The Federal Agencies Fighting America’s Opioid Crisis

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The opioid crisis is one of the most devastating public health emergencies in American history.

Since 1999, over 645,000 people in the United States have died from overdoses involving opioids. In 2023 alone, an average of 217 people died each day from opioid overdoses—a staggering toll that has prompted a massive, “whole-of-government” response.

On October 26, 2017, the Department of Health and Human Services formally declared the crisis a national Public Health Emergency, a declaration that has been renewed continuously, underscoring the sustained severity of the threat.

In response, the U.S. government has mobilized multiple federal agencies, deploying across multiple fronts in a coordinated battle against this epidemic. The fight extends from public health surveillance and scientific research to aggressive law enforcement, border security, and international diplomacy.

Strategy and Coordination: The Command Structure

The federal response to the opioid crisis operates under a deliberate, dual-command structure designed to align high-level national policy with on-the-ground public health execution. At the top, the Office of National Drug Control Policy sets the overarching strategy and budget for the entire government. From there, the Department of Health and Human Services commands the specific public health and medical components of the battle.

Office of National Drug Control Policy: The Nation’s “Drug Czar”

Located within the Executive Office of the President, the Office of National Drug Control Policy serves as the central nervous system for the nation’s drug control efforts. Its director, often called the “Drug Czar,” is responsible for advising the President and orchestrating a unified, government-wide approach to reduce illicit drug use, manufacturing, and trafficking.

The ONDCP’s primary instrument of power is the National Drug Control Strategy, an annual document submitted to Congress that functions as the master plan for the entire federal effort. This strategy establishes the administration’s priorities, sets quantifiable goals, and directs the allocation of a federal drug control budget that exceeds $44 billion.

It coordinates the actions of 19 federal agencies, ensuring their individual missions contribute to the unified goals of prevention, treatment, and supply reduction. While the strategy has historically been the cornerstone of the “war on drugs,” recent iterations reflect a significant philosophical shift, moving away from that terminology to embrace a more balanced, public health-informed approach.

Beyond policymaking, ONDCP directs hundreds of millions of dollars to the front lines through two crucial grant programs:

High Intensity Drug Trafficking Areas (HIDTA): Established by Congress in 1988, the HIDTA program is a cornerstone of collaborative law enforcement. It provides funding and support to designated areas of the country that are critical centers for drug trafficking and production.

This program fosters multi-agency task forces—uniting federal, state, local, and tribal law enforcement—to share intelligence, coordinate investigations, and conduct interdiction and prosecution operations aimed at dismantling major drug trafficking organizations.

Drug-Free Communities (DFC) Support Program: This program attacks the problem at its roots by focusing on youth prevention. The DFC program provides grants of up to $125,000 to local community coalitions, empowering them to build infrastructure and implement strategies to prevent and reduce substance use among young people.

The Government Accountability Office has reviewed ONDCP’s strategic planning process, noting that while the 2022 Strategy met some legal requirements, such as setting measurable goals, it fell short on others, including a systematic plan for improving data collection.

Department of Health and Human Services: The Public Health Command

If ONDCP is the government’s strategic command, the Department of Health and Human Services is the general leading the public health army. As the nation’s principal health agency, HHS orchestrates the vast medical, scientific, and public health response to the opioid crisis.

Its pivotal role was cemented with the 2017 declaration of a national Public Health Emergency, an act that unlocked special authorities, focused federal resources, and signaled the gravity of the epidemic to the nation and the world.

The department’s operational blueprint is the HHS Overdose Prevention Strategy. This framework has evolved to meet the changing dynamics of the crisis, expanding beyond a singular focus on prescription opioids to address the rise of synthetic drugs like fentanyl and stimulants like methamphetamine.

The modern strategy, detailed at HHS’s overdose prevention background page, is built on four key pillars:

Primary Prevention: Focusing on the root causes of substance use and promoting safe and effective pain management to prevent new cases of addiction from developing.

Harm Reduction: Acknowledging the reality of active drug use, this pillar focuses on evidence-based interventions that reduce the associated risks, such as overdose and the transmission of infectious diseases. This includes expanding access to naloxone and supporting syringe services programs.

Evidence-Based Treatment: Working to remove barriers and expand access to the most effective, scientifically proven treatments for substance use disorders, particularly Medications for Opioid Use Disorder (MOUD) like buprenorphine and methadone.

Recovery Support: Recognizing that treatment is just the beginning, this pillar aims to build and support the infrastructure—including housing, employment, and peer support—that helps individuals maintain long-term recovery.

HHS serves as the parent department for the most critical agencies in this fight—including the CDC, SAMHSA, NIH, CMS, and FDA. It coordinates their diverse activities, ensuring that the research, data, funding, and regulatory actions of its sub-agencies all align with and advance the goals of the Overdose Prevention Strategy.

The Public Health Corps

While strategy is set at the highest levels, the ground war against the opioid epidemic is fought by a dedicated corps of public health agencies. These are the disease detectives, the treatment funders, the scientific innovators, and the healthcare payers.

Their work reveals a sophisticated, multi-stage process—a science-to-service pipeline designed to discover, validate, fund, and deliver solutions to the American people. These agencies are pioneering the use of data as a primary weapon, using advanced surveillance to perform epidemiological surgery, precisely targeting interventions where they are needed most.

Centers for Disease Control and Prevention: The Disease Detectives

The Centers for Disease Control and Prevention acts as the nation’s chief epidemiologist in the fight against the opioid crisis. Its fundamental mission is to use data and science to monitor the epidemic’s trajectory, understand its evolving threats, and guide an effective public health response.

The CDC was one of the first federal agencies to sound the alarm, identifying the three distinct waves of the crisis and providing the data that underpins much of the national strategy.

The CDC’s flagship program is Overdose Data to Action (OD2A). This cooperative agreement is the primary mechanism through which the CDC builds state and local capacity. It provides hundreds of millions of dollars in funding to 90 health departments, enabling them to collect more accurate, comprehensive, and timely data on both fatal and non-fatal overdoses.

This isn’t data for data’s sake—the core principle of OD2A is to use this enhanced surveillance to drive targeted, on-the-ground prevention activities. This allows communities to identify emerging hotspots or dangerous new drug combinations and respond rapidly. Stories from funded health departments showcase this work in action.

Beyond funding, the CDC wields significant influence through its guidance and public education efforts. In 2016, the agency released its landmark CDC Clinical Practice Guideline for Prescribing Opioids for Pain, a document that has profoundly reshaped prescribing practices across the country by providing evidence-based recommendations for safer pain management.

The updated 2022 guideline reflects the latest evidence. The CDC also leads major public awareness campaigns, such as “Rx Awareness” and “Stop Overdose,” which use real stories and clear messaging to educate the public about the risks of prescription opioids and the deadly threat of illicit fentanyl.

Underpinning all of this work are the CDC’s powerful surveillance systems. The State Unintentional Drug Overdose Reporting System (SUDORS), accessible via a public dashboard, collects detailed data from death certificates and coroner/medical examiner reports to provide a granular understanding of the circumstances surrounding overdose deaths.

SAMHSA: The Treatment and Recovery Engine

The Substance Abuse and Mental Health Services Administration is the lead federal agency dedicated to advancing the behavioral health of the nation. In the opioid crisis, its core mission is to reduce the devastating impact of substance use disorders by dramatically expanding access to prevention, treatment, and recovery support services.

SAMHSA is, in essence, the financial engine driving the public treatment system’s response. The agency provides a national helpline at 1-800-662-4357 and a treatment locator at FindTreatment.gov.

SAMHSA’s primary tool is the power of the purse. It channels billions of federal dollars to states, territories, tribes, and local communities through a portfolio of grant programs designed to build and sustain the infrastructure for care. Key grant programs can be searched through SAMHSA’s grants dashboard.

State Opioid Response (SOR) / State Targeted Response (STR) Grants: Authorized by the landmark 21st Century Cures Act, these multi-billion dollar grant programs are the single largest federal investment aimed directly at the opioid crisis. They provide states with massive but flexible funding to address their most pressing needs, such as increasing the number of providers offering Medications for Opioid Use Disorder (MOUD), purchasing and distributing the overdose-reversing drug naloxone, and funding prevention and recovery support services.

Substance Abuse Prevention and Treatment Block Grant (SABG): First authorized in 1992, the SABG is a foundational funding stream for state public health systems. It provides reliable, flexible funding that accounts for about a third of all state substance abuse agency funding, representing the only support for treatment for many of the most vulnerable Americans.

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction (MAT-PDOA): These grants, like the one announced as NOFO Number TI-23-001, are specifically designed to expand and enhance access to MOUD in states and communities with the highest rates of opioid addiction.

In addition to its funding role, SAMHSA has a critical regulatory function. It oversees and certifies the nation’s Opioid Treatment Programs (OTPs), the only facilities legally permitted to dispense methadone for the treatment of opioid use disorder.

SAMHSA also managed the waiver process that, until the passage of the MATE Act in 2023, was required for physicians, nurse practitioners, and physician assistants to prescribe buprenorphine, another key medication for OUD.

National Institutes of Health: The Science Solution-Seekers

The National Institutes of Health is the nation’s medical research agency, and its mission in the opioid crisis is to accelerate the development of scientific solutions to address the twin problems of pain and addiction.

Recognizing that the crisis was fueled in part by a lack of effective, non-addictive alternatives to opioids for chronic pain, the NIH has embarked on an ambitious research agenda to fill this gap.

The centerpiece of this effort is the Helping to End Addiction Long-term® (HEAL) Initiative. Launched in 2018, HEAL is a massive, trans-NIH effort that involves almost every NIH institute and center.

Since its inception, the initiative has invested a cumulative $3.9 billion into more than 1,000 research projects in all 50 states, all aimed at stemming the opioid public health crisis. The HEAL Initiative pursues two parallel and equally important goals:

Enhancing Pain Management: A major focus of HEAL research is to understand the biological mechanisms of chronic pain and develop novel, effective, and crucially, non-addictive therapies. This includes research into new medical devices, pain biomarkers to predict who will develop chronic pain, and new non-opioid medications.

Improving Addiction Prevention and Treatment: The other half of the HEAL portfolio is dedicated to improving outcomes for people with opioid use disorder. This includes developing new and better medications and technologies to treat addiction and prevent overdose deaths.

The research funded by HEAL is producing tangible innovations. Examples highlighted in HEAL research spotlights and annual reports include:

The Naloxometer, an implantable device designed to automatically detect the physiological signs of an opioid overdose and deliver a life-saving dose of naloxone, which is critical for preventing deaths among people who use drugs alone.

Testing of long-acting formulations of addiction medications, such as a six-month naltrexone implant, to improve treatment adherence and provide sustained protection against overdose.

Investigating the potential of repurposed drugs, such as the diabetes medication liraglutide (a GLP-1 receptor agonist), to reduce opioid cravings, offering a potential non-opioid treatment option for OUD.

Centers for Medicare & Medicaid Services: The Power of the Payer

The Centers for Medicare & Medicaid Services wields one of the most powerful levers in the federal response: the power of the purse. As the federal agency that administers Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), CMS provides health coverage for more than 100 million Americans.

This includes populations disproportionately affected by the opioid crisis—rates of diagnosed opioid use disorder are significantly higher among Medicare and Medicaid beneficiaries compared to those with private insurance. This position allows CMS to use its payment policies and regulatory authority to drive systemic change in how pain is treated and how addiction is managed across the entire U.S. healthcare system.

CMS’s approach is detailed in its Opioid Strategy Roadmap, which lays out a three-pronged approach:

Prevention: Implementing policies to prevent new cases of opioid use disorder by encouraging appropriate prescribing and the use of non-opioid alternatives for pain.

Treatment: Expanding access to a broad range of evidence-based treatments for patients who have developed an opioid use disorder.

Data Utilization: Leveraging its vast repository of claims data to identify trends, target interventions, and monitor the success of its policies.

CMS translates this strategy into action through several key policy levers:

Medicare Part D Opioid Policies: CMS has implemented robust safety policies within the Medicare prescription drug benefit. These include safety alerts that pharmacists receive when a beneficiary fills an opioid prescription that may be high-risk. For patients considered “opioid naïve” (those who have not recently used opioids), there is a policy to limit the initial prescription to a 7-day supply.

Expanding Treatment Coverage: A landmark change occurred on January 1, 2020, when Medicare, for the first time, began covering services provided by Opioid Treatment Programs (OTPs), including the dispensing of methadone for OUD. This closed a major gap in care. CMS also allows states new flexibility through Medicaid 1115 demonstration waivers to cover a fuller continuum of care.

Data Analytics and Transparency: CMS provides powerful data tools to help states, providers, and the public understand prescribing patterns. The interactive Medicare Part D Opioid Prescribing Mapping Tool allows users to see and compare opioid prescribing rates at the state, county, and even ZIP code level.

Department of Veterans Affairs: Caring for Veterans

The Department of Veterans Affairs is the nation’s largest integrated healthcare system, responsible for the care of millions of veterans. This population has been uniquely impacted by the opioid crisis, often dealing with high rates of chronic pain and co-occurring mental health conditions resulting from their military service.

In response, the VA has become a national leader in developing and implementing comprehensive strategies for safer pain management and opioid use.

The cornerstone of the VA’s effort is the Opioid Safety Initiative (OSI), a system-wide program launched in 2013 to fundamentally change the culture of pain management within the VA. The OSI is a multi-faceted approach that has led to a dramatic reduction in opioid prescribing.

Since the initiative began, the number of veterans receiving opioids from the VA has decreased by hundreds of thousands.

Key components of the VA’s comprehensive strategy, now managed by the Pain Management, Opioid Safety, and PDMP (PMOP) office, include:

Stepped Care Model for Pain Management: This model prioritizes a holistic and interdisciplinary approach. It begins with the safest and least invasive options, such as physical therapy, cognitive behavioral therapy, and complementary and integrative health approaches, before considering opioids.

Robust Risk Mitigation: For veterans who do require opioid therapy, the VA has implemented strong safety protocols. These include requiring informed consent discussions about risks, routine use of state Prescription Drug Monitoring Programs (PDMPs) to check for outside prescriptions, and urine drug screening to monitor for adherence and other substance use.

Naloxone Education and Distribution: The VA has been a leader in educating veterans and their families about overdose prevention and equipping them with the overdose-reversing medication naloxone.

Opioid Therapy Risk Report (OTRR): The VA provides its clinicians with a powerful data dashboard that gives them an actionable, real-time view of their patients on long-term opioid therapy. This tool helps providers identify high-risk situations and facilitates better population health management.

The Regulators and Enforcers

While public health agencies work to reduce demand and treat addiction, a parallel front in the war on opioids is fought by the regulators and enforcers who control the supply. Their strategy is a sophisticated, multi-layered attack that targets every link in the supply chain.

The Drug Enforcement Administration pursues the international cartels trafficking illicit fentanyl. The Department of Justice holds corporate manufacturers and distributors accountable in the courtroom. The Food and Drug Administration regulates the safety profile of the products themselves. Together, they work to shut down the diversion of legal pills from local pharmacies and home medicine cabinets.

Food and Drug Administration: The Gatekeeper

The U.S. Food and Drug Administration serves as the nation’s gatekeeper for medical products. Its role in the opioid crisis is a delicate balancing act: ensuring that patients with legitimate pain have access to effective relief while simultaneously mitigating the immense risks of misuse, addiction, and overdose associated with opioid medications.

In recent years, the agency has moved from what some critics called “inadequate oversight” to a more proactive and comprehensive stance.

The FDA’s current approach is outlined in its Overdose Prevention Framework. This strategy aligns with the broader HHS goals and focuses on four priorities:

Supporting Primary Prevention: Working to eliminate unnecessary initial exposure to prescription opioids and prevent inappropriate prolonged prescribing.

Encouraging Harm Reduction: Fostering innovation and education to make tools like naloxone more widely available.

Advancing Evidence-Based Treatments: Facilitating the development and approval of new treatments for substance use disorders.

Protecting the Public from Illicit Drugs: Working to keep unapproved, diverted, or counterfeit drugs that present overdose risks off the market.

The FDA has implemented several key regulatory actions to advance this framework:

Significant Labeling Changes: The FDA has required sweeping updates to the prescribing information for all opioid pain medicines. This includes adding a “Boxed Warning”—the agency’s most prominent warning—to immediate-release opioids and strengthening warnings across the board about the risks of life-threatening respiratory depression, addiction, and overdose.

Opioid Analgesic REMS Program: The FDA mandates a Risk Evaluation and Mitigation Strategy (REMS) for all outpatient opioid analgesics. This program requires drug manufacturers to provide unrestricted grants to accredited continuing education providers to develop and offer free or low-cost courses for healthcare providers on pain management fundamentals and safe opioid prescribing.

Encouraging Abuse-Deterrent Formulations (ADFs): The FDA has actively encouraged the pharmaceutical industry to develop opioids with abuse-deterrent properties—formulations designed to be more difficult to crush for snorting or dissolve for injection.

Expanding Access to Naloxone: The FDA has played a pivotal role in making the life-saving overdose reversal drug naloxone more accessible, including approving the first naloxone nasal spray for over-the-counter sale.

Drug Enforcement Administration: The Front-Line Fighters

The Drug Enforcement Administration is the tip of the spear in the federal government’s law enforcement response. As the primary agency for enforcing the nation’s controlled substances laws, the DEA’s mission has shifted dramatically in recent years to confront the overwhelming threat posed by illicitly manufactured fentanyl and the transnational criminal organizations that produce and traffic it.

The DEA’s enforcement priorities are clear and focused:

Dismantling Fentanyl Trafficking Networks: The DEA’s number one operational priority is to defeat the two Mexican cartels primarily responsible for trafficking fentanyl into the United States: the Sinaloa Cartel and the Jalisco (CJNG) Cartel. The agency pursues a prosecutor-led, intelligence-driven, multi-agency approach through Organized Crime Drug Enforcement Task Forces (OCDETF) to identify, disrupt, and dismantle these networks at every level.

DEA seizures are staggering—in 2024, the agency seized over 60 million fentanyl-laced fake pills and nearly 8,000 pounds of fentanyl powder, equivalent to more than 380 million lethal doses.

Combating Prescription Drug Diversion: While fentanyl is the primary threat, the DEA continues its traditional mission of diversion control. This involves investigating and bringing to justice unscrupulous doctors, pharmacists, and others who operate as “pill mills,” illegally diverting legitimate pharmaceutical controlled substances for non-medical use.

Recognizing that enforcement alone is not enough, the DEA has also become a major force in public engagement and prevention:

National Prescription Drug Take Back Day: This biannual event is one of the DEA’s most visible and successful community outreach programs. Twice a year, the DEA partners with thousands of state and local law enforcement agencies to host collection sites where the public can anonymously and safely dispose of unused or expired prescription medications.

Since its inception in 2010, the program has collected nearly 10,000 tons of medication.

“One Pill Can Kill” Campaign: In response to the wave of deaths from counterfeit pills, the DEA launched this major public awareness campaign to educate Americans, particularly young people, about the lethal danger of fake prescription pills. The campaign warns that pills purchased outside of a licensed pharmacy—often through social media—are frequently laced with a deadly dose of fentanyl.

Department of Justice: The Prosecutors

The Department of Justice brings the full weight of the U.S. legal system to bear on the opioid crisis. Its mission is to use every available criminal and civil tool to hold accountable all who have contributed to the epidemic, from international traffickers to corporate executives.

The DOJ’s litigation and enforcement strategy is multi-pronged:

Targeting the Entire Supply Chain: Through its Consumer Protection Branch, the DOJ pursues complex civil and criminal cases against entities all along the prescription opioid supply chain. This includes landmark litigation against opioid manufacturers for fraudulent marketing, distributors for failing to report suspicious orders, and pharmacies for dispensing opioids outside the bounds of legitimate medical practice.

The DOJ also works with international partners to target companies supplying the precursor chemicals and pill presses used to create counterfeit pills.

Multi-Agency Task Forces: The DOJ leads the nation’s Organized Crime Drug Enforcement Task Forces (OCDETF) program. This model unites the skills and resources of federal agencies like the DEA, FBI, and IRS with state and local law enforcement to conduct sophisticated, long-term investigations into the highest-level drug trafficking and money laundering organizations.

Grant Funding for Local Support: The DOJ’s Office of Justice Programs provides hundreds of millions of dollars in grant funding to state, local, and tribal partners. This funding supports a wide range of activities, including law enforcement anti-trafficking efforts, the establishment and operation of drug courts that provide treatment as an alternative to incarceration, and programs to support youth and families affected by the crisis.

Protecting Civil Rights: The DOJ’s Civil Rights Division plays a unique and critical role by enforcing the Americans with Disabilities Act (ADA) to protect people with Opioid Use Disorder from discrimination. The DOJ issues guidance and files lawsuits to ensure that individuals in treatment or recovery are not unfairly denied employment, housing, or access to public services.

The Border Security Force

The fight against fentanyl is, fundamentally, a fight at the border. The vast majority of this synthetic poison is manufactured abroad and smuggled into the United States. In response, the federal government has implemented a sophisticated, multi-layered “defense-in-depth” security posture.

This strategy extends far beyond a single wall or a line of officers. It begins overseas, with investigators working to disrupt threats before they launch. It continues at the physical border, with a massive interdiction effort to seize drugs at and between ports of entry. It concludes within the U.S., with agents dismantling the domestic networks that distribute any drugs that get through.

Department of Homeland Security: The Border Command

The Department of Homeland Security serves as the strategic command for the entire border security mission. It coordinates the efforts of its component agencies, primarily U.S. Customs and Border Protection (CBP) and U.S. Immigration and Customs Enforcement (ICE), in a layered strategy to stop not only finished fentanyl but also the precursor chemicals, pill presses, and die molds that transnational criminal organizations use to manufacture it.

In the last two fiscal years, DHS has stopped more illicit fentanyl and arrested more individuals for fentanyl-related crimes than in the previous five years combined.

DHS orchestrates large-scale, intelligence-driven operations that surge personnel and technology to high-threat corridors. These operations are designed to maximize interdictions and gather intelligence on criminal organization logistics and routes. Key examples include:

Operation Apollo: A major ongoing counter-fentanyl operation initially focused in Southern California and now expanded to Texas. It enhances intelligence sharing and operational collaboration between federal agents and state and local law enforcement partners to disrupt drug and chemical supply chains.

Operation Blue Lotus: A previous surge operation that concentrated CBP and HSI resources at Southwest Border ports of entry, working with state and local partners to expose trafficking networks. In its final week alone, one port of entry saw a 2000% increase in seizures.

U.S. Customs and Border Protection: The Interdiction Force

U.S. Customs and Border Protection is the nation’s frontline defense against the flow of illicit drugs. Its officers and agents are responsible for securing the 328 official ports of entry (air, land, and sea) and the thousands of miles of border between those ports.

CBP’s work has shattered a common misconception about how fentanyl enters the country. Data consistently shows that the overwhelming majority—more than 90%—of interdicted fentanyl is seized at official ports of entry. It is most often smuggled in privately owned vehicles driven by U.S. citizens, not carried by asylum-seeking migrants crossing the border between ports of entry.

To combat this threat, CBP employs a combination of officer expertise, canine detection teams, and increasingly, advanced technology. A cornerstone of its modern strategy is the large-scale deployment of Non-Intrusive Inspection (NII) systems.

These are essentially giant X-ray and gamma-ray scanners that can screen entire passenger vehicles and commercial trucks for hidden contraband, allowing officers to scan a much higher volume of traffic than is possible with physical inspections alone.

CBP’s seizure statistics are a stark indicator of the scale of the threat. In Fiscal Year 2023, DHS, primarily through CBP and HSI, seized over 43,000 pounds of fentanyl. These efforts prevent millions of lethal doses from reaching American communities every year.

U.S. Immigration and Customs Enforcement: The Investigators

While CBP secures the physical border, U.S. Immigration and Customs Enforcement, through its primary investigative arm, Homeland Security Investigations (HSI), is tasked with dismantling the criminal infrastructure behind the smuggling.

HSI agents are plainclothes federal investigators who work to take down the entire criminal enterprise, from the foreign sources of supply to the distribution cells operating in American cities.

HSI’s strategy for combating illicit opioids is built on a three-pronged approach that leverages its unique customs and financial authorities:

Pushing the Borders Out: HSI has the largest international investigative presence of any DHS component, with agents stationed in 91 offices across 54 countries. They work with foreign law enforcement partners, including through vetted Transnational Criminal Investigative Units (TCIUs), to identify and disrupt the sourcing of precursor chemicals and the manufacturing of fentanyl before it is ever shipped toward the U.S.

Securing the Border: HSI works alongside CBP at the border, but its role is investigative. When a seizure is made, HSI agents often take the lead on the follow-up investigation to identify the broader conspiracy and trafficking network. They lead Border Enforcement Security Task Forces (BEST), which bring together federal, state, local, and foreign partners to target cross-border crime.

Attacking Illicit Finance: A key part of HSI’s mission is to “follow the money.” Special agents investigate the complex financial transactions, including the use of virtual currency and other money laundering techniques, that transnational criminal organizations use to fund their operations and repatriate their profits.

This layered approach—with HSI working abroad, CBP at the line, and HSI investigating domestically—creates the robust “defense-in-depth” model that is central to the federal government’s border security strategy.

Global and Community Connections

The U.S. government’s battle plan recognizes a fundamental truth about the opioid crisis: it cannot be won solely within America’s borders or by traditional means alone. The fight requires a sophisticated, two-pronged “connector” strategy.

The Department of State leads the global effort, building diplomatic coalitions to choke off the international supply of synthetic drugs at its source. Simultaneously, agencies like the Federal Communications Commission work at a hyper-local level, building the modern digital infrastructure needed to deliver life-saving treatment to the most remote and vulnerable American communities.

Department of State: The Diplomatic Corps

The U.S. Department of State leads the nation’s diplomatic charge against the global synthetic drug threat. Through its Bureau of International Narcotics and Law Enforcement Affairs (INL), the State Department works to build international cooperation and mobilize a unified global response to a crisis that is increasingly affecting countries around the world.

The UN Office on Drugs and Crime reported that in 2019, nearly 62 million people worldwide misused opioids.

The State Department’s international strategy is multifaceted:

Bilateral and Multilateral Engagement: The U.S. engages directly with key source and transit countries. This includes pressing China to place controls on the precursor chemicals used to make fentanyl and collaborating with Mexico to enhance its law enforcement capacity to dismantle cartels and clandestine labs.

On the multilateral stage, the U.S. works through international bodies like the United Nations Commission on Narcotic Drugs in Vienna to achieve international scheduling of new fentanyl analogues and other dangerous substances, making it harder for criminals to produce and traffic them globally.

Global Coalition to Address Synthetic Drug Threats: Recognizing the need for a broader coordinated effort, the U.S. launched this coalition, which has united more than 140 countries and international organizations. The coalition focuses on preventing the illicit manufacture and trafficking of synthetic drugs, detecting emerging threats, and promoting public health interventions.

Foreign Assistance and Capacity Building: INL provides critical funding, training, and technical assistance to foreign law enforcement and justice sector partners. These programs help other countries improve their own ability to eradicate illicit crops, interdict drug shipments, and prosecute major traffickers.

Narcotics Rewards Program: The State Department manages this program, which offers rewards of up to $25 million for information leading to the arrest and conviction of major international narcotics traffickers, providing a powerful tool to take key figures off the board.

Federal Communications Commission: The Digital Bridge

While not a traditional health or law enforcement agency, the Federal Communications Commission plays a unique and increasingly vital role in the domestic response to the opioid crisis. The FCC’s contribution centers on bridging the treatment gap through technology, recognizing that telehealth is a powerful tool for expanding access to care, especially in the rural and underserved communities that have been hit hardest by the epidemic.

At the direction of Congress, the FCC developed its Mapping Broadband Health in America platform, a powerful data visualization tool that connects the dots between the opioid crisis and digital infrastructure.

The platform integrates and maps diverse datasets, including:

• Opioid mortality and prescription rates
• Data on health provider shortages, including mental health and substance use disorder specialists
• Detailed information on broadband internet access and adoption, down to the census tract level

By overlaying these datasets, the FCC’s map allows policymakers, public health officials, and healthcare systems to identify “hotspots”—areas with high rates of opioid overdose and a severe lack of in-person treatment providers, but where broadband connectivity could potentially support a robust telehealth response.

This data-driven approach helps target investments in both healthcare and broadband infrastructure, highlighting where a fiber-optic cable could become a literal lifeline by enabling virtual access to Medications for Opioid Use Disorder consultations, counseling, and recovery support services.

The federal response to America’s opioid crisis represents one of the most comprehensive government mobilizations in modern public health history. From the White House strategy rooms to rural emergency departments, from Mexican laboratories to American courtrooms, the battle spans every level of government and every corner of society.

The complexity of this response reflects the complexity of the crisis itself—a problem that began with well-intentioned medical practice, evolved through regulatory failures and corporate deception, and now encompasses international criminal organizations, synthetic chemistry, and digital-age drug distribution.

Success in this fight requires sustained coordination across dozens of agencies, each bringing specialized expertise to a shared mission. The data shows both progress and persistent challenges, with recent declines in some overdose deaths offset by the continued evolution of the drug supply and the emergence of new threats.

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