Ending the Opioid Epidemic: Only the U.S. Can Stop China’s Counterfeit Pharmaceutical Trade

Ending the Opioid Epidemic: Only the U.S. Can Stop China’s Counterfeit Pharmaceutical Trade
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The United States is facing an explosion of counterfeit opioids from China. Illegal synthetic opioids like carfentanil and fentanyl are being packaged as legal prescription opioids (like oxycodone) and sold on the black market. The US has dealt with counterfeit drug scandals before, notably in 2008 when 149 Americans died from a counterfeit blood thinner found to have originated in China. Today, counterfeit opioid compounds with carfentanil and fentanyl are blamed for the sudden increase in overdose deaths in the United States, making drug overdoses the current leading cause of death for Americans under age 50.

According to the World Customs Organizations, most counterfeit drugs are manufactured in China. Despite the clear evidence of China’s culpability in the global counterfeit drug trade, no one has been able to get China to better regulate its pharmaceutical exports. The US opioid epidemic is changing that. The United States is the only actor that can effectively change Chinese behavior and it must pressure China to crack down on its illegal pharmaceutical manufacturing and exports, to not only curb the US opioid epidemic but also address the counterfeit drug crisis in the developing world.

This is not a crisis in the US alone: In parts of Africa and Asia more than 50 percent of all drugs sold are fake, and an estimated 700,00 deaths occur every year in the developing world just from counterfeit tuberculosis and antimalarial drugs. Taking pharmaceuticals in the developing world has been described as playing Russian roulette. Counterfeit drugs have been highly prevalent in developing countries since the early 2000s, with most believed to originate in China. In 2013, Indian officials discovered that 8,000 patients had died over the past five years because a post-surgery antibiotic had no active ingredient. In 2008, 34 Nigerian children died and over 50 were hospitalized with severe kidney damage after being given counterfeit teething syrup that contained anti-freeze. These counterfeits undermine public confidence in health systems and increase resistance to medicines like antimalarial drugs and antibiotics, threatening entire populations.

Chinese action is needed, and the only actor that can push China to make major pharmaceutical regulatory changes is the United States. Besides American geopolitical clout, the American pharmaceutical market is the largest in the world. The United States could implement trade restrictions that would devastate Chinese drug manufacturers, such as insisting on Food and Drug Administration oversight of all drugs and drug compounds that reach the United States or barring Chinese manufacturers with poor records from the American market. Although they bear much of the public health burden, developing countries do not have the influence to act unilaterally. They are also reliant on continued Chinese aid and therefore reluctant to overplay their hand. The United States is the only country with a reasonable chance of getting China to change its behavior.

American pressure on China has already resulted in minor regulatory reforms. The acting Drug Enforcement Agency (DEA) administrator, Chuck Rosenberg, visited China in January to discuss illegal shipments of fentanyl to the United States. China has since banned six variations of fentanyl and now blacklisted carfentanil. These regulations have already had an effect on the markets for counterfeits: Six months after China added acetyl fentanyl, a cousin of carfentanil, to its list of restricted substances in 2015, seizures of acetyl fentanyl in the United States had dropped by 60 percent. 

Political pressure from the United States is clearly working, but must be expanded. There is a political opening in Washington for this, as the opioid epidemic is a hot topic in Congress and President Trump is open to using trade instruments to punish China. Taking action to combat the opioid epidemic is also a rare area of bipartisan consensus. With Republicans in Congress and the Administration increasingly desperate for tangible action against opioids, achieving substantial progress in halting deadly counterfeit drug exports from China could provide a valuable win to bring back to their constituents.

There are specific actions the United States can push China to take: accredit each of its 5,000 pharmaceutical manufacturers and 12,000 drug wholesalers; enforce quality assurance certification for all drugs and drug ingredients entering the Chinese supply chain; and close the loophole in Chinese law that exempts chemical companies from regulatory oversight, even though they can make and export drug ingredients. These actions would not only have an immediate effect in the United States, but also help curb the public health catastrophe that poorly regulated Chinese counterfeits have inflicted on the developing world. To put a dent in these crises, the United States must keep the pressure high.


Emily Foecke Munden is the International Development Fellow at Young Professionals in Foreign Policy (YPFP). She is also a Research Assistant with the Center for Global Development in Washington, DC. Emily earned her Master of International Affairs in 2016 from the University of California-San Diego, where she concentrated on international development policy.


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