GAO Stopping the Misuse of Fentanyl and Other Synthetic Opioids Highlights from GAO-18-205 What are synthetic opioids? - Synthetic opioids are chemically produced in a lab. - They mimic the effects of natural opioids derived from the poppy plant, like heroin and morphine. - Legitimate synthetic opioids are pharmaceuticals that doctors prescribe for severe pain. - Illicit synthetic opioids are relatively inexpensive to produce, and are sold on the black market. Synthetic opioids such as fentanyl can be extremely potent. Figure: According to the Drug Enforcement Administration (DEA), just two milligrams of fentanyl can be lethal. Adapted photo showing Penny (2x scale) next to Relative size of a potentially lethal dose of fentanyl. Source: Adapted from DEA. In 2016 - Nearly 64,000 Americans died from drug overdoses. - That's about 175 people every day. - 31 percent of those overdose deaths involved synthetic opioids such as fentanyl--more than any other drug category. Source: Centers for Disease Control and Prevention. What is the federal government doing to curb the supply of illicit synthetic opioids? According to federal law enforcement agencies, China is the primary source of illicit synthetic opioids in the U.S. market. Figure: Trafficking of illicit synthetic opioids into the United States Map showing showing direct and indirect shipments. Indirect: From China to Canada, from China to Mexico Direct: From China to the United States, from Canada to the United States, from Mexico to the United States Source: GAO analysis of DEA information, Map Resources (map). Federal agencies have been working with foreign officials to - share information - coordinate on drug investigations For example - A foreign government informed a U.S. agency about an inbound fentanyl shipment in 2017 - which allowed the agency to seize the shipment before it reached the United States. What is the federal government doing to curb synthetic opioid abuse? Federal law enforcement agencies are shifting their focus. Drug trafficking organizations: - High level = Cartel and importers - Middle men = Pound/kilo distributors - Street level = Ounce/gram distributors Agencies used to mainly focus on the top level. They now increasingly focus on lower levels that can control the price and flow of drugs into communities. Additionally - Law enforcement is increasingly treating overdose deaths like crime scenes - by collecting evidence to identify the source of the drugs that caused the overdose. Federal agencies could do more. - Improve data collection and sharing between law enforcement and public health officials to better track trends in drug use. - Reduce backlogs at key Customs and Border Protection labs that test suspicious substances at ports of entry. - Develop ways to measure the impact of federal efforts to combat the opioid epidemic--such as documented decreases in the number of overdose deaths. For more information on the federal government's efforts to reduce illicit synthetic opioid use, see GAO-18-205 at GAO.GOV This work has been released into the public domain. GAO