How the first Trump administration and China reduced US fentanyl deaths

With the US and China looking for ways to cool their trade war, both governments might draw lessons from a previous conflict for a path to ease tensions and save lives.

The Trump administration this year cited China's role in fueling fentanyl flows among the reasons for hiking tariffs on that country, which responded in kind against the US. The two sides recently agreed to slash tariffs temporarily while they continue negotiations, but the duties remain higher than before President Donald Trump began his second term in January. New research shows that cooperation between the first Trump administration and Beijing in 2019 resulted in roughly 1,000 fewer fentanyl overdose deaths than would have occurred otherwise.

The first Trump administration also pressed Beijing on fentanyl and found that cooperation between the two governments yielded benefits. At US urging, Chinese leaders in May 2019 began to bar fentanyl exports. Our research finds the embargo materially increased street prices for fentanyl for three to five months, resulting in roughly 1,000 fewer fentanyl overdose deaths than would have occurred otherwise, a roughly 25 percent reduction–not a small number if one of your loved ones was among the people whose deaths were averted.

We arrived at this estimate partly by analyzing fentanyl pricing data.

Illicit drug consumption is a first order public health problem in the United States. Drug overdose is the leading cause of death among Americans aged 15–44 years, exceeding heart disease, cancer, suicide, vehicular accidents, and COVID-19 in 2023. Overdose deaths among 15- to 19-year-olds increased by 150 percent between 2018 and 2021. Since 2016, fentanyl—a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine—has been the drug most frequently associated with these deaths, although there is evidence of a decline since 2023.

Although at first blush it may seem odd, illegal drugs, even highly addictive ones like fentanyl, are subject to market forces. Previous researchers have estimated price and income elasticities of demand, recognizing that with addictive substances current consumption may be conditional on time and tolerance dependencies of past use. To a degree, high prices reduce use by current users, but high prices really deter potential users from starting use. Drug users are discerning consumers: Pill formulations that are amenable to crushing for insufflation and injection fetch a premium, while those combined with an antagonist (such as naloxone in the case of opioids) trade at a discount. And like all products everywhere, bulk purchases trade at a discount.

StreetRx, a public health crowdsourcing surveillance system that collects product- and geographical area–specific data on street prices of diverted prescription or illicit drugs is operated in conjunction with the Researched Abuse, Diversion, and Addiction-Related Surveillance System (RADARS) administered by the Denver Health and Hospital Authority, a Colorado state institution. Through the website StreetRx.com, visitors can anonymously submit and view prices submitted by others. These data are highly correlated with law enforcement reports of street prices and "dark web" online prices, and have been widely used in the public health literature.

Our estimates indicate that these drug prices are generally affected by their specific product characteristics, availability of prescription drugs as a source of diversion, changes in income per capita, and price movements of similar drugs. There is only very modest evidence that interdiction efforts have an impact.

What did seem to matter for fentanyl prices (and ultimately for overdose deaths) was US-China diplomacy. At the 2018 Group of 20 summit, China announced that it would tighten regulations on opioids and ban direct shipments to the United States. But these moves were sidestepped by traffickers, and we detected no impact on prices.

The May 2019 Chinese embargo on fentanyl exports was different, however. We estimate that this action materially increased street prices for fentanyl for a period of three to five months, before production was relocated, primarily, though not exclusively, to Mexico. During this period of higher prices, we estimate that approximately 1,000 fewer fentanyl overdose deaths occurred in the United States than would have been expected without the embargo.

What these results suggest is that diplomacy with key supplier countries can play an important role in addressing the drug problem in the United States. Perhaps this consideration should be taken into account when formulating trade policy.