0:02

Welcome to the President's Inbox, a CFR

0:05

podcast about the foreign policy

0:07

challenges facing the United States.

0:09

I'm Jim Lindsay, Director of Studies

0:12

at the Council on Foreign Relations. This

0:14

week's topic is the fentanyl

0:17

epidemic.

0:23

With me to discuss why the United States is struggling

0:26

to stop the flood of fentanyl from coming

0:28

across the border is Vonda

0:30

Felbaugh-Brown.

0:32

Vonda is a Senior Fellow in the Strobe

0:34

Talbot Center for Security, Strategy,

0:37

and Technology

0:38

in the Foreign Policy Program at

0:41

the Brookings Institution.

0:42

There she directs the Initiative on

0:44

Non-State Armed Actors. She

0:47

also co-directs the Africa Security

0:49

Initiative and the Brookings Series

0:51

on Opioids, the Opioid Crisis

0:54

in America, Domestic and International

0:57

Dimensions. She recently

0:59

wrote a piece for Foreign Affairs titled,

1:02

Why America is Struggling to Stop the

1:04

Fentanyl Epidemic. Vonda, thanks

1:06

for joining me. My pleasure. If

1:08

we may, I'd like to begin by identifying

1:11

the scope of the problem, Vonda.

1:14

Something on the order of 100,000 Americans died

1:17

last year from preventable

1:19

drug overdoses, a number

1:21

that is up nearly 60% in just

1:24

the past four years and

1:26

up nearly 800% over 25 years. The

1:31

statistics show that the vast majority

1:33

of those preventable overdoses involve

1:36

fentanyl. Indeed, the head of the

1:38

Drug Enforcement Agency has called it

1:40

the single deadliest drug threat

1:43

our nation has ever encountered.

1:46

What exactly is fentanyl? Fentanyl

1:50

is a synthetic opioid that has

1:53

important legal medical uses.

1:56

It is an anesthetic that's used

1:58

in surgeries.

1:59

GMU or your listeners really

2:02

don't want to have a surgery without

2:04

anesthetics.

2:05

Fentanyl is also used

2:08

when people have to be put on ventilators. For

2:10

example, during the most intense days

2:12

of the COVID pandemic, people

2:15

who had to be placed on ventilators

2:17

to keep them alive and breathing would be given

2:19

fentanyl.

2:20

Nonetheless, fentanyl is also

2:22

a drug that is being used

2:25

in the illegal market, that has very

2:27

high addictive properties and that

2:29

is enormously potent.

2:31

Its potency is multiple times that

2:34

of heroin, on the order of 50

2:37

times as potent, and heroin perhaps 100 times

2:40

as opium.

2:41

And because it is so

2:44

potent, the potency-per-weight

2:47

ratio makes the drug

2:49

ideal to smuggle.

2:51

It is the dream drug for traffickers

2:53

because very small amounts are sufficient

2:56

to supply very large markets.

2:58

But it is a nightmare for users and

3:01

from public health perspectives. On the one hand,

3:03

it can give very intense highs because

3:05

of the potency, but the chance

3:08

that overdose will result

3:10

is enormous. Now, you

3:12

mentioned those really devastating statistics, 100,000

3:15

Americans dying, but

3:17

fentanyl today in the United States

3:19

and more broadly North America, also Canada,

3:22

is being mixed into not just

3:25

heroin and opioids, it's also

3:27

being mixed into methamphetamine and

3:29

cocaine.

3:30

In fact, arguably, the presence of fentanyl

3:33

is one of the reasons that's keeping the cocaine

3:35

market in the United States alive.

3:38

So it's really swept through the North

3:41

American markets and

3:43

we are seeing fentanyl emerging

3:46

in other parts of the world.

3:47

Okay, so Vonda, there's a lot there

3:49

I'd like to unpack it. Maybe

3:51

we could begin with this issue of how

3:53

fentanyl is a synthetic

3:56

opioid. That contrasts with

3:58

a natural opioid. heroin,

4:00

morphine, which are derivatives

4:03

of the poppy plant, whereas

4:06

fentanyl is a chemical

4:09

or the combination of a series of chemicals,

4:12

it can be made in a lab, correct?

4:13

That is absolutely right. So broadly

4:16

in the world, in the illicit markets

4:18

and in legal markets as well, there are

4:20

two types of drugs.

4:22

Those that are derived from plants

4:25

like heroin and

4:27

cocaine or cannabis,

4:29

and those that are synthetically

4:32

mixed in labs.

4:33

And synthetic opioids like fentanyl

4:36

or methamphetamine are part

4:39

of that latter class. And

4:41

just as the fentanyl is devastating

4:44

the United States and spreading and

4:46

Canada and spreading to other parts of the world,

4:48

the globe is really undergoing

4:51

synthetics drugs revolution that's taking

4:53

place from Afghanistan

4:56

to Australia, New Zealand to

4:58

Latin America and features other

5:01

drugs, not just synthetic opioids,

5:03

but synthetic opioids are currently

5:06

the most dangerous drugs on the market.

5:08

Now fentanyl is different

5:10

than the drug problem

5:13

we saw emerge at the beginning of this

5:15

century in the United States with

5:17

the abuse of OxyContin, correct?

5:20

Well, it is a different drug, but it

5:23

is also an opioid. So

5:25

the United States is experiencing

5:29

an opioid epidemic and

5:31

its current phase, the most legal phase

5:34

is the synthetic opioid element

5:37

of the opioid epidemic. But the epidemic started

5:40

with a legal market.

5:42

It is a significant because sometimes

5:45

people who are understandably frustrated

5:47

with the challenges, problems and failures

5:51

of counter narcotics approaches over many

5:53

decades say, well, drugs should just be legal.

5:56

If drugs were legal, then we would have better

5:59

ability to. deal with demand and

6:01

make sure that demand does not escalate

6:04

into problematic dimensions.

6:06

While the US opioid epidemic should be

6:08

a strong warning against

6:10

that with respect to many drugs, it

6:13

was the legal market in pharmaceutical

6:15

prescriptions like Oxycontin

6:18

that really started

6:20

the opioid epidemic that caused massive

6:23

levels of substance use disorder and

6:26

ultimately mutated to the current

6:28

legal phase of fentanyl.

6:30

No illegal market could

6:32

get as many people addicted to

6:35

use the

6:36

common parlance as a legal,

6:38

commercialized, heavily promoted

6:40

market did.

6:41

With the major companies, the major villains

6:44

in the story

6:45

like Purdue Pharma really

6:47

being able to co-opt and subvert

6:50

essentially every regulatory body

6:52

that was supposed to protect

6:54

consumers and public health

6:56

by making fallacious claims

6:59

that drugs like Oxycontin were

7:01

not addictive.

7:03

Okay. So we had the issue with

7:05

Oxycontin in that epidemic.

7:08

Those who are legal drugs that were overprescribed

7:11

by doctors, at least in the beginning,

7:13

thought that these had magical properties

7:16

in the sense they alleviated pain

7:18

and would not be addictive. And

7:20

it turned out, in fact, they were. All

7:23

we're seeing is the spread largely

7:26

through illegal manufacture

7:29

and distribution. One of the things

7:31

you said, Vonda, that struck me

7:33

is that we're seeing fentanyl

7:35

combined with other drugs. Why

7:38

is that? Why

7:39

is fentanyl being added to cocaine

7:42

or to heroin or to methamphetamines?

7:45

Let me a little bit back up, Jim, in

7:47

answering that question and kind of filling

7:49

in the story which explains why fentanyl

7:52

today is present in other drugs. So

7:54

after the 1990s and 2000s, when there is this massive overprescribed

7:57

drug, we're seeing of

8:00

legal opioids, pharmaceutical opioids

8:02

like oxycontin, the United States

8:05

wakes up to the fact that oxycontin,

8:08

seabane-based opioids are still

8:10

highly addictive.

8:12

And the spigot is turned off,

8:14

not completely turned off, but very

8:16

much turned off compared to the 15

8:18

years. But at this point, you have vast

8:21

numbers of Americans with substance

8:24

use disorders, specifically opioid

8:26

use disorders. And this is

8:28

a different market. This is not just

8:31

kids when they are 13, 14, in their teens

8:33

or even younger, starting

8:36

to experiment with illicit recreational

8:38

drugs. This is everyone

8:41

from young

8:42

people, perhaps high school sports

8:45

athletes, all the way to 60, 70 year

8:49

old grandmothers who are suffering

8:51

from substance use disorder. But all of

8:53

a sudden, they can no longer just show up. And

8:56

their doctor and say, give me more

8:58

Vicodone, give me more

8:59

oxycodone. And

9:01

so they start sourcing opioids

9:04

in the illegal market. And

9:06

it is two set of actors that come in,

9:08

Mexican cartels and Chinese producers.

9:12

The Mexican cartels such as Sinala Cartel

9:14

and Cartel Cáisko Navajena Racion, at

9:16

first start bringing in the opioid

9:19

to which they are used, which is heroin.

9:21

So we see poppy cultivation going

9:24

up significantly in Mexico and

9:26

heroin being produced and brought into

9:28

the US market.

9:30

But the Chinese producers with

9:32

Chinese traders with the vast pharmaceutical

9:35

chemical sector industry in

9:37

China, second in

9:39

the world, perhaps the largest in the world with

9:41

very poor monitoring, comes in

9:44

and brings in much more potent synthetic

9:46

opioid, fentanyl, that is very

9:49

cheap and now very easily

9:51

made,

9:52

and much more potent than heroin. And

9:54

so the Chinese traders

9:57

start shipping directly through

9:59

mail. fentanyl to the illegal

10:02

US drug market. And the

10:04

Mexican cartels are watching it, and all of a

10:06

sudden realize that there is this drug that's

10:08

superior to what they can bring from

10:11

Mexico and has tremendous advantages.

10:14

It's very potent, so very small

10:16

amounts are sufficient

10:17

to supply the market. That means

10:19

that evading law enforcement becomes

10:22

very easy.

10:23

You don't need to control territory.

10:25

Growing puppy, growing coca requires

10:28

the control of territory and the ability

10:31

to prevent the government from

10:33

destroying those crops. All of a sudden,

10:35

all you need is precursors to be bought

10:37

in China or India and a

10:39

few labs, and you can supply

10:41

the US market. And

10:43

because synthetic opioids in particular

10:45

are so cheap to make, it's also

10:48

easy to mix them. It's also appealing

10:50

to traffickers to mix them to other drugs

10:53

because that reduces the cost,

10:55

but because of their qualities, their

10:58

highs, the intensity of the high and the addictive

11:00

quality,

11:01

they also generate new

11:04

substance use disorders, new addicts.

11:06

Basically, you hook your customers. Right,

11:08

so very recently, the Drug Enforcement

11:11

Administration released the indictments

11:14

of the current heads of the Sinaloa

11:16

cartel,

11:17

Los Chapitos, the sons of the

11:19

notorious El Chapo.

11:21

And the indictments are absolutely striking

11:24

in many ways, including the way

11:27

the current leaders of the cartel speak

11:29

about what they are doing with fentanyl

11:32

and how from about 2014, 2015, they

11:35

really invest heavily into fentanyl,

11:38

both to deal with their competitor, the other

11:40

big cartel, Jalisco Nueva Henration,

11:42

but they also speak about wanting to

11:44

create streets of American junkies,

11:47

streets of junkies around the world to

11:49

whom they can supply this very cheap

11:51

truck on which they make these high marks-ups.

11:55

And it's also really striking the indifference

11:58

with which they look at over the years.

11:59

overdose and lethal overdose.

12:02

You quoted the statistics at the beginning

12:05

about lethal overdose. But for every

12:07

overdose for which someone dies, there

12:10

are five overdose that are reversed.

12:13

But not all overdose that are reversed

12:15

mean that the person is completely healthy.

12:18

Many of the people who will experience overdose

12:20

will have devastating morbidity

12:23

effects for the rest of their lives. So

12:25

the level of devastation is much

12:27

greater than already the huge number

12:30

of tens of thousands of people dying

12:32

actually from the drug. So Vonda,

12:34

let's talk about the source

12:36

production of fentanyl. And

12:39

I take your point that fentanyl appeals

12:42

to producers on the basis

12:45

that you get a lot

12:47

of potency out of a small amount

12:49

of substance. I read recently that

12:51

the Customs and Border Patrol

12:54

in the United States intercepted a shipment.

12:56

It was 54 pounds

12:58

of fentanyl. And it was estimated

13:00

that that would produce enough doses

13:03

to kill 12 million people. So

13:06

again, it goes a long way. And let's

13:09

talk first about the provision

13:11

of what

13:11

are called precursor chemicals from

13:14

China

13:15

to drug cartels

13:17

in Mexico. I take it

13:19

that you have these pharmaceutical

13:22

companies and other perhaps mid or

13:24

small size companies in China make

13:26

the ingredients, sell

13:28

them to drug traffickers who

13:30

combine them in labs in Mexico

13:33

to create fentanyl.

13:36

But I thought the Obama administration

13:38

had reached out to Beijing to

13:41

get Beijing to crack down on this

13:43

trade. What happened?

13:44

So when first fentanyl

13:46

emerges in the illegal

13:49

US market in around 2013, 2014, it

13:52

is shipped as a whole

13:54

Finnish fentanyl from China directly

13:56

to the United States from Chinese

13:59

traders, farm

13:59

pharmaceutical companies, chemical

14:02

brokers, directly to wholesale

14:04

suppliers or even retail dealers

14:07

and sometimes directly to customers. Essentially,

14:10

people will just log into the

14:12

web and buy fentanyl from China.

14:15

And this is at the time when fentanyl

14:18

and

14:18

other opioids in the fentanyl

14:21

class of opioids are

14:24

produced in China without any restrictions.

14:27

So as the problem emerges in the United

14:29

States, two things happen. Two set of

14:31

actors notice it. One is

14:33

the Mexican criminal groups, the big cartels,

14:36

who are fearing that their heroin

14:39

is no longer of interest because there

14:41

is this new

14:43

potent opioid coming out of China

14:45

and they want to get in on the game. And

14:48

the second is US authorities,

14:51

law enforcement authorities, the US government,

14:53

who are starting to comprehend

14:56

that a much worse mutation of

14:59

the opioid crisis is taking

15:01

place. And so the Obama

15:03

administration starts engaging China

15:06

to get China to schedule

15:08

fentanyl class drugs.

15:10

Now what does scheduling mean? It does

15:12

not mean banning the drugs.

15:14

We don't want to ban them because they are important

15:17

in surgeries. They are important as anesthetics.

15:19

They are important for palliative care.

15:22

But to produce them and sell

15:24

them and export them with tight control

15:27

and restriction, special licenses,

15:30

this process is called scheduling. So

15:32

the Obama administration starts the process

15:35

and ultimately during the Trump administration

15:37

in December 2018, President

15:40

Xi Jinping announces that the

15:42

entire class of fentanyl type

15:45

drugs would be scheduled

15:47

in China,

15:48

a regulation that comes in effect

15:51

in May 2019. Now

15:53

this was a significant move by China

15:55

because there are really only two countries

15:58

in the world that scheduled drug

15:59

by class. The United States,

16:02

their fentanyl class drugs are currently

16:04

scheduled as a class of drugs, but

16:07

actually it's just a permanent measure.

16:10

The US Congress still has to make this

16:12

measure permanent. And the second is China.

16:15

So China had to change its laws to

16:17

be able to accommodate this request

16:19

from the United States.

16:21

Both Trump and Obama administrations

16:24

also engaged China on other

16:26

efforts to crack down on the vast

16:29

illegal supply that's coming out of

16:31

China and going to the United States at

16:33

first and then Mexico.

16:35

So after China's schedules

16:37

in 2019, we see changes in

16:39

behavior in the Chinese market

16:42

with many of the traders that

16:45

were selling fentanyl to the United States

16:48

now switching to selling precursor

16:51

chemicals. Those are basic chemicals

16:53

from which fentanyl is mixed. And

16:55

they're selling those chemicals to Mexican

16:58

cartels

16:59

that then mix them into fentanyl

17:02

and export fentanyl from Mexico

17:04

to the United States. China

17:06

subsequently scheduled three other precursors

17:09

for fentanyl,

17:11

but in the current market, both

17:13

in fentanyl and in methamphetamine,

17:16

the crystal meth and fentanyl

17:19

are produced from such basic chemicals.

17:21

They have such wide use in all

17:24

kinds of legal chemistry, pharmacology,

17:27

pharmaceutical industry, that they will

17:29

just not be scheduled.

17:31

They are very basic chemicals with wide

17:33

use and the Mexican cartels have now

17:35

perfected methods with both crystal meth

17:38

and fentanyl to be making

17:40

those dangerous drugs out of those

17:42

very basic chemicals. And that's giving

17:45

China a claim to say, look,

17:47

we cannot do anything more on enforcement

17:49

because those drugs are

17:51

not scheduled.

17:53

That's not completely true, however, because

17:55

it's quite obvious when Chinese

17:58

sellers sell to the Mexican

17:59

cartels. They often

18:02

advertise a combination of

18:04

precursors for methamphetamine, fillers

18:07

for cocaine, precursors

18:09

for fentanyl. They will sometimes

18:12

combine their sale pitch with

18:14

commercials, such as we know how to evade

18:17

Mexican customs. In some of

18:19

the web pages, it's pretty obvious that

18:21

the target is criminal

18:23

groups. So we have Beijing

18:26

no longer trying to crack down

18:29

on the sale of precursor chemicals,

18:31

most of which go to the Mexican

18:34

drug cartels.

18:36

What's happening in Mexico? What

18:38

is the Mexican government doing

18:40

or has been doing to try to stop

18:43

the flow of drugs north across the

18:45

border? Well, tragically, we are

18:47

in a moment where neither China nor

18:49

Mexico is doing anything remotely

18:52

enough.

18:53

So China made these moves to tighten

18:55

supply, to schedule fentanyl

18:58

class drugs, to mount more

19:00

inspection in its ports and post

19:02

offices in 2019. At the

19:04

time, it also acted on US intelligence

19:07

and arrested key fentanyl

19:10

smugglers who were identified

19:12

at the time by the US Drug

19:14

Enforcement Administration. But

19:16

at the peak of activity 2018-2019, the enforcement activity

19:22

and cooperation by China fell off. Why?

19:25

Because China views counter

19:27

narcotics cooperation as derivative

19:31

of the overall geo-strategic relationship

19:33

it has with countries. So with

19:36

countries whom it has a good geo-strategic

19:38

relationship or whom it seeks to court,

19:41

it cooperates in law enforcement

19:43

and counter narcotic efforts. This

19:45

was the case with Australia until

19:48

relations between Australia and China

19:50

soured.

19:51

This has been the case to some extent with

19:53

Southeast Asian countries.

19:56

But when the relations tends,

19:58

certainly relationship with the United States,

20:01

as approached Cold War like dynamics,

20:04

China stops law enforcement cooperation.

20:07

And so China invested in this counter

20:10

narcotics law enforcement cooperation with

20:12

the US when it hoped that

20:14

would make the Trump administration

20:16

to back off from the tariff

20:19

war and would make the Biden

20:21

administration bless the

20:23

economic pressure and basic containment

20:26

geostrategic competition.

20:28

When neither happened, China just pulled

20:30

back and really frankly

20:32

abrogated its law

20:34

enforcement and counter

20:35

narcotics cooperation. With Mexico,

20:37

the story is also a very troubled

20:40

one, but for different reasons.

20:42

Since the administration

20:45

of Andres Manuel Lopez Obrador, who

20:47

is popularly referred to as AMLO, came

20:49

to office in December 2018, the

20:52

administration has pulled back both

20:54

from cooperating with the United States

20:57

in law enforcement counter narcotics domains,

21:00

and has significantly pulled back from

21:03

taking on Mexican criminal

21:04

groups domestically in Mexico

21:06

as well. And

21:08

this has multiple sources,

21:12

one of which is the political persuasion

21:14

ideology of President Lopez Obrador,

21:17

his view of the world

21:19

that's very much like that of a

21:22

Mexican nationalist politician

21:24

of the 1950s, 1960s. He does not like intense presence

21:29

of US in Mexico. Multiple

21:31

Mexican administrations have been unhappy

21:34

with the US seeing the levels of corruption

21:36

and infiltration by the

21:39

cartels into all domains of life

21:41

in Mexico.

21:43

And Lopez Obrador has also believed

21:45

that if he doesn't put law enforcement

21:47

pressure on the cartels, if he just lets them

21:49

be, they will redivide territories

21:52

among themselves and violence will subside.

21:56

Unfortunately, almost at the end of his

21:58

administration, we have one more year to go.

21:59

ago. This has not happened. The cartels

22:02

are not just more powerful than

22:05

ever, but they're also more ambitious

22:07

and aggressive than ever.

22:09

And they are taking over Mexico's

22:12

territory, institution, people

22:14

and legal economies.

22:16

And they're also shipping fentanyl

22:19

and mass to the United States

22:21

mixed in fake oxycodone,

22:23

mixed in heroin, mixed in methamphetamine

22:26

and cocaine and strikingly

22:28

indifferent to the deaths and

22:30

devastation these causes in the United

22:32

States. So, Vonda, how should

22:35

the United States

22:35

respond to this? And maybe we

22:37

could begin first by talking

22:39

about dealings with China.

22:42

I will note the historical irony.

22:45

China suffered in the 19th century

22:47

from the flood of opium into

22:50

China, was one of the causes

22:52

of the opium wars. And

22:54

now China seems to be facilitating

22:57

the flow of deadly

22:59

drugs into the United States.

23:02

As I understand what you're telling me,

23:04

Xi Jinping views these issues

23:07

as, if you're not going

23:09

to scratch my back, I'm not going to

23:11

scratch your back. He's not getting what

23:13

he wants from the United States on

23:16

other issues. So, he is not going

23:19

to use the power of the Chinese

23:21

state, which is considerable to

23:24

crack down on this trade.

23:26

What should US policy do? Yeah.

23:29

So, unfortunately, especially

23:31

the China, I think we are in the tough

23:34

bind because of this basic calculus

23:36

that China makes of subordinating

23:40

law enforcement narcotics cooperation

23:42

to the geostrategic relationship. I

23:45

think it's very unlikely that we would see

23:47

significant improvements in the geostrategic

23:50

relationship

23:51

that would likely be necessary for

23:54

much better, more robust and

23:56

sustained Chinese cooperation. Nonetheless,

23:58

we have a very good question.

23:59

a set of opportunities. China

24:02

very much likes to position itself

24:04

as the global drug cop

24:07

because of the Opium Wars

24:09

and the opioid epidemic that

24:11

China went through. Certainly in scale,

24:14

if not lethality, perhaps the second

24:16

largest opioid epidemic after

24:18

the current North American one. China

24:21

is very sensitive about drugs

24:23

and likes to define itself as

24:25

a very strict drug cop.

24:27

In practice, there are multiple

24:30

connections between the Chinese triads.

24:32

Those are the equivalents of the Mexican

24:34

cartels, the very powerful criminal groups,

24:37

and the Chinese government and the

24:39

Chinese Communist Party, with the

24:42

triads often providing a variety of

24:44

services to Chinese government

24:46

offices, embassies abroad, including

24:49

monitoring diaspora, engaging

24:51

in extra legal or illegal enforcement.

24:54

And so China likes to schedule drugs.

24:57

It likes to act as a global drug diplomacy,

24:59

but it very rarely acts against

25:02

stop echelons of the cartels, only

25:04

when they cross particular interests

25:06

of the Chinese Communist Party or particular

25:08

government officials. But nonetheless,

25:11

we should use this image that China

25:13

wants to foster of being

25:15

a counter narcotics leader to

25:18

emphasize that it needs to act

25:20

against synthetic drugs. China

25:23

is also the principal exporter

25:25

of precursors for the production of crystal

25:27

meth devastating Southeast Asia

25:30

and Asia Pacific, including Australia

25:32

and New Zealand. And Chinese triads

25:35

are the principal traffickers. China

25:38

is very focused on that region. So

25:40

we can be combining forces with

25:43

countries like Vietnam, Cambodia,

25:45

Thailand, Indonesia, the Philippines,

25:48

all of which are experiencing big

25:50

devastating increases in crystal

25:52

meth use and substance use disorder

25:55

to push China on cracking down on

25:57

trafficking, on acting more robustly.

25:59

on money laundering measures.

26:03

We can go tougher than just that.

26:05

We could, for example, and we being the United

26:07

States, condition access to

26:10

US markets on best

26:13

practices for Chinese firms.

26:16

The large Chinese pharmaceutical

26:18

industries are often less likely

26:20

to be the major violators

26:23

that leak precursors to criminal

26:25

groups than are smaller companies.

26:27

But nonetheless, even the large Chinese pharmaceutical

26:30

companies and chemical companies often

26:33

have very minimal monitoring enforcement

26:35

measures, hardly adequate,

26:38

and certainly not up to the standards of best

26:40

practices that Western companies

26:42

operate with. We should be encouraging

26:45

self-regulation

26:46

and regulation of the industry. And

26:49

we can do so also through indictment

26:51

portfolios against certainly

26:53

individuals linked to illegal activities.

26:57

But perhaps even pressure mechanisms

26:59

on important leaders in the pharmaceutical

27:02

sector, in the industry sector.

27:04

Nonetheless, I want to caution that

27:08

while the United States tries to delink

27:10

the counter-narcotics cooperation from

27:13

the overall dual-strategic competition, China

27:16

very much mixes the two.

27:17

So there are limits to how

27:20

much we can induce China to

27:23

cooperate better in the

27:25

absence of a warming of the relationship.

27:28

OK, Vonda, let's talk about the other

27:30

country at play here,

27:32

which is Mexico. Now, I will note

27:35

that many Mexicans would say,

27:37

and they would say they have

27:39

their own grievances against the United States

27:42

about the flow of guns coming

27:45

from north of the border south into Mexico,

27:48

arming these drug cartels.

27:52

And that America's reaction to that

27:54

seems to be to throw its hands

27:56

up in the air, sorry, we can't do anything

27:58

because of the war. the Second Amendment.

28:01

So what is it that Washington

28:04

can do to change the dynamic

28:07

with Mexico to get greater

28:09

cooperation to disrupt

28:12

these drug cartels?

28:14

Well, certainly the issue of guns

28:16

coming from the United States has been

28:18

a high focus for many Mexican

28:20

administrations going way beyond

28:23

the Lopez Obrador administration, even

28:25

at the heyday of US-Mexico

28:28

cooperation between the Calderón administration

28:32

and first the George W. Bush administration,

28:34

and later the Obama administration. This

28:37

was a steady issue that the Mexican government

28:39

has focused on,

28:40

understandably. The Mexican

28:42

government also has focused on the United

28:45

States reducing demand for drugs. Again,

28:48

important, very difficult when

28:50

traffickers mix fentanyl into

28:52

other substances that makes demand the

28:55

reduction measures even more complicated

28:57

than they are. But I want to correct

29:00

the impression that the United States simply

29:02

throws his hands in the air about stopping

29:05

the flow of guns to Mexico

29:07

because of the Second Amendment. No

29:09

doubt the legislation

29:10

creates all kinds of challenges,

29:14

but the US government has steadily invested

29:16

and focused on stopping flows of

29:18

guns.

29:19

Is it enough?

29:21

Certainly not from the perspective of Mexico,

29:23

but much more effort on the US

29:25

side has gone into that element,

29:28

including during the Biden administration.

29:31

So let's say we accept that point. The United

29:33

States can say to Mexico, look,

29:36

we're doing something on guns. We

29:38

need you to do more on drugs. What

29:41

is it that we can do to persuade

29:44

the Mexican government, given

29:46

the preferences you've ably laid

29:48

out that AMLO has,

29:51

to induce greater cooperation?

29:54

I think we are left with a set of difficult

29:57

options that nonetheless might be necessary.

30:00

as Republican politicians such

30:02

as Senator Lindsey Graham have suggested

30:04

designating Mexican criminal groups

30:06

as foreign terrorist organizations.

30:09

This is a proposal that very

30:11

much resonates in Mexico. The Mexican

30:13

government is very focused on it and strongly

30:16

doesn't want it, does not like the idea.

30:19

I do not support that proposal

30:22

because I don't believe that it would add

30:24

significant law enforcement measures, including

30:27

in terms of money laundering.

30:29

The most significant expansion of authority

30:31

that the designation brings is the ability

30:34

to use military force. But obviously,

30:36

we don't want to be in the war with our important

30:39

neighbor and we don't want

30:41

to provoke even more difficult diplomatic

30:44

relations. Plus the amount

30:46

of targets would be very minimal. I don't think

30:48

it would significantly impact the cartels.

30:51

However, the well-being approach

30:53

constrained by migration that

30:55

the Biden administration has adopted

30:57

toward the Mexican government has

30:59

also not produced cooperation. So

31:02

some tougher measures might be needed.

31:04

And perhaps the measure that we might need

31:06

to resort to is far tougher and

31:08

systematic inspections at the US-Mexico

31:10

border. That is

31:12

difficult because it will significantly

31:15

slow down legal trade and it

31:17

will cause damage to legal trade,

31:19

including to agricultural exports

31:22

from Mexico.

31:23

Well, it would also cause damage to

31:25

US industry because a lot of American

31:28

industries depend upon goods

31:30

coming across the border to the United States,

31:33

particularly the North American automobile

31:35

industry. Absolutely. But the

31:37

cost to the economy, even on

31:39

our side, is still significantly

31:41

smaller than the cost to the economy,

31:44

not even counting the human cost that

31:47

the fentanyl crisis is causing.

31:50

The level of estimates are about

31:52

a trillion dollars worth of impact

31:54

from the fentanyl epidemic and

31:57

that's even without the latest

31:59

numbers. Jim, these are not preferable

32:01

policies. Preferably, the Mexican

32:03

government would come to realize that

32:06

its own country is being destroyed

32:09

by the Mexican cartels, and it

32:11

would finally find the responsibility

32:14

and wherewithal to stand up to them.

32:16

So I don't suggest tightening the border

32:19

and mounting inspections lightly, and

32:21

it's devastating to see the indifference of the

32:24

Mexican government to the multifaceted

32:26

harm

32:27

than the cartels are causing in Mexico.

32:29

Another possibility would be to

32:32

increase the amount of indictments

32:35

against corrupt Mexican officials

32:37

by the United States.

32:39

We have seen very significant move

32:41

in the fall of 2020, when the

32:43

United States indicted the former Mexican

32:46

Secretary of Defense, Alvaro Cienfuegos,

32:49

on drug trafficking charges and collusion

32:52

with one of the vicious cartels.

32:54

The Mexican government reacted extremely

32:56

strongly

32:57

and threatened to suspend all law enforcement

32:59

cooperation, unless we hand Cienfuegos

33:02

back. The U.S. did so, but the

33:04

Mexican government still liquidated counter-narcotics

33:08

cooperation.

33:09

So it's perhaps time to look for more opportunities

33:12

like that. Now, there is one caveat

33:15

that I would add, and that is that we are heading

33:17

into elections in 2024 in the

33:19

United States and also in Mexico.

33:21

So presumably, there will be a new Mexican

33:23

government,

33:24

and there might be some opportunities to

33:27

reset

33:28

the law enforcement cooperation.

33:30

And the second caveat I want to put on is

33:33

the most important one, which is that

33:35

we can do much more on the U.S.

33:37

law enforcement side, even

33:40

in the absence of cooperation from

33:42

Mexico and China.

33:43

We still continue to think about

33:46

the cartels in quite narrow

33:48

terms

33:49

as entities that traffic drugs,

33:52

and they certainly do so. But

33:53

they do much more than traffic drugs.

33:56

They are taking over legal economies

33:58

in Mexico, like agriculture. and

34:00

fisheries.

34:01

They are involved in wildlife trafficking.

34:03

They are intimately connected to

34:05

wildlife trafficking markets in

34:08

China and through that indirectly

34:10

to even Chinese government actors beyond

34:13

Chinese triads.

34:14

So we really need to expand the lens

34:17

through which US enforcement looks at

34:19

the cartels and not just focus

34:21

on stopping the flow of drugs

34:23

but really attacking the cartels

34:26

along all the activities in which

34:28

they are involved.

34:29

That means boosting, for example,

34:32

the priority of intelligence collections

34:35

on issues like wildlife trafficking,

34:37

which will provide a lot of intelligence both

34:40

on the criminal groups but also on

34:42

their state sponsors.

34:44

Fonda, I take your point that elections

34:47

in the United States, perhaps more important in

34:49

Mexico, could create new

34:51

opportunities for cooperation.

34:54

But we probably don't want to slide too quickly

34:57

by a

34:58

concern that Washington has aside

35:01

from drugs in its dealings with Mexico.

35:04

And that's the flow of immigrants across

35:06

the border. You alluded to it a moment

35:08

ago, I think the Biden administration is

35:11

very concerned

35:12

that Mexico will cease to cooperate

35:15

in this policy of keeping migrants

35:17

south of the border, which obviously gives

35:20

the government in Mexico some leverage.

35:22

But I want to close by getting back

35:25

to the domestic side of the issue. You

35:27

referenced demand reduction and talked

35:29

about it being complicated because

35:32

what I often hear from people saying is

35:34

that US policy focuses too

35:37

much on supply side drugs

35:39

coming into the United States and not

35:41

enough on keeping people

35:44

from either becoming addicted

35:47

or helping people break their addiction.

35:49

How do you respond to that argument? Well,

35:51

domestic measures, demand

35:54

reduction, prevention, and even domestic

35:56

law enforcement are absolutely crucial.

35:59

And indeed, history...

35:59

Historically, the balance has been overwhelmingly

36:03

focused on stopping supply and

36:05

not doing enough on demand. Ironically,

36:08

in the Biden administration, the focus

36:11

has been very much on increasing demand

36:13

and the focus on supply

36:15

or the opportunities on supply have

36:18

been very constrained with both China and Mexico.

36:21

I think you mean increasing investment

36:23

in attacking demand. Absolutely. Starting

36:26

with the Obama administration, we have

36:28

seen several sets of improvements.

36:32

Expanded access to treatment, including

36:34

through greater recognition of

36:36

substance use disorder in medical

36:38

insurance plans. Is it sufficient?

36:41

Absolutely not. It can cost $40,000

36:44

a month out of pocket to

36:47

be dealing with fentanyl or opioid

36:49

use disorder for a person excruciating

36:51

amount of money. So far,

36:54

still only perhaps 13% of

36:56

people in need of treatment are able

36:59

to access treatment. So much more

37:01

needs to be done on that matter. Absolutely.

37:04

We have seen another big breakthrough, which is finally

37:07

the important acceptance

37:09

of harm reduction measures in

37:11

the United States. Naloxone,

37:14

the Narcan, the overdose

37:16

reversing medication has become widely

37:19

available without prescription first

37:21

responders carried it. And indeed

37:23

the lethality would be far higher

37:25

if Narcan was still suppressed

37:28

and prohibited and used to be the case

37:30

for a long time in the United

37:32

States. That is finally

37:34

slow experimentation, recognition

37:37

of issues such as methadone maintenance

37:40

for those with substance use disorders,

37:42

safe needle exchange and

37:45

safe injection signs.

37:46

All those measures are important and

37:49

need

37:49

to be expanded.

37:51

But we have a live

37:54

demonstration of why

37:56

relying on demand and harm

37:58

reduction alone is not

37:59

And that is British Columbia

38:02

in Canada. That's a region

38:04

of the world that has perhaps the most expansive

38:07

demand access and demand treatment and

38:10

the most expansive harm reduction measures

38:12

anywhere in the world. And

38:14

yet their fentanyl opioid

38:16

lethality rate are on par with

38:19

some of the worst hit states in the United States, such

38:21

as West Virginia. The

38:23

important lesson from that is that

38:26

supply side alone will not stop drugs, but

38:29

neither will harm and demand reduction.

38:32

And we need to avoid situations

38:34

when the legal market, like the

38:37

1990s pharmaceutical market, causes

38:40

devastating addictions. And

38:42

we need to do as much as we can to

38:44

be countering those very dangerous lethal

38:47

drugs, like synthetic opioids, to

38:49

be entering the United States.

38:52

Supply will not alone solve it,

38:54

but if it saves some lives, that's really

38:57

important.

38:58

On that note, I'll close up

39:00

the President's Inbox for this week. My

39:02

guest has been Wanda Felbaugh-Brown,

39:05

a senior fellow in the foreign policy

39:07

program at the Brookings Institution.

39:10

Wanda, thank you for joining me. Please

39:13

subscribe to the President's Inbox on Apple Podcasts,

39:16

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39:18

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39:20

the feedback.

39:22

The publications mentioned in this episode

39:24

and a transcript of our conversation are

39:26

available on the podcast page for

39:29

the President's Inbox on CFR.org.

39:33

As always, opinions expressed on the President's

39:35

Inbox are solely those of the host or our

39:37

guests, not of CFR, which

39:40

takes no institutional positions on

39:42

matters of policy. Today's episode

39:44

was produced by Esther Fang, with Director

39:47

of Podcasting, Gabrielle Sierra. Special

39:50

thanks go out to Michelle Carrillo for

39:52

her research assistance. This

39:54

is Jim Lindsay. Thanks for listening.