping crises reveal that the harms associated with synthetic opioids are not confined to one country but span all of North America.
This policy brief sheds light on how illicitly manufactured fentanyl (IMF) is produced and distributed within and across Mexico, the US, and Canada. The report reveals a complex and highly integrated system of production, tablet pressing, trafficking, and consumption. Far from being a product trafficked into North America, IMF is increasingly produced on its soil.
Key insights include the emergence of a new “golden triangle” of trafficking and violence between the Mexican states of Baja California, Sonora, and Sinaloa, where fentanyl production overlaps with high levels of firearm-related homicides. Fentanyl production in Mexico is closely linked to firearms trafficking from the United States, with Arizona emerging as a predominant source. In Canada, production largely serves the domestic market using chemical precursors imported directly and processed in clandestine labs. In the US, criminal actors engage in adulteration and tablet pressing—often making use of legal trade flows and customs loopholes to facilitate trafficking.
The paper also challenges common assumptions: 83.5% of those convicted of fentanyl trafficking in the US in 2024 were US citizens, and most trafficking across the Mexico–US border occurs through legal ports of entry, not between them.
Recommendations for all three countries focus on data transparency, coordinated public health responses, and transnational cooperation. The paper calls for more investment in evidence-based interventions and a shift away from unilateral or enforcement-only strategies.
Deaths in North America from overdoses and homicides linked to fentanyl are not inevitable. But addressing it requires governments to exchange know-how and coordinate action across borders, just as criminal networks do.
Price data
Price data is notoriously absent from drug policy conversations. Although drug prices show extreme variability over time and place, and there is mixed evidence about the ability of policy to influence prices, this data is nevertheless relevant for understanding market dynamics.
An overview of the effects of fentanyl use in Mexico
The year 2025 began with a new campaign against substance use in Mexico, with a particular focus on fentanyl. On the radio, a deep, solemn voice warns: ‘Fentanyl kills you; a united family gives you life.’
In this section we share information on everything you always wanted to know about fentanyl but were afraid to ask.
Some questions and answers include this symbol (see above), which indicates that, while we acknowledge these questions are common, we do not recommend this type of language because it stigmatizes people who use drugs. If you want to learn more about how to cover drug markets, we recommend consulting our glossary as well as this project by the organizations Elementa DDHH and FES Colombia.
Women pay the highest price in the war on drugs
In the 11 years she has spent behind bars at the Cereso prison in La Pila, San Luis Potosí, María, 57, has seen countless women come and go. In recent years, she has noticed a growing number of arrests for drug-related health offences.
This glossary features terms used in Mexico related to fentanyl used in medical settings and the one produced in the unregulated market.
The glossary is aimed for journalists, researchers and people with a general interest on this issue. While the glossary is only available in Spanish (insofar it explains terms used in the Baja California–California border region and the state of Sinaloa) we recommend you consult it, especially if you are a journalist covering fentanyl use or illicitly manufactured fentanyl in Mexico.
The cost of healing: Opioid bans in Mexico
In 2021, amid ongoing medicine shortages caused by the COVID-19 pandemic, Mexican anaesthesiologist Marisa Brito made a desperate decision: she bought medical fentanyl online with an official prescription to intubate critically ill patients.
This work was made possible thanks to the contributions of Marcela Del Muro and Marcos Vizcarra. Illustrations by Dante Aguilera.
REPORT HIGHLIGHTS NEW “GOLDEN TRIANGLE” OF FENTANYL AND FIREARMS TRAFFICKING IN NORTH AMERICA
A new report by the Global Initiative Against Transnational Organized Crime (GI-TOC) highlights the regional dynamics of illicitly manufactured fentanyl in North America. While underlining the public health crisis caused by opioid-related overdoses in the United States and Canada in the past two decades, it also draws attention to high homicide rates in Mexico.
To illustrate this point, while the United States and Canada, respectively, have opioid death rates of 25 and 21.5 per 100,000, Mexico has a homicide rate of 24 per 100,000 (more than four times the global average of 5.8 per 100,000). More than two-thirds of firearms recovered from crime scenes in Mexico and submitted for tracing were sourced from the United States (particularly from Arizona and Texas). Ready access to such firearms is exploited by groups involved in fentanyl trafficking. The two markets are interconnected.
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