US tariffs vs Fentanyl: What does the opioid do to the body? Will trade barriers impact costs of other drugs?

First, what is fentanyl?

Fentanyl is a potent, fast-acting synthetic opioid, meaning it can be chemically manufactured in a laboratory. To compare, opioids such as morphine and codeine are derived from the opium poppy plants. These are a class of medication usually used for the management of severe pain in cancer patients or those who have undergone various surgeries.

What is the health impact of Fentanyl addiction?

These drugs can be extremely addictive. What makes Fentanyl a bigger problem is that it can be 30 to 100 times more potent than heroin or morphine and is fast-acting, leading to a rapid and high number of overdose deaths. Fentanyl-related overdoses resulted in more than 69 per cent of the total overdose deaths in the US.

Does India manufacture Fentanyl?

With India providing affordable, generic medicines to the world, it also manufactures synthetic opioids such as Fentanyl and Tramadol. However, it is not the legal export of the drug that is a cause of concern. Illicit trade of Fentanyl and its precursor chemicals NPP and ANPP are what the US is targeting.

While China continues to be the primary source of these chemicals, there has been some shift of illicit manufacturing to India after China strengthened its regulations on NPP and ANPP in 2018. A 2020 intelligence report from the US Drug Enforcement Administration says that a tip-off from it led to the takedown of an illicit laboratory in Indore in 2018. An Indian national associated with the Mexican Sinaloa Cartel was supplying precursor chemicals, according to the report.

The report also said that 100kg of NPP was seized and four Indian nationals arrested by Mumbai’s Anti Narcotic Cell in December 2018 in another incident. Again, the chemical was destined for Mexico and deliberately mislabelled.

Earlier this year, two India-based companies, Raxuter Chemicals and Athos Chemicals, were charged with criminal conspiracies to distribute and import Fentanyl precursor chemicals to the US, according to the US Department of Justice.

Which opioids are used in India?

In India, heroin and its derivatives like smack continue to be the most common opioids leading to addiction. An estimated 63 lakh people are addicted to heroin as compared to 25 lakh to pharmaceutical opioids, according to 2019 survey called Magnitude of Substance Use in India by the AIIMS National Drug Dependence and Treatment Centre.

What will be the impact of tariffs on India’s pharmaceutical industry?

Any tariff imposed on pharmaceuticals by the US is likely to have a significant impact on the Indian industry, considering US is the largest importer of the country’s drugs. The US accounted for 31.3 per cent of all drugs exported from the country in 2024. The second largest importer is the UK, which accounted for only 2.8 per cent of the imports, according to data from Pharmaceutical Export Promotion Council of India (Pharmexcil).

Around 10 per cent duty is imposed on pharmaceutical products from the US, while barely any duty is imposed on Indian drugs in the US. Any reciprocal tariff may increase the price of the products in the US.

This is important considering Indian companies supplied 47 per cent of all generic medicines prescribed in the US. In fact, Indian companies supplied more than half of the prescriptions of five of the ten most common therapy areas — hypertension, mental health, medicines to control lipids, medicines for nervous system disorders, and anti-ulcer drugs. Medicines from Indian companies provided $219Bn in savings to the US healthcare system in 2022, according to data from IQVIA.