By CECILIA FARFÁN-MÉNDEZ | JASON ELIGH

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.

By Richard A. Miech,  Lloyd D. Johnston, Megan E. Patrick, Patrick M. O’Malley

Substance use is a leading cause of preventable morbidity and mortality; it is in large part why, among 17 high-income nations, people in the United States have the highest probability of dying by age 50.1,2,3 Substance use is also an important contributor to many social problems including domestic violence, violence more generally, criminal behavior, suicide, and more—and it is typically initiated during adolescence. It warrants our sustained attention. Monitoring the Future (MTF) is designed to give such attention to substance use among the nation’s youth and adults. It is an investigator-initiated study that originated with, and is conducted by, teams of research professors at the University of Michigan’s Institute for Social Research. Since its onset in 1975, MTF has been funded continuously by the National Institute on Drug Abuse—one of the National Institutes of Health—under a series of peer reviewed, competitive research grants. The 2024 survey, reported here, is the 50th consecutive national survey of 12th grade students and the 34th national survey of 8th and 10th grade students (who were added to the study in 1991). MTF contains ongoing national surveys of both adolescents and adults in the United States. It provides the nation with a vital window into the important but often hidden problem behaviors of use of illegal drugs, alcohol, tobacco, and psychotherapeutic drugs used without a doctor’s orders. For nearly five decades, MTF has helped provide a clearer view of the changing topography of these problems among adolescents and adults, a better understanding of the dynamic factors that drive some of these problems, and a better understanding of some of their consequences. It has also given policymakers, government agencies, public health professionals, and nongovernmental organizations (NGOs) in the field some practical approaches for intervening. A widespread epidemic of illicit drug use emerged in the 1960s among U.S. youth, and since then dramatic changes have occurred in the use of nearly all types of illicit drugs as well as alcohol and tobacco. Of particular importance, as discussed in detail below, are the many new illicit drugs that have emerged, along with new forms of alcoholic beverages and nicotine products. Among the substances and devices that have emerged over the life of the survey are new classes of drugs that include vaping devices, hookah smoking, synthetic marijuana, and drugs taken for performance enhancement. New devices and methods for taking drugs, such as vaporizers and e-cigarettes,number of new substances added to the list over the years substantially outnumbers the number removed because so many substances remain in active use. Throughout these many changes, substance use among the nation’s youth has remained a major concern for parents, educators, health professionals, law enforcement, and policymakers, largely because substance misuse is one of the largest and yet most preventable causes of morbidity and mortality during and after adolescence. The MTF annual monograph series is a key vehicle for disseminating MTF’s epidemiological findings. In addition to this monograph, the series includes a separate, annual monograph that presents prevalence and trends among U.S. adults now ages 19 to 65, including both college students and their age peers who are not attending college (scheduled for publication this summer), as well as an additional, periodic monograph that presents information on risk and protective behaviors for HIV among young adults. All MTF publications, including press releases, are available on the project website at www.monitoringthefuture.org 

Ann Arbor: University of Michigan Institute for Social Research , 2025. 484p.