U.S. Flags India, Pakistan, China, Afghanistan in Major’s List on Drug Trafficking

In its latest submission to the U.S. Congress, President Donald Trump identified 23 countries as significant sources and/or transit points for illicit drugs, particularly fentanyl, which he described as a major threat to the American people. The list, known as the Major’s List, includes India, Pakistan, China, and Afghanistan.

The Major’s List is issued annually to highlight regions where geography, commerce, or industry play a role in the movement of narcotics and their precursor chemicals into global markets.

Fentanyl, a synthetic opioid first developed in the 1960s for medical use in extreme pain management, is currently the leading cause of overdose deaths in the U.S. While safe under regulated prescriptions, in illicit settings fentanyl is nearly 50 times more potent than heroin, with just 2 mg proving potentially fatal.

Medically, fentanyl binds to mu-opioid receptors on nerve cells that regulate pain, but in high doses it crosses the blood-brain barrier, concentrating in the central nervous system and depressing respiratory functions. This often results in hypoventilation and respiratory failure.

Unlike plant-derived narcotics such as heroin or cocaine, fentanyl is produced in laboratories using precursor chemicals. Key among these are N-phenethyl-4-piperidone (NPP) and 4-anilino-N-phenethylpiperidine (4-ANPP). While these compounds have legitimate industrial and pharmaceutical applications, they are increasingly being diverted into illicit drug supply chains, heightening global concerns.