Synthetic opioids management in Sino–American relations: focus on fentanyl by Zha Daojiong

PKU professor says no justification for either rhetoric or policy to hold the other responsible for the fentanyl-related predicament and cooperation should remain consistent regardless of fluctuations

In a major scoop earlier today, the Wall Street Journal reported Trump, Xi to Discuss Lowering China Tariffs for Fentanyl Crackdown, citing “people familiar with the talks” as saying, “If Beijing takes action to cut export of chemicals that make fentanyl, the U.S. would cut in half the 20% fentanyl-related levies on Chinese goods.”

In the afternoon, the Chinese foreign ministry signaled willingness over dealmaking

China’s position on this issue has been consistent and clear.

China is the most resolute country in drug control, with the most thorough policies and the best record, and it is also one of the countries in the world that list the largest number of controlled substances and exercise the strictest regulation.

China expresses sympathy for the American people suffering from the fentanyl crisis, has provided assistance in this regard and achieved positive results, and remains open to continuing cooperation with the U.S. side.

The U.S. side should take concrete actions to create the necessary conditions for cooperation between the two sides.

Professor Zha Daojiong of Peking University has repeatedly written on the issue, including saying China should crack down on illicit fentanyl flows regardless of U.S. rhetoric.

Below is his latest English-language article on fentanyl, published open access on June 18 in China International Strategy Review, a journal run by the Institute of International and Strategic Studies (IISS), Peking University. His conclusion:

…for both China and the United States, there is no justification for either rhetoric or policy to hold the other responsible for the fentanyl-related predicament, whether it stems from negligence or is perceived as intentional. Both societies must face the salient fact that they are sites of production, transit, and consumption of conventional and the ever-growing classes of NPS and other illicit drugs. In terms of both public health rationality and practical necessity, enhanced bilateral cooperation should be established as a standard practice. This approach should remain consistent, regardless of fluctuations in trade and other aspects of interactions between the two governments over other issue areas, and irrespective of the connections identified in research and broader policy-making contexts.

Last but not least, there is indeed a competitive dimension to the logic behind continuing with the notion of enhanced functional cooperation in counternarcotics. From an international relations perspective, the quality of the competition hinges on the degree of progress in finding effective solutions to the fentanyl/opioid challenge through domestic efforts and international cooperation. Either in aggregate terms or on specific issue areas covering medicinal sciences, pharmaceutical regulation, law enforcement issues, etc., both China and the United States stand a chance to enhance their soft power attraction through setting an example for the rest of the world. In that sense, the ultimate winner is progress in humanity.

Synthetic opioids management in Sino–American relations: focus on fentanyl

Abstract

Synthetic opioids are introduced as an addition to medicinal instruments for pain management. When misused, they present a unique burden of effective regulation and policing of cross-border flows, as illicitly synthesized opioids emerge as products purposefully designed to evade a government’s regulation and interdiction at the border. Since 2017, fentanyl has become a prominent issue in Sino–American relations, with the second Trump administration’s reference to fentanyl-related matters as a justification for levying additional tariffs on imports from China. The prevailing viewpoint appears to be that China does not have an illicit fentanyl challenge of its own. However, the current state of affairs in popular narratives may well have stemmed from a lack of presentation of China’s fentanyl/opioids governance. This article provides an overview of the evolution of fentanyl governance in China since its introduction for medical use in the early 1970s. Like the United States, China has been making efforts to police illicit production, trade, and consumption within its society, in addition to cooperation with the United States and other countries on narcotic control for over four decades. The article further discusses the structural issues that will continue to factor in dialogue and cooperation between the functional agencies of China and the United States on enhanced management of fentanyl and other synthetic opioids moving forward. Regardless of how the 2025 tariff discussions progress, there continues to be value in fostering exchange in scientific knowledge on opioids and evidence-based cooperation between China, the United States, and the rest of the world.

1 Introduction

Sino–American cooperation on narcotics control, made more challenging with the spread of illicit synthetic opioids, has risen from “low politics” in interactions among functional agencies to “high politics” in economic and political relations between the two countries. In 2016, fentanyl emerged as the leading cause of overdose deaths in the United States, surpassing both heroin and other natural and semi-synthetic opioids. A year later, President Donald Trump highlighted fentanyl as a major issue in bilateral relations on his official visit to China. Starting May 1, 2019, China has included all fentanyl-related substances in the supplementary list of controlled narcotic drugs and psychotropic substances with non-medical use. The policy led to the end of authorized sales of fentanyl or controlled precursor chemicals to the United States (International Narcotic Control Board 2021).

Ever since, fentanyl has continued to be identified as one of the major issues between the American and Chinese governments at the diplomatic level. At the November 2023 summit in California between U.S. President Joseph Biden and Chinese President Xi Jinping, the U.S. prioritized enhanced cooperation on the fentanyl issue alongside the resumption of military-to-military contacts, which had been suspended in the wake of U.S. House Speaker Nancy Pelosi’s trip to Taipei in August 2022. In February 2024, China and the United States established a joint counternarcotics working group to deepen counter-narcotics efforts between the two countries at all levels. The group’s agenda encompasses a range of topics, including policymaking, law enforcement coordination, the sharing of technical information, and the exchange of best practices. In December 2024, U.S. Ambassador Nicholas Burns to China cited fentanyl cooperation as a notable achievement during his tour of service. According to Burns, after the Biden-Xi meeting in California, China banned the export of 55 precursor chemicals and synthetic drugs, in addition to taking related law enforcement action on over three hundred Chinese citizens (Straits Times 2024).

Come February 2025, shortly after the inauguration of the second Trump administration, the United States cited fentanyl as a cause for increasing tariffs on imports from China: by two installments of 10% each within 1 month. These additional tariffs are to remain in effect until the U.S. certifies satisfaction with Chinese efforts to cooperate in controlling the inflow of fentanyl and its precursors into the United States.

In response to the trade actions by Trump, China rejected the fentanyl-tariff linkage by the U.S. On the fentanyl issue, China released a white paper entitled “Controlling Fentanyl-related Substances: China’s Contribution” (China State Council Information Office 2025).The document makes a textbook-like introduction to the toxicological and pharmacological basics of the substance and summarizes Chinese domestic regulatory and law enforcement approaches to fentanyl-related issues. The document also includes a summary of China’s records of international cooperation on narcotics control and pledges to continue international cooperation, including with the United States.

Prospects for delinking fentanyl from tariffs and/or other trade or non-trade measures remain uncertain. On one hand, the illicit drug market has a global reach and a unique resilience that is set to survive national and international control efforts. On the other hand, each country’s approach to drug control encompasses a broad range of policies and activities at domestic, bilateral, and multilateral levels. As a result, achieving synergies can often prove challenging, while instances of antagonism are frequently abundant.

For opioids, with fentanyl being synonymous with an ever-increasing class of anesthetic, psychotropic, and psychoactive substances, to have entered into high-level diplomacy is emblematic of the meme of a “China Shock” to the United States. Against the backdrop of the rise in “deaths of despair”—including drug overdose, suicide, and diseases of the liver—in the United States in the 2000s, narratives about holding China responsible are prolific and sustained, resulting in deeply rooted domestic American support for punitive policies. A notable example is that, in the United States, literature in economics joins that in law enforcement and public health to ascertain “a large, plausibly exogenous shock to local labor markets driven by a change in US trade policy” (Pierce and Schott 2020, 47). Among other points of causality, the decision made by the United States in December 2000 to stop subjecting its normal, i.e., those applied to the overwhelming majority of US trading partners, trade relations with China to annual review is understood to have exposed US regions to increased import competition. In its wake, “counties more exposed to the change in US trade policy exhibit relative increases in deaths of despair”, with the health effects “present primarily among working-age whites” (Pierce and Schott 2020, 48). Furthermore, a frequently cited paper on counternarcotics control between the two countries observes that “China subordinates its counternarcotics cooperation to its geostrategic relations” (Felbab-Brown 2023). In short, there is a widespread, deep-seated, and enduring sentiment among American elites that connects unnatural mortality in the United States to China.

This paper treats the fentanyl issue as separate from the ongoing trade disputes and/or attribution of responsibility between China and the United States. Instead, this paper gives weight to the theory of functional cooperation in dealing with cross-national issues and challenges. “Functions” refer to public-sector responsibilities of a government, with public health being a standard example in the literature on the evolution of world affairs. Functional agencies operate primarily within the territories of the state. Between a pair of countries, functional cooperation—either based on rationality or out of necessity—can and should occur based on rationality or necessity, even in the absence of progress on high-level political matters, such as citizenship, monetary union, or national defense. National governments can also join multilateral agencies established to facilitate functional cooperation and collaboration (Britannica online n.d.).

In the functional area of counternarcotics control, examples of multilateral regimes include the United Nations Commission on Narcotic Drugs, the International Criminal Police Organization (Interpol), the World Customs Organization, etc., for monitoring and interdicting the cross-national flow of controlled materials. The International Narcotics Control Board and the World Health Organization provide expert recommendations on drug and chemical materials to put under international control (United States Department of State Bureau for International Narcotics and Law Enforcement Affairs 2024).

An important caveat that must be noted is that discussing international counternarcotics cooperation is a profoundly challenging task for observers like this author who are trained in International Studies. The topic is inherently multi-disciplinary and a comprehensive understanding and assessment would necessitate a wide range of expertise and experience. In addition to a solid understanding of social sciences, mastery of fundamentals in biological, biomedical, medicinal, medical, pharmacological, and pharmaceutical sciences is required for assessing validity behind descriptions, analytical frameworks and cause–effect relationships presented in the extensive literature. As such, much of the rest of this paper is based on the author’s self-learning. Instead, the main purpose behind this writing is to help facilitate continued exchange with interested observers in the field of international relations.

The remainder of this paper begins with an overview of synthetic opioid management in China to the best of the author’s ability. Doing so is useful and even necessary as, throughout the past few years in the author’s exchange of views on the topic, American and other international colleagues often proceed by assuming that either China does not have a fentanyl or opioid malaise of its own or worse still, fentanyl was a product designated for foreign use only. In the third section, this paper draws attention to several structural issues that must be addressed in future discussions regarding the management of the synthetic opioid challenge in both China and the United States, which is both bilateral and global. The final section offers a few concluding thoughts for thinking about functional cooperation in health and other functional areas between China and the rest of the world, the United States included.

2 Management of synthetic opioids in China: a learner’s sketch

Opioids are a class of natural, semi-synthetic, and synthetic drugs. The scope of reference includes legally authorized and medically administered medicine, medicine diverted for non-medical use, and substances flowing in the world’s illicit/illegal markets. In both medical and extra-medical uses, opioids produce the same analgesic (pain control during and its relief after surgery), psychotropic, and psychoactive effects.

Worldwide, since its introduction in the 1960s, an ever-expanding fentanyl family of opioids has been produced and approved for both human patients and wild animals (Stanley 2014). Its chemical structure is easily changeable. Its potency is stable. In the illicit opioids markets, unlike more historical materials such as morphine and codeine that rely on soil and sunshine for growing natural plants, the unlawful production of fentanyl can be completed using a broad and increasingly varied category of chemical materials in clandestine laboratories. Accordingly, fentanyl is often categorized as a new psychoactive substance (NPS) and presents a unique challenge to public health management and law enforcement in all countries.

In China, fentanyl was first synthesized in 1971(Peking University Pharmaceutical Company 1971). Two years later, Chinese chemists reported the successful synthesis of two derivatives using methods “different from those reported in patents published abroad” (Peking University Pharmaceutical Company 1973). The product was approved for medical use in 1974, first on an experimental basis in Beijing and later gradually extended to the rest of the country.

China’s drug regulation regime evolved out of the country’s concerted effort to eradicate domestic production and extra-medical use of opium-based substances in the 1950s. Anesthetics and psychotropic substances are grouped into one category. In 1978, Fentanyl Citrate (for intravenous or intramuscular injection) was for the first time added to the list of such substances for controlled production and medical use (Chen et al. 2021).

By the mid-1980s, on one hand, Chinese medical professional literature reported a trend of using fentanyl as a replacement for morphine in hospitals and for pain management (Zhang 1988). On the other hand, the country’s first Institute on Drug Dependence was established in the Beijing Medical University in 1984, “with the cooperative support of the United Nations Fund for Drug Abuse Control and the World Health Organization” (Beijing Review 1987). Creation of the institute and its upgrade to national center status in 1988 can be understood as an indication of awareness of the severity of counternarcotics work through gathering toxicological and epidemiological evidence. A paper submitted to the first China toxicology conference in 1993 maps connections between dependence effects on prescription drugs, including fentanyl, and illicit narcotics in the country (Cai 1993).

A title word search using “fentanyl” in the China National Knowledge Infrastructure (CNKI, www.cnki.net) database, the most inclusive and comprehensive archive of China-based publications, indicates that the number of entries began to rise in the early 2000s (Fig. 1).

A discernible contributing factor may well be the increasing awareness of the spread and misuse of fentanyl and other opioids. For example, in 2003, the State Food and Drug Administration issued a circular to tighten control of active pharmaceutical ingredients and formulations of Remifentanyl and Sufentanyl by reclassifying them as anesthetic medicinal products (National Medical Products Administration 2003).

Statistical compilation of identified cases of fentanyl abuse in China is scarce, with fourteen cases among drug users in Beijing between 2005 and 2009 being a rare exception (Ma et al. 2012). The absence of data on the number of fentanyl misuse or overdose cases thereafter may be attributed to a shift in institutional responsibility for case tracking from the Institute on Drug Dependence to substance monitoring by the country’s medicine regulatory agencies in the 2010s. For the country’s law enforcement agencies, the spread of adoption of methods like nuclear magnetic resonance spectroscopy has enhanced technical capabilities to identify fentanyl-like substances in illicit drugs. As summarized in a recent review of literature published in the journal Police Technology, into the 2020s, the rise in illegal production, trafficking, and abuse of fentanyl-class substances and synthetic cannabinoids has emerged as one of the most pressing concerns in the country (Zheng and Zhang 2025).

Also in the early 2000s, Chinese medical industry news reports started to express concerns about the harmful effects of aggressive and irresponsible marketing of medicines, including fentanyl, for self-administered pain relief (Zhao 2005). Band-aid-like patches containing fentanyl were first introduced as an imported product in China for medical use in 1999 (National Medical Products Administration and the Ministry of Public Health 2002). Public advisory reports issued by the U.S. Food and Drug Administration against the improper use of fentanyl transdermal patches were dutifully reported (Anonymous 2005). Since then, (in)proper use of such patches, especially on children, late-stage cancer patients, and old patients, has become a standard theme in publications by the medical profession in the country.

According to AI-generated data on CNKI, Chinese language publications overwhelmingly concentrate on fentanyl and related substances as material topics of research (see Fig. 2). However, this does not mean China’s management of fentanyl-related production and use does not concern illicit and/or illegal activities.

In China, drug trafficking and drug abuse once again became a prominent issue in national governance in the early 1980s. Whereas opium trafficking from the “Golden Triangle” was a renewed phenomenon, illicit and illegal processing of heroin, amphetamines (ice), etc., worsened the challenge. As the country’s chemical and pharmaceutical production systems began to liberalize, “drug dealers from Taiwan, Hong Kong, aided by Mainland middlemen, requested Mainland pharmaceutical and chemical factories to process [illicit and illegal] drugs for alleged legitimate use” (Yang 1993, 21). In the 1990s, the development of the “three evils” of narcotics production, prostitution, and underground gambling, particularly in southern China, led to concerted efforts in police cooperation among the Mainland, Hong Kong, and Taiwan (Lo 2016).

The mid-2010s saw a notable rise in the use of the Internet to facilitate production, transportation, and transactions within the supply chain of illicit and illegal products and materials. The number of cases involving online sales and transactions of controlled NPS substances, with ketamine, synthetic cathinone, and fentanyl analogs being the most frequently cited examples, increased. One study of closed criminal cases concerning illicit NPS supply (manufacturing, distributing, trafficking, and smuggling) from 2012 to 2017 identified 341 cases. Those cases included both domestic and external supply chains: smuggling from China to other countries around the world, including the United States, Canada, Mexico, Malaysia, Spain, Australia, and the United Kingdom (Zhao 2022).

Fentanyl is one of the three groups of NPS substances in the concluded cases, with the other two being the ketamine group and the synthetic cathinone group. “More than half of the [fentanyl] manufacturing cases (38 cases) occurred in rural areas, in hold houses and abandoned farms in the countryside, whereas in 20 cases, manufacturing took place in rental apartments in a city center” (Zhao 2022, 10).

The Supreme People’s Court organized three symposiums of the country’s court system on the trial of drug-related crimes in 2008, 2015, and 2022 and published summaries of each meeting (Li et al. 2023). Fentanyl and other NPS-related cases continuously feature in each of these documents. Among China’s judiciary professionals, debates and decisions on NPS-related sentencing, particularly those involving the use of the Internet, are a continuous process as they involve defendant declarations, forensic conclusions, and other evidentiary matters in prosecution, trial, and sentencing (Yin 2013; Peng and Li 2018; Hu et al. 2024).

In the mid-2010s, Chinese counternarcotics agencies identified an increased inflow of cannabis trafficked from North America to China, primarily carried by Chinese students traveling internationally. Cannabis, more commonly known as marijuana, is illegal for non-medical use in China. In stark contrast, North America has witnessed a growing social acceptance of cannabis, along with increasing levels of deregulation and legalization. In the 2019 edition of national narcotics control, issued by the National Narcotics Control Commission, Chinese customs reported the seizure of 252 kg of cannabis, involving 268 cases of inward trafficking from the North American region (China National Narcotics Control Committee 2019).

In the 1990s, cases of abuse of ketamine dramatically rose in China and other countries of East Asia and Southeast Asia (for example, see Li et al. 2020). Ketamine, a derivative of phencyclidine that was developed in the 1960s, is an anesthetic and analgesic with hallucinogenic effects. One measure China undertook was to recommend that ketamine be included as a Schedule I medication under the U.N.-based counternarcotics regimes. Materials listed in Schedule I are considered to have limited or no medical applications; hence, their production is to be restricted, and medical usage is to be monitored. China persisted for a decade, until 2015, when the recommendation failed to secure passage by agencies under the UN Commission on Narcotic Drugs (U.N. Commission on Narcotic Drugs 2015).

By way of conclusion, China’s opioid management took place against the background of the number of the country’s registered drug users rising from 0.86 million in 2000 to 2.47 million in 2016 (Su et al. 2019), peaking in 2019 (11.3 million) but rising again by one million from 2022 to 2023 (China National Narcotics Control Committee 2024). Like many other countries around the world, China is experiencing a transition from conventional narcotics to NPS substances. International communication and cooperation with countries, including the United States, have been, and will continue to be, pillars of China’s narcotics control efforts.

3 Opioid management between China and the United States

Narratives within the United States about Chinese connections to its opioid epidemic are widespread. Meanwhile, narratives within China about American and Chinese efforts to manage drug abuse within their respective borders are just as diverse. It is impossible to summarize the diversity of viewpoints and counterviews, especially those concerning the attribution of cause and effect in each society and between them. In the space below, the author highlights three structural (i.e., irrespective of trade or other policy linkages) issue areas that merit attention, if only to facilitate conversations among the community of scholars in international studies on the topic in the future.

3.1 Pain management

Students of international politics and diplomacy can and indeed should bear in mind that pain management is the over-riding purpose for the introduction of man-made opioids. The knowledge base for a country’s drug regulatory and counternarcotics policies is built upon academic and professional consensus formed in the biological, biochemical, and pharmaceutical industries, together with insights from professions in public health and law enforcement. In any case, “industrial and postindustrial societies have been grappling with the challenge of balancing these benefits and risks for more than 150 years.” (National Academies of Sciences, Engineering, and Medicine 2017).

This is not to imply that the rising rates of opioid use disorder and opioid overdose deaths—the factual basis for President Donald Trump to declare a public health emergency in 2017 and again in 2025—are viewed as an American issue per se. Quite the contrary, pain management professionals in China do and will continue to learn from their peers in the United States to ensure that opioids are used effectively as a beneficial medicine rather than being misused as a harmful drug. As experts in the Chinese Pharmacopoeia Commission remind us, medication safety concerning fentanyl- and other classes of opioids affects the health protection needs of all ages of the population, including children, who are often not capable of making independent decisions on drug use for medical or recreational purposes (Yue and Li 2017). In other words, the continuation of knowledge exchange in areas of both medicinal and medical sciences and counter narcotics cooperation, made more challenging by the availability of NPS, is a constituting pillar of making each society function through the reduction of despair.

3.2 Scheduling

Pharmaceutical products and substances in different schedules are subjected to commensurate levels of restrictions for production and use. A country’s scheduling forms the legal basis for regulatory control, law enforcement, and international cooperation.

Scheduling responsibility is both a national prerogative as well as a duty of narcotics control agencies under the UN system. In the UN-based system on narcotics control, drugs, substances, and certain chemicals used in drug production are classified into distinct categories or schedules. This classification is based on the drug’s acceptable medical use and the drug’s abuse or dependency potential, with abuse rate serving as a determining factor. Recommendations and findings of the World Health Organization and the International Narcotics Control Board play a crucial role in shaping multilateral scheduling. The UN Office on Drugs and Crime is an operational agency that monitors global drug abuse and assists law enforcement efforts. Member states of the UN’s counternarcotics and public health institutions both campaign to have particular substances included and choose to adopt international listings to fit with their respective domestic contexts.

Fentanyl has been internationally controlled under the 1961 Single Convention on Narcotic Control since 1964. In the ensuing decades, more and more fentanyl analogues and precursors have been subjected to international control (United Nations Office on Drugs and Crime 2017). International efforts to control fentanyl-related substances were enhanced with the passage of the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988, which includes strengthening provisions against money laundering and authorizing asset forfeiture.

Studies in forensic science have recorded an observable market response in the United States to fentanyl substances—precursor chemicals—scheduling decisions taken, respectively, by the UN system, China, and the United States itself (Weedn et al. 2021). There continue to exist differences in opioid scheduling between the two countries. In the future, functional agencies of both countries have every reason to continue to engage with each other to enhance mutual understanding of their respective approaches to and paces in scheduling.

3.3 Law enforcement cooperation

Arguably, cooperation between law enforcement agencies of China and the United States since the establishment of diplomatic relationship began with that of narcotics control. Before synthetic opioids became the main cause of unnatural mortality in American society, counternarcotics cooperation was a positive highlight between the two countries’ functional agencies (Zhang 2012). As summarized in a 2019 U.S. Department of Justice report to Congress, over the years, fentanyl has continuously been dealt with as an issue between both sides, including the establishment of working groups between multiple agencies on both sides (Statement of Matthew Donahue 2019).

For both American and Chinese law enforcement agencies, the nature of illicit fentanyl as a “designer drug” poses a particular challenge, as Gary Henderson, the pharmacology professor who coined the phrase, warned in the late 1980s (Henderson 1988). They are faced with the stubborn ease for “street chemists” to purposefully design illicit materials to deceive their final consumers and evade law enforcement authorities in their respective jurisdictions.

Even before the age of modern commerce, which has been made significantly more efficient by the Internet for product transactions and payment settlements, the movement of goods through different jurisdictions is a standard practice in the world’s illicit and illegal markets. Increasingly, the Internet is abused for money laundering—made more deceptive in the age of cryptocurrencies—across nation-state boundaries in the conventional sense of the term (Hendershot 2020).

Typically, in international counternarcotics control, information exchange covers, but is not limited to, details about individuals engaged in drug trafficking, on drug caches, trafficking routes, trafficking techniques, destination points, specific details of particular cases. It also includes information exchange on national classification lists of controlled substances and notifications regarding any changes to those lists. Between a pair of government agencies, mutually verifiable information forms the basis for domestic action, legal assistance, and controlled deliveries.

As such, enhancing the quality of exchange of information/intelligence is not only useful but also essential for continued collaboration between the narcotics control agencies of both governments. The Drug Enforcement Agency (DEA) of the United States and the Ministry of Public Security (MPS) of China began to post liaison officers in their respective embassies since the early 1990s, and in 2003 formalized an information exchange mechanism. As stated in a U.S. Department of Justice readout of a Bilateral Drug Intelligence Working Group in September 2015, “going forward, law enforcement exchange and cooperation mechanisms such as these will facilitate more effective cooperation between the two countries in confronting their shared problem of drug trafficking and abuse” (United States Department of Justice 2015).

In short, in the bilateral context, future interactions among the functional agencies must focus on the quality of information exchange and effectiveness of joint operations. Pursuit of that quality must cover both evidentiary and procedural components.

4 Concluding thoughts

The core contribution this paper makes is that, contrary to popular perceptions, China faces its own challenges with synthetic opioids, including fentanyl-class substances. Similar to other countries, one component of China’s counternarcotics effort involves curbing the inflow of materials from abroad. Between China and the United States, there exists a record of cooperation in counternarcotics, including working group mechanisms among the two governments’ functional agencies. Improvement in science-based consensus on scheduling fentanyl-class substances and the quality of law enforcement cooperation in counternarcotics efforts is key.

Emphatically speaking, fentanyl-related challenges are not limited to the United States or China. According to forecasts by public health economists, globally, heroin and other semi-natural materials will likely account for a declining share of illegal opioids. Individuals may consume fentanyl more frequently and with greater intensity due to a shorter duration of action compared to heroin. Violence and corruption may decline, but opioid related mortality and morbidity, as well as property crime, are likely to rise (Reuter et al. 2021).

A cursory search in counternarcotics literature alerts us to the fact that fentanyl and other illicit synthetic opioids are a growing concern in the Asia Pacific (Taylor et al. 2020) and in Europe (Jannetto et al. 2019) as well. Furthermore, a growing number of low-income countries include fentanyl in their essential medicines lists, which are endorsed in the 20th edition of the Model List of Essential Medicines of the World Health Organization (Richards et al. 2020).Associated risks of diversion, improper and illicit use (and production), will likely become more globally spread.

Therefore, for both China and the United States, there is no justification for either rhetoric or policy to hold the other responsible for the fentanyl-related predicament, whether it stems from negligence or is perceived as intentional. Both societies must face the salient fact that they are sites of production, transit, and consumption of conventional and the ever-growing classes of NPS and other illicit drugs. In terms of both public health rationality and practical necessity, enhanced bilateral cooperation should be established as a standard practice. This approach should remain consistent, regardless of fluctuations in trade and other aspects of interactions between the two governments over other issue areas, and irrespective of the connections identified in research and broader policy-making contexts.

Last but not least, there is indeed a competitive dimension to the logic behind continuing with the notion of enhanced functional cooperation in counternarcotics. From an international relations perspective, the quality of the competition hinges on the degree of progress in finding effective solutions to the fentanyl/opioid challenge through domestic efforts and international cooperation. Either in aggregate terms or on specific issue areas covering medicinal sciences, pharmaceutical regulation, law enforcement issues, etc., both China and the United States stand a chance to enhance their soft power attraction through setting an example for the rest of the world. In that sense, the ultimate winner is progress in humanity.

Focus On Fentanyl

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Zha, D. Synthetic opioids management in Sino–American relations: focus on fentanyl. China Int Strategy Rev. 7, 70–83 (2025). https://doi.org/10.1007/s42533-025-00185-w