Sinaloa Cartel Presence and Its Impact on Fentanyl Mortality in the United States

Abstract: The deadliest phase of the U.S. opioid epidemic was driven by illicitly manufactured fentanyl: annual fentanyl deaths rose from roughly 3,000 in 2013 to over 70,000 by 2022. I show that the Sinaloa Cartel played a key role in where and when this wave hit hardest. Among Mexican trafficking organizations, Sinaloa was uniquely positioned to produce and distribute fentanyl at scale, with synthetic-drug labs, precursor supply chains, and U.S. wholesale networks already built for heroin and methamphetamine. Using DEA intelligence on cartel control, I classify U.S. counties by pre-2014 Sinaloa dominance and compare them to counties dominated by rival cartels in an event-study difference-in-differences design. After 2014, fentanyl mortality in Sinaloa-dominated counties rose by 5.5 deaths per 100,000 relative to rival-dominated counties, about 30% of the overall rise in fentanyl mortality in my sample. The effect is specific to fentanyl, with no impact on non-fentanyl mortality or violent crime. The burden is concentrated among non-college-educated adults and, unlike in earlier waves, rises across all racial and ethnic groups, with the largest increase among Hispanic residents.

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