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The fentanyl epidemic in North America and the global reach of synthetic opioids

Providing actionable recommendations for U.S. domestic and international policies to the fentanyl epidemic and lessons for other governments.

A stop opioids use door knocker hangs on a doorknob during an opioids outreach event along W. 23rd and N. Market streets in Wilmington, Wednesday, Dec. 6, 2023.
A stop opioids use door knocker hangs on a doorknob during an opioids outreach event along W. 23rd and N. Market streets in Wilmington, Wednesday, Dec. 6, 2023. (Benjamin Chambers/USA TODAY NETWORK via Reuters Connect)
527,344 Americans have died from opioid overdoses since 2012, the year fentanyl started entering the U.S. illicit drug market
+100K died from drug overdose annually since 2021
#1 main cause of death for Americans aged 18 to 45 since 2021

Over the past three decades, the United States has faced an unprecedented opioid crisis, with synthetic opioids like fentanyl driving overdose deaths to catastrophic levels. Although overdose fatalities declined by nearly 25% from 2023 to 2024, the crisis is far from over.

Recent domestic policy changes by the Trump administration herald a new phase in the U.S. government’s response to the deadly epidemic. The Trump administration’s external counternarcotics policies also push drugs into an unprecedented level of prominence in U.S. geopolitical and trade relations while synthetic opioids and drugs continue to evolve and spread globally, posing an escalating international threat.

For years, the Brookings Institution has conducted extensive research into the public health and security dimensions of this crisis to develop effective policy solutions. The previous phase of the initiative produced 12 in-depth papers and a podcast series, “The Killing Drugs,” offering actionable recommendations for U.S. domestic and international policy, as well as insights for other governments. Building on this foundation, the project’s second phase provides timely analysis of the shifting policy and crime market landscape while continuing to offer policy recommendations.

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U.S. drug markets

U.S. domestic policies

Synthetic opioids beyond North America

The Killing Drugs podcast

On “The Killing Drugs” podcast, project director and host Vanda Felbab-Brown interviews leading experts on the devastating synthetic opioid crisis to find policies that can save lives.

Listen to all the episodes

Project organizers

Director

Vanda Felbab-Brown Director - Initiative on Nonstate Armed Actors, Co-Director - Africa Security Initiative, Senior Fellow - Foreign Policy, Strobe Talbott Center for Security, Strategy, and Technology

Conveners

Natalie Britton Director of Operations - Strobe Talbott Center for Security, Strategy, and Technology
Diana Paz García Senior Research Assistant - Strobe Talbott Center for Security, Strategy, and Technology