The Fentanyl Paradox: Why We Know the Supply Chains of Drug Cartels Better Than Those of Pharmaceutical Companies

Fentanyl, a powerful opioid, relieves pain in hospitals but destroys lives in drug scenes. The origin of the raw material often leads to the same place in both scenarios. Enea Martinelli, a hospital pharmacist, wishes to know more about the supply chains of medications due to his interest and to anticipate supply shortages. He traced the origin of the Fentanyl in Fentanyl patches used by hospital doctors, but it led him no further than the pharmaceutical company Bichsel.

Very few medications show this lack of transparency as much as Fentanyl, which is a crucial pain reliever in modern medicine. Physicians inject it for anesthesia during surgeries, and cancer patients use Fentanyl patches for pain relief. Swiss doctors and pharmacists prescribed around 288,000 Fentanyl preparations in 2025, while in the US, 1.9 million doses were administered in 2023.

Meanwhile, Fentanyl is a warning signal of the drug crisis in the US. A milligram of the opioid can cause a high, and two milligrams can be fatal. Thousands of people have died from overdoses in the past decade. The illegal trade thrives, with the US Drug Enforcement Agency seizing over 47 million falsified Fentanyl tablets and nearly 4,500 kilograms of Fentanyl powder in 2025.

This amounts to more than 369 million lethal Fentanyl doses. The paradox is that much is known about the smuggling routes of drug cartels, but almost nothing about the legal supply chains of pharmaceutical companies. This raises a troubling question: Do the two supply chains intersect? Both drugs and medicines are the same substance.

Like gold, crude oil, or cocoa beans, many chemicals are globally traded raw materials. They are interchangeable and travel from one middleman to another, making their origin difficult to trace and increasing the risk of overlap between legal and illegal supply chains. The NZZ investigated a Fentanyl patch and interviewed pharmaceutical companies, supply chain experts, and analyzed trade data from various countries.

When a Swiss hospital prescribes a Fentanyl patch, patients often receive a box containing Mepha Teva, Sandoz, or Spirig products. However, these three pharmaceutical companies do not produce the patches themselves; they only distribute them in Switzerland. They handle licensing with the Swissmedic drug authority and marketing and sales.

The production of the patch is done by a contract manufacturer. The active ingredient Fentanyl, which gives the patch its pain-relieving effect, is sourced from a manufacturer of active ingredients. The manufacturer combines the active ingredient with various precursor chemicals like sodium and piperidine in a chemical process. These precursor chemicals come from numerous suppliers.

In theory, every step is known, but in practice, the trace ends at the active ingredient manufacturer. Major suppliers of Fentanyl patches in Switzerland reveal little. Mepha Teva states that customers must obtain the patches from a "production partner," without disclosing the name of the partner. They also do not reveal the country where the partner is located or where the active ingredient Fentanyl is purchased.

Mepha Teva at least names its contract manufacturer: Luye Pharma in Germany. The patch is produced in a factory in Miesbach, Germany, and Luye Pharma sources the active ingredient from three different manufacturers: one in South Africa, one in Germany, and one in Scotland. Transparency ends there. Mepha Teva refuses to disclose the names of the precursor chemical manufacturers, and Swissmedic provides no information, referring to the right of pharmaceutical companies to maintain business secrets.

The legal supply chain of Fentanyl is buried under layers of secrets. However, following the illegal trade routes of drug cartels reveals hints about the origin of the precursor chemicals for pharmaceutical Fentanyl. The US Drug Enforcement Agency's investigations show that criminal organizations in Canada and primarily cartels in Mexico source precursor chemicals from China and increasingly from India.

In underground labs, they process these chemicals into Fentanyl and smuggle it into the US. Even the supply chains for medical Fentanyl patches often lead to China. China is the world's largest chemical industry, supplying chemicals to the entire world. Stephan Wagner, a professor of supply chain management at ETH Zurich, estimates that about 40% of all pharmaceutical active ingredients come from China, with precursor chemicals even accounting for up to 60%.

In Europe, this percentage is only 15-20%, and in the US, even less. "The further one traces the supply chains of a Fentanyl patch, the higher the likelihood that the supplier is located in China," Wagner says.