Fentanyl supply and seizure trends in the United States

The fentanyl crisis in the United States involves a massive supply of illicit substances, primarily driven by Mexican criminal organizations like the Sinaloa Cartel and CJNG. These groups press fentanyl into counterfeit pills designed to mimic prescription medications such as Xanax, oxycodone, and Percocet.

Data from 2025 shows the DEA seized over 47 million counterfeit pills and nearly 10,000 pounds of powder, totaling an estimated 369 million lethal doses. Research indicates that illicit fentanyl use in the U.S. is more than twice as common as medical use, with illicit-source users accounting for 71.1% of a large-scale study cohort. Illicit exposure also carries a nonfatal overdose risk up to three times higher than medical-source exposure.

By 2026, trends in the U.S. Midwest indicated a shift in the composition of the drug supply. While fentanyl pill seizures have declined, fentanyl powder seizures in the DEA’s Omaha Field Division increased by nearly 87% compared to the same period in 2025. This represents a significant change for a region where counterfeit pills have historically been the dominant form of the drug.