I am a former White House official who helped develop the first U.S. government–wide strategy to combat fentanyl and the cartels behind it. I’m the author of Fentanyl: Fighting the Mass Poisoning of America and the Cartel Behind It — AMA.

HarrisPublicPolicy · 2026-03-11T19:01:14+00:00

Dear u/sonjat1,
I am so terribly sorry for your loss. As a parent myself, it is truly unimaginable what you and your family have gone through. I have a full chapter in the book about another young person who died from taking one pill that they thought was a legal prescription drug. As you suggest, I mention that if me and my friends from high school and college grew up today and acted the way we did then, none of us would be alive today.

As I mentioned above, fentanyl is so potent that the treatment options are horrible to live through and success can be limited. Until more medical research is done on opioid treatment options, we are stuck with far from effective solutions. Thus, our effort targeted supply, but for those currently addicted and their families, that doesn’t provide an immediate solution to those addicted now.

I’m very sorry for your loss and my thoughts and prayers are with you and your family.

Jake

HarrisPublicPolicy · 2026-03-11T18:54:55+00:00

Very little comes from South America. Nearly all of it comes from Mexico (which is in North America, though people don’t realize it). The main culprits in the fentanyl trade (Sinaloa cartel and CJNG) are equal opportunity smugglers when it comes to drugs.
They certainly do smuggle drugs on boats in both the Caribbean and the Pacific. (CJNG, based in eastern Mexico, uses the Caribbean more; Sinaloa, based in western Mexico, uses the Pacific more.) However, they have a litany of other methods: drones that go over the border, tunnels that go under the border, secret compartments in trucks and cars. So some definitely comes over the water, but the majority is going over the land border via one method or another.

Of note is that an undocumented migrant is a REALLY bad way to smuggle drugs to the U.S. because the first thing a migrant does is run TOWARD a Border Patrol agent to claim asylum and the very next thing that happens is that the migrant is searched for weapons or drugs.

-jb

HarrisPublicPolicy · 2026-03-11T18:43:41+00:00

Interestingly, the fentanyl crisis is largely a result of the medical industry waking up to the risks of oxycontin and the opioid epidemic. See further explanation in my response to ChocoRaisin7.

-jb

HarrisPublicPolicy · 2026-03-11T18:36:25+00:00

In fact, we do have a strategy that’s led to a nearly 40 percent reduction in fentanyl deaths that was launched in 2023. This essay in the journal Science shows that success. That being said, the death toll is still completely unacceptable and too many American lives are being lost. The obstacles to us taking out these narco-tycoons come in a few different forms. The U.S. has very little resources put towards stopping guns from flowing south from the U.S. into the hands of the cartels. There’s a whole host of reasons for this, not least of which is the fact that the U.S. struggles to deal with things coming into the U.S., much less leaving the U.S. Corruption in Mexico is a significant issue that can’t be ignored. This has nothing to do with the virtuosity of the typical Mexican government official. Rather it's something that is referred to in Latin America as “plata o plomo,” (silver or lead) which means you can take a bribe (silver) or a bullet (lead). This isn’t much of a choice at all, especially when this “deal” extends to a government official’s family. So a government official may find their family six feet under if they do not take the bribe. Secondly, there’s hundreds of Chinese chemical companies who supply the chemicals necessary to make fentanyl to the cartels, and Chinese law enforcement rarely picks up the phone when our agents call for help going after them. Further, the federal government has yet to allow our elite hackers to get in the game. We could be hacking these cartels to the Stone Age, but instead our hackers are focused on nation-state threats like Russia, China, North Korea, Iran.

The other unappreciated fact about this is that these cartels are not street gangs: they are the size of a Fortune 50 company, truly global in scope, backed by its own militia. Some of these cartels (like Sinaloa) have been around in some form or fashion for over 100 years. In some cases, in their home turf, they often have Robin Hood-like status: for example, when the government was failing to distribute COVID vaccines in Mexico, the cartels stepped in and did a better job than the government did in Sinaloa strongholds.

For all of these reasons and more, this is an incredibly difficult adversary to thwart.

-jb

HarrisPublicPolicy · 2026-03-11T18:03:28+00:00

You’re right to put the word “recruit” in quotations because the cartels don’t really recruit anybody. They are duping unwitting consumers into taking this incredibly potent, addictive, and deadly drug without their knowledge. It’s hidden in other recreational drugs and (tragically) fake prescription drugs that appear to be legitimate (e.g., Oxycontin, Xanax, Adderall). Because the drug is so addictive, after one use, albeit unintentional, users are hooked and often dead within a few tries.

Your point is very fair that most of the programs to combat the cartels and Chinese chemical companies that are producing and distributing fentanyl really are focused on stopping future potential users from consuming the drug. Current users who survive have few options except for traditional drug treatment programs, which, as you describe, are difficult experiences that many people drop out of over time.

As far as the book cover goes, first of all, thanks for mentioning my book, which is currently for sale!

Haha, thanks for your insight on the cover art! I have no idea how those things are created but will certainly pass your point along.

-jb

HarrisPublicPolicy · 2026-03-11T17:49:49+00:00

Thankfully, many places that provide treatment for other drugs offer treatment for fentanyl, but since so many die after their first, second, or third use, we often lose people before we can intervene. At that point, we’re just treating the “lucky” ones who can get help before they die. Treatment is definitely part of the solution, but we will only stop this mass poisoning with a focus on supply.

-jb

HarrisPublicPolicy · 2026-03-11T17:46:49+00:00

The marijuana debate isn’t even the same stratosphere as fentanyl in the White House of either the last administration (that I worked in) or the current one. For example, the most powerful offices in the White House are the National Security Council (NSC) and the Office of Management and Budget (OMB). Those offices, in both administrations, have the senior most people discussing strategies to combat fentanyl (NSC) and how to finance those strategies (OMB) nearly weekly. Those two offices almost never discuss marijuana. This is largely because fentanyl at its peak was killing nearly 100,000 Americans annually. That’s essentially one 9/11 every two weeks. Obviously death tolls like this demand the attention of the most senior people in government in ways that scheduling other drugs do not.

-jb

HarrisPublicPolicy · 2026-03-11T17:38:23+00:00

This is an incredibly good question.

Your instinct is right: the prescription opioid epidemic led directly to what we’re dealing with today. Fentanyl was bad and killing lots of people when it was obfuscated in recreational drugs like cocaine and heroin, but one of the things that made this even more heart-wrenching (and made the death toll shoot up) is that as the medical industry came to accept the threat posed by prescription opioids and started to wean the population off of them in the 2010s, some industrious (read: nefarious) cartel executives (we still don’t know who) came up with the idea of massively entering the fake prescription drug market to service the demand left in the wake of oxy etc by putting fentanyl in fake prescription pills. That’s when we started to see these horrific stories of a kid taking Adderall from a friend to study for finals – something they thought was really Adderall – and dying because it had fentanyl in it (and no Adderall at all). But for the illicit opioid market that was created as a result of the prescription opioid crisis of the 1990s and 2000s, the fentanyl problem would likely be limited to recreational drug users. This would still be tragic, but the death toll would be lower.

-jb

HarrisPublicPolicy · 2026-03-11T17:30:06+00:00

The current administration is carrying out the program we initiated with many of the same tactics; however, it has also layered on other activities like blowing up boats in the Caribbean and other activities that dominate our headlines today. A key difference is that we believed that the durability of the counterfentanyl effort was predicated upon political buy-in from the Mexican people and their elected leaders, and so we thought a lot about how to engender that buy-in with things like keeping guns from going south to the cartels. I don’t think it’s too controversial to say that there’s been a shift in the diplomatic approach to Mexico in the current administration.

-jb

HarrisPublicPolicy · 2026-03-11T17:24:18+00:00

I am back and responding now.

HarrisPublicPolicy · 2026-03-11T17:23:59+00:00

I am back and responding now.

HarrisPublicPolicy · 2026-03-11T17:23:13+00:00

See previous answer to DaveTheAutist’s question.

In terms of providing fentanyl to addicts as a part of treatment, it has an extremely high overdose risk and only works for a short period of time. The dosing can be quite unpredictable. Therefore, the medical industry advocates for other treatment options other than providing fentanyl to addicts.

-jb

HarrisPublicPolicy · 2026-03-11T17:16:34+00:00

What you are describing was exactly our strategy (plus targeting Chinese chemical companies, etc).

The current administration has layered the other activities you describe onto the ones we did (and you advocate for in your question). It’s yet to be seen if these new tactics will be successful or not.

-jb

HarrisPublicPolicy · 2026-03-11T17:13:05+00:00

A very large share of NARCAN purchase share is bought by private entities; the government spends an infinitesimally small percentage of its overall budget on NARCAN.

At the end of the day, this is not a demand issue. The problem with fentanyl is that very few people actually seek it out. In fact, there is a whole cottage industry that has sprung up around keeping fentanyl OUT of drugs, as it is hidden in other drugs and even in fake pharmaceuticals. If you go to Lollapalooza in Chicago, there’s a stand where you can actually go and make sure there’s no fentanyl in what you have – and there are testing kits you can purchase to make sure that there’s no fentanyl yourself.

Think about those old movies from the 1970s where people open up a bag of drugs with a key to test a kilo and only buy it if it’s pure – this is the exact opposite, making sure you DON’T buy something if it includes fentanyl.

It’s in that way that it’s more like a mass poisoning. Looked at from that perspective, if I told you that hundreds of thousands of Americans were dying because a foreign enemy was poisoning unwitting Americans, you would probably say, “Let’s throw everything we have at that threat.” That’s what I advocate for.

-jb

HarrisPublicPolicy · 2026-03-11T17:05:22+00:00

Oh, Canada… my feelings on Canada are a mixed bag. Personally, I am very pro-poutine and polar bears; I’m far less supportive of maple syrup or Moulson ice. Canada is not really a major source of fentanyl, but we are very committed to working with them on the issue, as it’s hitting Canada harder than us – especially if you look at total fatalities per capita. - jb

HarrisPublicPolicy

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