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1 UNCLASSIFIED //LAW ENFORCEMENT SENSITIVEUNCLASSIFIED//LAW ENFORCEMENT SENSITIVEUNCLASSIFIEDUNCLASSIFIEDUNCLASS IFIEDUNCLASSIFIEDThis page intentionally left National Drug Threat AssessmentDrug Enforcement AdministrationThis product was prepared by the DEA Strategic Intelligence Section. Comments and questions may be addressed to the Chief, Analysis and Production Section, at page intentionally left National Drug Threat AssessmentUNCLASSIFIEDUNCLASSIFIEDTABLE OF CONTENTS Letter from the Acting Administrator.

2 Iii Executive Summary ..v Controlled Prescription Drugs ..1 Heroin ..11 Fentanyl and Other Synthetic Opioids ..21 Cocaine ..39 Methamphetamine ..59 Marijuana ..77 New Psychoactive Substances (NPS) ..89 Transnational Criminal Organizations ..97 Gangs ..107 Illicit Finance ..123 Puerto Rico and the Virgin Islands ..131 Guam ..135 Tribal Lands ..137 Appendix A: Additional Tables ..140 Appendix B: Twenty-Three DEA Field Divisions ..144 Appendix C: National Drug Threat Assessment Scope and Methodology.

3 145 Appendix D: Acronym Glossary ..1462018 National Drug Threat AssessmentiiUNCLASSIFIEDUNCLASSIFIEDThis page intentionally left National Drug Threat AssessmentUNCLASSIFIEDUNCLASSIFIEDLETTER FROM THE ACTING ADMINISTRATORI am pleased to present the 2018 National Drug Threat Assessment (NDTA), a comprehensive, strategic assessment of the illicit drug threats posed to our NDTA was produced in partnership with local, state, tribal, and federal agencies. It integrates reporting from law enforcement, intelligence, and public health agencies to provide timely, strategic drug-related intelligence to formulate counterdrug policies.

4 Further, it helps law enforcement personnel, educators, and prevention and treatment specialists establish priorities and allocate trafficking and abuse of illicit drugs poses a severe danger to our citizens and a significant challenge for our law enforcement and health care systems. Through robust enforcement, public education, prevention, treatment, and collaboration with our partners, we can protect our citizens from dangerous drugs and their dire you to our partners for their contributions to this report.

5 Your input continues to help us meet the needs of the law enforcement, intelligence, prevention, and treatment provider communities as well as shape counterdrug policies. My colleagues and I at DEA look forward to collaborating on future strategic counterdrug initiatives that impact our national security interests, at home and ,Uttam Dhillon Acting AdministratorDrug Enforcement Administration2018 National Drug Threat AssessmentivUNCLASSIFIEDUNCLASSIFIEDThis page intentionally left National Drug Threat AssessmentUNCLASSIFIEDUNCLASSIFIEDEXECUT IVE SUMMARYF igure 1.

6 Number of Injury Deaths by Drug Poisoning, Suicide, Homicide, Firearms, and Motor Vehicle Crashes in the United States, 1999 20152 Source: Centers for Disease control and Prevention1 Analyst Note: The information in this report is current as of August Drug overdose deaths are identified using ICD-10 underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14. Drug overdose deaths involving selected drug categories are identified using ICD-10 multiple cause-of-death codes: heroin, ; natural and semisynthetic opioids, ; methadone, ; synthetic opioids other than methadone, ; cocaine, ; and psychostimulants with abuse potential, Categories are not mutually exclusive because deaths may involve more than one drug.

7 Also, not all states report death data the same or at all to the Centers for Disease control and Prevention (CDC), meaning nationwide counts of drug overdose deaths, especially deaths by a specific drug(s), may vary from statewide counts. As a result, CDC has stated the true number of drug overdose deaths is almost certainly much higher than the numbers officially 2018 National Drug Threat Assessment (NDTA)1 is a comprehensive strategic assessment of the threat posed to the United States by domestic and international drug trafficking and the abuse of illicit drugs.

8 The report combines federal, state, local, and tribal law enforcement reporting; public health data; open source reporting; and intelligence from other government agencies to determine which substances and criminal organizations represent the greatest threat to the United States. Illicit drugs, as well as the transnational and domestic criminal organizations who traffic them, continue to represent significant threats to public health, law enforcement, and national security in the United States. Drug poisoning deaths are the leading cause of injury death in the United States; they are currently at their highest ever recorded level and, every year since 2011, have outnumbered deaths by firearms, motor vehicle crashes, suicide, and homicide.

9 In 2016, approximately 174 people died every day from drug poisoning (see Figure 1). The opioid threat (controlled prescription drugs, synthetic opioids, and heroin) has reached epidemic levels and currently shows no signs of abating, affecting large portions of the United States. Meanwhile, as the ongoing opioid crisis justly receives national attention, the methamphetamine threat remains prevalent; the cocaine threat has rebounded; new psychoactive substances (NPS) are still challenging; and the domestic marijuana situation continues to evolve.

10 2018 National Drug Threat AssessmentviUNCLASSIFIEDUNCLASSIFIEDC ontrolled Prescription Drugs (CPDs): CPDs are still responsible for the most drug-involved overdose deaths and are the second most commonly abused substance in the United States. As CPD abuse has increased significantly, traffickers are now disguising other opioids as CPDs in attempts to gain access to new users. Most individuals who report misuse of prescription pain relievers cite physical pain as the most common reason for abuse; these misused pain relievers are most frequently obtained from a friend or : Heroin use and availability continue to increase in the United States.