Fentanyl Pill Market (Depressingly) Still Booming
A drug supply check up: Fentanyl's takeover still going strong. The shift from powder to pills is growing. No end in sight to the synthetic era. In other words: yikes.
So I had to basically take a break from writing about this stuff because it is so grim. After covering drug policy for well over 5 years and seeing things only get worse, watching very minor and patchwork policy progress get immediately reversed, it’s been beyond demoralizing. There remains a massive gap in drug treatment. Meanwhile, drug enforcement all but ensures people will not access treatment that is remotely effective. The number of people on methadone or buprenoprhine—the only two drugs that work more than 50% of the time for treating opioid use disorder—has barely budged in 5 years.
And so here we are, left defenseless, as fentanyl is roaring across the US.
A new study found that fentanyl pill seizures recently quadrupled, with pills representing 49 percent of illicit fentanyl seizures in 2023 compared to just 10 percent in 2017. The powder fentanyl market isn’t slowing down either. The same study also found a large increase in both the number and weight of fentanyl powder seizures during the same time window: fentanyl seizures (pills + powder combined) increased 1,700 percent in the U.S. from 2017 to 2023.
Drug seizures only provide a small glimpse into the enormously complex global drug trade. But they are an indicator of a drug’s availability: the more a drug gets seized, the bigger the supply of that drug there is. It’s estimated that law enforcement interdiction captures roughly 10 percent of the total market. If 10 million fentanyl pills get seized, then roughly 100 million pills floated through undetected. It’s quite rare you’ll hear about this massive denominator in a border patrol or DEA press release. But any honest drug policy analyst or researcher will tell you how outmatched the current strategies are.
Based on this new data, combined with continuously high mortality, it’s also safe to say the availability of illicit fentanyl in the U.S. is skyrocketing. That’s also according to this study’s lead author, Joseph J. Palamar, Ph.D., M.P.H., associate professor at NYU’s Grossman School of Medicine. Drug markets in the US are regionally hetergenous. But fentanyl seizures are basically up everywhere, especially on the West Coast (re: Arizona and California).
This indicates a logistical pattern in drug flows. If fentanyl pills are almost entirely manufactured in Mexico, then smuggling routes for pills likely target California and Arizona ports of entry. California and Arizona could be acting as giant hubs for fentanyl pills (similiar to how Southern California and Phoenix functioned as giant hubs for black tar heroin). Once the fentanyl pills arrive safely in the American Southwest, from there they are smuggled all over the US. And these are small packages of pills, making them easy to transport and difficult to detect.
Whether powder or pills, fentanyl’s penetration of the drug market is still going strong.
Pills, especially, are causing a lot of chaos and grief. The fentanyl pill market has hit young people (teens to 20s) quite hard: over 22 percent of drug-involved deaths among people less than 25 years old involved counterfeit pills, typically pressed to look like oxycodone. If you’re curious to learn more about how bad the pill market is, I dove into that world for The New Republic last summer. Reporting this story was so emotionally taxing. I basically felt dead inside for weeks after writing it.
Thousands of young people dying in their bedrooms. Their parents find them cold and lifeless next to their laptops with Netflix still streaming and a few lines of a crushed blue pill on their nightstand. This trauma has caused many parents and families to become activists. Some become staunch supporters of things like naloxone, better drug education, test strips, and a more robust set of public health and harm reduction policies. Other turned to a more vengeful position and they want to severely punish anybody who sells fentanyl with harsh, decade-long mandatory minimum sentences.
I think something important gets lost in what’s happening re: fentanyl, young people, and the internet. There is clearly still a demand for prescription pills, especially opioids, among young people. That’s how it was when I was in high school. And that’s obviously still the case if a lot of teenagers and twenty-somethings are comfortable buying oxycodone from complete strangers on the internet and social media apps like Snap. But the real oxycodone pills have almost completely dissappeared from the illegal market. All that’s left is super potent fentanyl in disguise.
So what’s new here is not that kids want pills. What’s new is how deadly and dangerous the demand for pills has become in the current market conditions. It’s both a function of the fentanyl pills themselves and the expanded market reach thanks to the ease of phones and apps that make ordering anyting online way too easy. To buy drugs as a young person usually meant needing to know a guy who knew a guy who knew a guy. You needed phone numbers. You needed addresses. You needed to have somebody vouch for you. The boundaries, barriers, and limits of real world social networks often kept these little drug rings among young people small and somewhat containted. The internet has knocked down these limits.
The ease of buying random shit on the internet from total strangers can’t be downplayed here. Imagine you’re a drug dealer who has a stash of fentanyl pills that are pressed to look like oxycodone. Now you’re friend calls you up and asks for some pills. You’d probably say, “All I have are these fentanyl pressies… they’re much cheaper, also way stronger. You only need tiny a bit.” Or imagine a friend referred their friend to you. You might say the same thing. These are people you kinda know. They have your phone number. Maybe they drove to your place or your parents’s place to buy drugs. You probably are less inclined to decieve them.
Now imagine you’re selling pills online to complete strangers. There is an impersonal nature to the internet transaction that might make deception in the market much more likely. That’s why I think it takes both the fentanyl pills and the anonymous digital marketplace working together to create this awful mess of so many young people dying from counterfeit pills. And frankly, I do not see how a severely harsh sentence for one small bit dealer at a time is going to make a dent in this. Drug-induced homicide laws have spread to 23 states, including the D.C. There has also been a federal drug-induced homicide law on the books since the 1980s. There is little evidence to show a strong deterrent effect from these hyper-punitive laws.
Therefore….
We’re back at square zero. Stuck in the muck.
Sates across the US are tightening drug laws and ramping up old school drug enforcement. Access to quality and effective treatment remains abysmal. The Modernizing Opioid Treatment Access Act, a small step in the right direction that’s about 30 years too late, languishes in the Senate. Every other US peer country let’s regular doctors and pharmacies dispense methadone, and their overdose death rates are a tiny fraction of our; Lev Facher has a great piece on that for STAT. One of his sources from Switzerland, where people recieve excellent care for addiction care, put it succinctly.
“In America, you can’t expect this [level of compassion]. If you’re on the street, you’re on the street. Nobody cares.”