By Brian Banda:
Fentanyl—hitherto spoken of in undertones—has, like a newly wed couple, all of a sudden attracted all the attention to itself.
Unfortunately, one country is also using it as a tool for punishing others.
Centres for Disease Control (CDC) of the United States (US) describe fentanyl as a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine, such that it is a contributor to fatal and nonfatal overdoses in the US.
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For starters, heroin is an illegal, highly addictive drug processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. According to the National Institute on Drug Abuse of the US, it is typically sold as a white or brownish powder that is “cut” with sugars, starch, powdered milk or quinine.
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Morphine, on the other hand, is a substance most commonly used in pain management, with the National Library of Medicine indicating that the substance has, like many others, its own side effects. They include constipation.
According to the National Library of Medicine, its use could also inhibit gastric emptying and reduce peristalsis, with other side effects cited as central nervous system depression, nausea, vomiting and urinary retention.
However, despite the potential danger to life due to these negative side effects, CDC describes fentanyl as more lethal than heroin and morphine.
Now, while some countries have been using the possession of nuclear weapons as a weapon of threatening other countries, the new US administration, seems to have found another weapon of threatening other sovereign states.
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The new ‘weapon’ is, apparently, fentanyl. Just this month, the US threatened to impose a 10 percent tariff, effective March 4 this year, on Chinese products that are exported to that country.
Apparently, one of the accusations it is levelling on the People’s Republic of China pertains to the alleged misuse and smuggling of fentanyl and related substances, practices the US claims the Asian country is failing to tame.
However, evidence on fentanyl use indicates that the People’s Republic of China has been doing its part to tame the vice.
On March 5, 2025, for example, the State Council Information Office of the People’s Republic of China published a white paper, titled ‘Controlling Fentanyl-Related Substances – China’s Contribution’, in which it outlined measures the authorities have been taking to put the situation in check.
By the way, a white paper is an informational document issued by a company or not-for-profit organisation to highlight the features of a solution, product or activity. It is designed to help stakeholders understand an issue, solve a problem or make a decision.
In the China case, contents of the article included the definition of fentanyl-related substances based on science, measures put in place to ensure both rational use and rigorous control and action taken on those linked to fentanyl-related crimes.
The white paper also outlined how the authorities were enforcing strict control over precursors of fentanyl-related substances, accelerating technology research, development and application, adopting comprehensive measures for more efficient drug control and promoting global governance of fentanyl-related substances.
It must be borne in mind that fentanyl was first synthesised in 1960 by Belgian pharmacologist Paul Janssen. It was then produced by Janssen Pharmaceutica, Belgium, and has been widely used in Europe since the mid-1960s.
As for the US, it was approved for medical use in 1968. Later, sufentanil, remifentanil and alfentanil were developed and came onto the market, such that these four fentanyl-related medications are now used globally for medical purposes. Their usual dosage form includes injection, transdermal patch, sublingual tablet and nasal spray.
“By slightly modifying the chemical structure of fentanyl, fentanyl-related derivatives with similar structures and effects – and even stronger effects – can be obtained. Most of them have either been illegally produced based on formulae retrieved from academic articles published by pharmaceutical companies or designed to circumvent legal controls.
“At present, nearly 100 fentanyl-related substances are being abused around the world, and potentially they may number in the tens of thousands. Unlike the four fentanyl-related medications, the remaining fentanyl-related substances have not been found to have any medical value, and are often abused together with heroin, cocaine, or other controlled drugs to cause euphoria, an effect of taking opioids,” the white paper reads.
“In addition, their anesthetic and sedative effects affect the central nervous system of abusers, and an overdose can lead to coma, respiratory depression, or even death,” it adds.
On April 1, 2019, Chinese authorities issued a statement in which they outlined measures to control the use of fentanyl-related substances.
As part of its cramp down on fentanyl and fentanyl-related substances use, China approved fentanyl, sufentanil, remifentanil, and alfentanil for pharmaceutical use in the forms of transdermal patches and injections only. In fact, in the 1970s, China began to approve the production of fentanyl-related substances for medical purposes, with fentanyl injections getting approved in 1974.
Subsequently, remifentanil injections were approved in 2003, sufentanil injections and fentanyl transdermal patches in 2005 and alfentanil injections in 2020.
Compared with traditional opioids such as morphine and pethidine, these fentanyl-related medications “have few side effects and enable quick recovery from anesthesia. With these advantages, they are widely used in the induction and maintenance of intraoperative anesthesia, postoperative and labour analgesia, and for the relief of cancer pain, thereby ensuring that the public have ready access to effective medications. Fentanyl-related medications now account for around 66 percent of the market share of narcotic drugs and Class I psychotropic substances in China”, according to the white paper.
“China has enumerated fentanyl-related medications in the List of Controlled Narcotic Drugs and exercises strict control in terms of their manufacturing, sale, use, and export,” the white paper indicates.
Indeed, China has approved five companies for manufacturing fentanyl-related medications and these are Yichang Humanwell Pharmaceutical Co., Ltd., the Langfang Branch of China National Pharmaceutical Industry Corporation Ltd., Jiangsu Nhwa Pharmaceutical Co., Ltd., Henan Lingrui Pharmaceutical Co., Ltd., and Changzhou Siyao Pharmaceuticals Co., Ltd.
To continue operating in the country, they are required to conform to Good Manufacturing Practice (GMP) of Medical Products guidelines with security facilities combining manpower, equipment, and technology.
In addition, they are required to “strictly” carry out annual plans for production, as defined by the National Medical Products Administration (NMPA), and report regularly on the production, sales and inventory of fentanyl-related medications to drug supervision authorities.
Statistics indicate that in 2023, Chinese enterprises manufactured a total of 84.969 kilogrammes (kg) of fentanyl-related bulk drug substance (BDS), including 9.89kg of fentanyl BDS, 4.702kg of sufentanil BDS, 5.805kg of alfentanil BDS and 64.572kg of remifentanil BDS.
As for importers of fentanyl-related products, China’s control measures date back to 2006, when the authorities approved Xi’an Janssen Pharmaceutical Ltd. as an importer of fentanyl-related medications; that is, limited to fentanyl transdermal patches only.
The Chinese officials also have tight controls over the wholesale trade. For instance, as at now, three national wholesalers—namely China National Medicines Corporation Ltd., Shanghai Pharmaceutical Co., Ltd. and Chongqing Pharmaceutical (Group) Co., Ltd.—as well as 626 regional wholesalers, at least by 2023, are accredited to engage in the sale of fentanyl-related medications there.
As a result, manufacturers are obliged to sell fentanyl-related medications to the three national wholesalers, who resell them to provincial-level regional wholesalers before the medications enter the medical institutions in the said provinces and equivalent administrative units.
“Pharmaceutical retail companies are not allowed to sell fentanyl-related medications,” the white paper further indicates.
In 2023, China had domestic sales of 20.86kg of fentanyl BDS, 5.21kg of sufentanil BDS, 6.84kg of alfentanil BDS and 63.06kg of remifentanil BDS, including carryovers from 2022.
As of March 20, 2025, there were no cases of fentanyl-related medications disappearing in manufacturing or circulation detected in China.
To further ensure that fentanyl-related medications are under the strictest control, they are subject to medical prescription and real-name patient registration, and are securely stored in cabinets with double locks handled by authorised medical workers each with a key.
Not just that, newly prescribed medications can only be obtained by presenting the used packages of previous prescriptions.
“In addition to these security measures, law enforcement and administrative departments have strengthened communication for the timely identification of problems and weak points and the closure of administrative loopholes.
“Since 2017, three criminal cases of trafficking fentanyl-related medications have been concluded in China, and no cases of outbound smuggling and trafficking of fentanyl-related medications have been detected,” the white paper indicates.
To further ensure strict regulation, the NMPA implements a permit system for the export of fentanyl-related medications. Among other things, it verifies with, and obtains confirmation of legality of the transaction from, the competent authorities of the importing country for each exported shipment of narcotic drugs before issuing a permit for export.
Currently, Yichang Humanwell Pharmaceutical Co., Ltd. is China’s only exporter of fentanyl-related medications.
In terms of statistics, in 2023, China exported 9.766kg of fentanyl-related medications, mainly to Asian countries that include the Republic of Korea, Vietnam, Malaysia, and the Philippines, Latin American countries including Chile, Panama, Columbia, and Paraguay, and European countries including Poland, Germany, and France.
In fact, China has never exported any type of fentanyl-related medication in any form to North America.
It has also been working to establish a digital tracking system for fentanyl-related medications. The comprehensive use of new technologies and methods—notably radio frequency identification tags, the Internet of Things, and artificial intelligence—enables whole-process dynamic monitoring and closed-loop management of the manufacturing, sale, transport, use, import, and export of fentanyl-related medications, which further prevents them from becoming lost.
Not surprisingly, on March 4 this year, the Foreign Ministry of China said: “With a vision of a community with a shared future for mankind, China always earnestly fulfills its international obligations in drug control and participates in international counternarcotics affairs in an in-depth manner, stays fully committed to advancing the global governance of drug control and makes relentless effort to work with other countries in the joint response to the new challenge posed by the fentanyl issue. What has been achieved is there for all to see.
“Facts speak louder than words. The US is spreading all kinds of false information on the fentanyl issue, smearing and scapegoating China, and hiking tariffs on Chinese imports over fentanyl. Such [a] move is unjustified and will do no one good. China’s position is clear-cut. We stand ready for practical cooperation with the US based on equality and mutual respect. That said, we firmly oppose the US pressuring, threatening and blackmailing China under the pretext of the fentanyl issue. We urge the US to respect facts, bear in mind its own interest and make the right choice.”
And, writing in The Global Times, Zhang Yong-an indicated that the “white paper provides evidence of China’s contribution to drug governance”.
I particularly liked his point that “First, China consistently upholds the principle of balancing “rational use” with “rigorous control”, ensuring that fentanyl-based medications are confined strictly to medical and scientific research purposes….”
Alice Wu, of China Daily, is also spot on when she says “Tariffs are not the cure for the US Fentanyl crisis”.
She writes: “The US may see tariffs as the cure. They are not. The only significant effect was a heavier burden on American consumers. The cure must come from within. In recent years, fentanyl abuse has become a severe crisis in the US. With less than 5 percent of the world’s population, the country consumes over 80 percent of the global opioid supply. Statistics from the US Centres for Disease Control and Prevention show that synthetic opioids—primarily illicitly manufactured fentanyl—were involved in 75,000 overdose deaths in 2023, accounting for nearly 70 percent of the total.
“Over 150 Americans die daily from overdoses linked to synthetic opioids like fentanyl, making it the leading cause of death for Americans aged 18 to 45. A key driver of this crisis is easy access: over-prescription, lax regulation, and insufficient public awareness campaigns. As a Los Angeles County sheriff noted, “Getting fentanyl is as easy as ordering pizza.”
In other words, the US is failing to do what China is doing.
Ironically, it points a finger of blame at China.
It could be that in the US’s book of excuses, everything goes.
What is clear though is that, as new Canadian Prime Minister Mark Carney, who is also the head of the governing Liberal Party, puts it, “Nobody wins a trade war”.
