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On February 4, World Cancer Day, when the world focussed on fighting one of the deadliest diseases, the United States and China—two of the biggest economies—were caught in a serious trade and tariff war. The main reason behind this conflict was the fentanyl crisis in the US. The US government responded by imposing new tariffs on Chinese goods. In response, China announced counter-tariffs of 10-15 per cent on US products, starting February 10.
This trade war highlights not only economic tensions between the two countries but also how complex the fentanyl issue is. It is not just about trade—it also connects to healthcare, international relations and policies that affect both nations.
Fentanyl as a national security threat in US
From the perspective of the second Trump administration, fentanyl is an existential crisis for American society, with drug overdoses from synthetic opioids rising sharply in recent years. Washington has long blamed China for being a major source of fentanyl and its precursor chemicals, contributing to an illegal drug trade that has severely harmed American communities.
In response, the administration imposed tariffs on Chinese goods, aiming to pressure Beijing into taking stronger action against fentanyl-related exports. However, Chinese state media outlet The Global Times argues that the crisis is mainly driven by factors within the US, such as domestic demand, regulatory gaps and illegal supply chains that extend beyond national borders. Without addressing these core issues, unilateral trade measures might end up being more symbolic than truly effective.
China’s counterargument
Beijing has repeatedly denied claims that it is the main cause of the US fentanyl crisis. Instead, it argues that the real problem lies in the high demand for fentanyl within the US. Chinese experts say that illegal fentanyl production continues because of the availability of synthetic alternatives and weakly regulated pharmaceutical supply chains.
Rather than tackling these root causes, Washington’s strategy of using trade pressure does not lead to lasting solutions. The Chinese outlet said a more effective approach would be for both countries to work together by strengthening law enforcement cooperation, tightening regulations, and improving intelligence-sharing to stop the trafficking networks that spread fentanyl.
Fentanyl and cancer: A complex relationship
Fentanyl is widely known for its role in the opioid crisis, but it is also a crucial drug for managing cancer pain. Many cancer patients, suffering from severe pain due to tumours, chemotherapy, or surgery, rely on fentanyl for relief. It comes in different forms, such as patches, lozenges and injections, and is preferred because it is very strong and causes less kidney damage than morphine. However, using fentanyl for a long time can lead to dependence, tolerance and even addiction, making it a challenge to balance its medical benefits with the risk of misuse.
Due to the opioid crisis, fentanyl now faces stricter regulations, which has unintentionally made it harder for cancer patients to get the medication they need. The stigma around opioids has led to tighter prescription rules, while illegal fentanyl—often mixed with heroin or cocaine—continues to fuel overdose deaths. This situation shows the difficulty of controlling a drug that is both a life-saving medicine and a dangerous substance of abuse.
The fentanyl economy
Despite its controversial reputation, the global fentanyl market is growing quickly. Research Nester estimates that the market size was over $17 billion in 2024 and is expected to cross $37 billion by 2037, with an annual growth rate of more than 6.4 per cent. The main reason for this growth is the rising number of cancer cases worldwide, as cancer remains one of the leading causes of death. According to the WHO, cancer-related deaths increased from 9.6 million in 2018 to over 10 million in 2020. This has pushed governments and healthcare institutions to invest more in pain management solutions, including fentanyl-based treatments.
Another factor driving the fentanyl market is the rise in global healthcare spending. The World Bank reported that healthcare spending per person increased from $999 in 2015 to $1,111 in 2018. As awareness grows about fentanyl’s medical benefits, its demand in cancer treatment centres and palliative care facilities is expected to increase, despite strict regulations.
The rapid expansion of the global fentanyl market is further driven by several key factors. The ageing population is a major contributor, with the proportion of individuals over 60 expected to double from 12 per cent in 2015 to 22 per cent by 2050. As age-related diseases like cancer become more common, the demand for fentanyl-based pain management is likely to rise. Additionally, the increasing incidence of cancers with high survival rates, such as breast and prostate cancer, necessitates long-term pain relief solutions, reinforcing fentanyl’s medical importance.
At the same time, surging healthcare expenditure is supporting this growth. According to Research Nester, Global healthcare spending as a share of GDP rose from 8.5 per cent in 2000 to nearly 10 per cent in 2019, reflecting greater investment in medical treatments. Specifically, oncology-related spending has seen a significant increase, jumping from $85 billion in 2015 to $185 billion in 2021. This substantial investment in cancer care highlights the continued demand for effective pain management solutions like fentanyl, despite ongoing regulatory and ethical concerns surrounding its misuse.
The fentanyl irony
The ongoing US-China trade dispute over fentanyl highlights a deeper challenge: how to regulate a substance that is both a vital medicine and a dangerous drug. While Washington tries to reduce fentanyl trafficking through tariffs, this approach does not address the demand within the US. that fuels the crisis. On the other hand, China argues that the problem lies in US regulatory gaps and domestic consumption, but this does not completely absolve Beijing, as some illegal fentanyl does come from Chinese sources. As the world struggles with both opioid addiction and the need for effective cancer pain management, fentanyl remains a critical issue in public health and global diplomacy.