
Do Changes in Mexico’s Fentanyl Production Explain a Drop in US Overdoses?

Kevin González was at a point of total desperation when he decided to check himself into an addiction treatment center in the Mexican city of Nogales, in the state of Sonora, on the US border.
After more than a decade of using fentanyl and other opioids in Phoenix, Arizona, González said his body could no longer find relief from the usual doses. The pain, insomnia, and anxiety of withdrawal were unbearable, and the pills on the streets lacked enough potency to take effect.
“I was consuming 50 fentanyl pills a day, sometimes smoking four at a time. They weren’t enough,” González told InSight Crime in November when he was three months into treatment.
The amount might seem alarming, considering that a single pill with more than 2 milligrams of fentanyl concentration could have been lethal. However, several users and staff members at treatment centers in Sonora and Arizona told InSight Crime that consuming amounts like that had become common. Gonzalez, moreover, said he had not been around an overdose for years or known of friends who had gone through one.
SEE ALSO: How Fentanyl Is Synthesized in Mexico
This was due, in part, to the tolerance he had developed after so many years of use. He had also learned risk-reduction strategies, such as dosing himself, using with others, and always carrying naloxone, the overdose reversal medication used for fentanyl and other drugs.
However, in his opinion, another important factor was the decrease in the concentration of fentanyl in the pills he bought on the street.
“They used to be more loaded. Now it’s very hard to find one with enough potency,” he said.
Kevin’s experience mirrors that of many opioid users in the United States, where there has been an unprecedented reduction in fentanyl overdose deaths. From July 2023 to July 2024, for example, the US Centers for Disease Control (CDC) reported a 17% national drop.
Several experts say that more data is still needed to determine the exact cause of this trend and that the phenomenon could vary across the country. However, from the supply side, there are some factors that could provide clues.
Widespread Availability of Pills
The reduction in overdoses could be linked to the growing prevalence of fentanyl pills on the market, known as “M30s.”
Over the past five years, seizures of M30 in the United States have increased significantly, outpacing the growth of other forms of fentanyl, such as powder or liquids. In Mexico, recent seizures indicate that criminal groups continue to produce these pills on a large scale. For example, on December 3, authorities made a record seizure of 20 million pills in the state of Sinaloa. There has also been a reported proliferation of pill manufacturing centers on the northern border.
“Pills are taking over the fentanyl supply [in the United States],” Dan Ciccarone, a professor of family community medicine at the University of California, San Francisco, and an expert on opioid use trends, told InSight Crime.
In part, this is due to their low price. In some US cities, pills cost less than a dollar each, according to our interviews with consumers. In contrast, a powder dose can cost up to ten times as much.
In addition, the pills appear to have more consistent purity levels. According to US Drug Enforcement Administration (DEA) data, in 2024, five out of every 10 pills contained a lethal dose of fentanyl. This represents a decrease from the seven out of 10 pills identified in 2023.
In contrast, the purity of the powder varies considerably, from almost no fentanyl in a dose to a concentration of 85%, according to the most recent DEA data.
Ciccarone has noted that this variability in supply influences the growing preference for pills, which may be key to avoiding overdoses.
“Pills have a relatively fixed dose, which allows users to gauge how many to take,” he said. “But [the concentrations in] powders can undulate considerably within a given week, so they don’t know either how much to consume or what dose might be fatal.”
The method of consumption can also play a role. Pills are usually smoked rather than injected. And while there is debate in the scientific community about which method is safer, some studies have found lower lethality among users who smoke fentanyl.
Greater Control Over Production
In northwest Mexico, the epicenter of illegal fentanyl production, there has been a restructuring of the market that could explain the reduction in the strength of M30 pills.
For several years, fentanyl production operated on an “open” basis, with numerous independent producers, mainly in Sinaloa, involved in the process. This created a greater variability in production methods and quality, which would contribute to several products having potentially lethal concentrations.
SEE ALSO: Chemists and ‘Cooks’: How Fentanyl Kills
However, since mid-2023, this model changed following a ban imposed by factions of the Sinaloa Cartel, which prevented independent actors from continuing production. During a visit to Culiacán, the capital of Sinaloa, and border cities in Baja California in August 2024, InSight Crime found that fentanyl production is now concentrated in fewer hands and only among people close to the more prominent group factions.
This shift could have led to greater homogeneity in the quality of the product, as it leaves less room for intervention by novice cooks or improvisation in methods.
“Before, anyone could grab the formula, but now there are orders, and not just anyone throws their hat in the ring,” a fentanyl producer in Culiacán told InSight Crime.
For the DEA, these changes are the result of pressure imposed on criminal groups trafficking fentanyl. In a column published in USA Today, agency chief Anne Milgram stated that the reduction in the concentration of pills was “proof that our efforts are working.”
However, it could also be a strategy by criminal groups to maximize their profits. Reducing the concentration of fentanyl allows a greater volume of pills to be produced from the same base amount of the drug. Moreover, as the case of Kevin González suggests, lower concentration not only decreases the number of deaths but also forces customers to buy more pills to achieve the desired effect.
A Market of Mixtures
Fentanyl users in the United States are also increasingly facing a polydrug market. In some cases, this may be associated with a lower mortality risk.
For example, several users interviewed by InSight Crime at the US-Mexico border commented that street dealers often offer them stimulants to counteract the effects of the opioid. González, for example, reported using cocaine to stay awake during his work hours and that he avoids using fentanyl during that time.
In his research in San Francisco, California, Ciccarone has also found that several users are using meth instead of fentanyl, either because of the lower cost or because of the effects it produces. This allows them to reduce the frequency with which they are exposed to the risks of fentanyl.
“They’ve told us they can miss a fentanyl shot because of methamphetamine and feel ok,” he said.
Fentanyl supply networks have also begun mixing the opioid with other substances. For example, in the past two years, US authorities have issued alerts about the increasing presence of xylazine mixed with fentanyl. This substance, a veterinary sedative known on the streets as “tranq,” can cause serious skin infections if consumed by humans.
In Sinaloa, two fentanyl producers told InSight Crime that in 2023 they began mixing xylazine with fentanyl to make the product yield more without losing its effects as a depressant drug. These mixtures could also be made at the retail level, where distributors are looking to increase the volume of the drug.
Some experts suggest that the combination with xylazine could reduce the risk of death, as its sedative effect is more prolonged, which could lead users to consume less frequently.
But not everyone is convinced. Ciccarone points out that although xylazine is less lethal than fentanyl, mixtures often have very high concentrations of the latter, which aggravates the risk of overdose.
Moreover, these adulterations are carried out without the users’ knowledge, so users still cannot calculate how much they can safely consume.
“The effects are terrible … It’s a classic example of an adulterant. People are looking for fentanyl and getting tranq,” he warned.
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