How the US and China play the fentanyl blame game

The White House has made cracking down on the illicit trade a cornerstone of its narcotics policy. Photo: Bloomberg

China is an easy scapegoat for America's fentanyl addiction. The US has made it part of trade negotiations between the two superpowers, but recent shifts in production and supply tell a more nuanced story.

Addressing fentanyl's flow requires cooperation from both nations. That's challenging, but not impossible. Beijing could work more closely with American law enforcement to crack down on Chinese chemical firms that export the ingredients going into the drug. Washington could stop using it as a political weapon, while also keeping up hard-fought momentum against the opioid crisis. 

Trade talks between the two have stalled due to various grievances. A back-and-forth in US courts about the validity of President Donald Trump's tariffs is also complicating things. White House officials have suggested that Trump and Chinese leader Xi Jinping will speak soon, but Beijing has yet to confirm. Instead, China on Monday accused the US of violating their agreement and vowed to take measures to defend its interests. 

Beyond this upheaval, it's important to note that the US is finally making headway against fentanyl, which has claimed the lives of more than 400,000 Americans since taking over from heroin in the drug supply. Overdose deaths plummeted by 27 percent in 2024, according to the Centers for Disease Control and Prevention, a stunning reversal that will require a careful balance of policy at home and abroad to maintain.  

The White House has made cracking down on the illicit trade a cornerstone of its narcotics policy. Trump explicitly pointed the finger at China, accusing it of "actively sustaining and expanding the business of poisoning our citizens." It's a view shared on both sides of the aisle. Nicholas Burns, the former US ambassador to Beijing under President Joe Biden, said on 13 May that as an authoritarian country it "has the capacity to stop the flow of these precursor chemicals." 

That's only partly true. Expecting China to halt all exports of potentially illicit chemicals is unrealistic, notes Vanda Felbab-Brown, senior fellow at the Washington-based Brookings Institution. Many of the raw materials are legal, and used to manufacture ordinary products, including insecticides and fragrances. "What we don't want is Chinese brokers blatantly selling them on the international market," she said. "We want authorities to act reliably and induce law enforcement cooperation from China that has been building since 2024."   

A 2022 report from the US Senate's Committee on Homeland Security and Governmental Affairs underscores the complexity of enforcement. The chemicals used in fentanyl production are easily modified, it notes, and traffickers adapt quickly. Other countries, most notably India, have also emerged as new sources. 

China was once the main supplier of fentanyl to the US, but that changed in 2019 when Beijing announced the production, sales, and export of all fentanyl-class drugs were prohibited, except by authorised firms that the government had granted special licenses to. It was around that time that Mexico replaced China as the primary source, the US government reported.  

But Chinese chemical companies switched to supplying precursors — the ingredients needed to manufacture the opioid — and remain a critical player in the supply chain, according to the US Drug Enforcement Agency. These are often sold online on dark web platforms, and then shipped to Mexico through standard courier services, thus evading border controls.  

Despite that, Chinese officials have often claimed the country has achieved success in controlling the substances and done all it can for the US. In March, Beijing told Washington it should have said a "big thank you" instead of announcing levies on Chinese imports.  

The reality is that enforcement has been uneven, and contingent on the Communist Party's mood. After a 2018 meeting between Trump and Xi at the Group of 20 summit in Argentina, China tightened supervision around production and allowed US law enforcement authorities to take a bigger role in investigating smuggling. 

That partnership stalled when politics got in the way. In 2022, China announced it was suspending all counter-narcotics and law enforcement cooperation with the US after a visit by then House Speaker Nancy Pelosi to Taiwan angered Beijing. Talks were only restored during the Biden administration, but only resulted in vague commitments.

Still, even if the US and China were to succeed in cutting off the fentanyl supply, it wouldn't solve America's addiction crisis. A recent analysis from the Peterson Institute for International Economics found that the Chinese embargo on shipments to the US during the first Trump administration led to a temporary surge in prices, which researchers credit with a meaningful decline in overdoses. But that effect lasted less than six months, as traffickers found other ways to get their product into the US.

Those who study addiction warn that an abrupt crackdown can have unintended consequences. A fentanyl vacuum can open the door to even deadlier narcotics, including powerful synthetic opioids such as nitazenes that could complicate prevention and treatment. The worry is those newer substances can't be detected by drug users' fentanyl strips and might require higher or multiple doses of the overdose reversal agent naloxone.

The magnitude of the drop in drug overdose deaths last year surprised even addiction experts. A better handle on supply certainly contributed to that improvement, but as crucial was the gargantuan effort to ensure widespread availability of naloxone and improved access to treatments. Now, that progress could be in jeopardy.

Trump's tough stance with China has paradoxically come as his administration seeks sharp reductions to the programs and public safety nets that have been vital to addressing the opioid crisis. His pending budget includes steep cuts to public health agencies responsible for tracking and responding to the opioid epidemic, and imposes new work requirements on adults insured by Medicaid, one-in-five of whom has a substance use disorder. Although the bill exempts those struggling with addiction from working, analyses by multiple health policy experts have found that millions could still lose coverage — and access to treatment. All of that could undo any benefits from reining in supply from China.

Momentum is building on both sides, despite recent disruptions to negotiations. US Treasury Secretary Scott Bessent had previously noted China's willingness to address the problem, which could eventually lead to the elimination of an additional 20% tariff tied to Beijing's actions on the drug. That would help Xi, as he tries to reinvigorate an economy enduring a prolonged property slump, weak consumer and business confidence, and persistent deflation.    

But these moments of cooperation are rare. Weaponising fentanyl as part of trade negotiations will only yield limited results. If Washington wants lasting progress, it must engage Beijing as a partner, and match any expectations abroad with serious commitments at home.