Just blocks from where U.S. President Joe Biden and his Chinese counterpart Xi Jinping will meet other Asia-Pacific leaders this week in San Francisco is a neighborhood where it is commonplace to see people using and selling drugs.
While the leaders are unlikely to see the blunt reality of the U.S. opioid crisis as they attend the Asia-Pacific Economic Cooperation (APEC) forum, it will be a topic of discussion when Biden and Xi meet one-on-one on Wednesday.
The United States wants China's cooperation to stop an illicit flow of "precursor" chemicals that are used to make fentanyl, which is up to 50 times stronger than heroin and is increasingly mixed with other drugs - often with lethal results.
In the first nine months of this year, 619 people died of an opioid overdose in San Francisco, most related to the synthetic opioids, compared with 647 such deaths in the whole of 2022, according to the city's Office of the Chief Medical Examiner.
"It's out of control," said Mike Odeh, 36, a salesperson at a liquor store near where APEC leaders will meet.
He said that while the city had been cleaning up the streets ahead of APEC, he normally sees people using fentanyl while walking his son to the park and to school, adding: "You can see it all over. Not this week of course."
Across the country the rate of drug overdose deaths involving fentanyl more than tripled from 2016 through 2021, according to the U.S. Centers for Disease Control and Prevention (CDC). Tens of thousands of people die annually from synthetic opioid overdoses, government statistics show.
U.S. National Security Advisor Jake Sullivan said on Tuesday that Washington hoped the Biden-Xi summit would result in action to combat the fentanyl trade. A source familiar with plans said the U.S. was ready to remove restrictions on the Institute of Forensic Science, part of China's Ministry of Public Security.
Washington put the institute on the Commerce Department's "entity list" in 2020 over alleged abuses toward Uyghurs and other minority groups - effectively barring it from receiving U.S. exports. China has long questioned why the U.S. would expect cooperation on fentanyl while targeting the institute.
CHINA, MEXICO, US STANCES
China's embassy in Washington declined to comment on the fentanyl issue. Chinese state media has repeatedly said addiction and demand for the drug are U.S. domestic problems.
U.S. officials say that small chemical businesses in China make precursor chemicals that are shipped to Mexico to produce illicit fentanyl, which is often mixed with other illegal drugs, sold as powders and nasal sprays, and increasingly turned into pills that look like legitimate prescription opioids. These are then smuggled into the United States, the officials say.
Last month, the United States imposed sanctions on 28 people and entities involved with the international proliferation of illicit drugs, including a large China-based network.
"We know that this global fentanyl supply chain, which ends with the deaths of Americans, often starts with chemical companies in China," said U.S. Attorney General Merrick Garland.
Advocates have also accused pharmaceutical companies and related businesses of fueling the crisis through downplaying the risks of opioids and lack of regulation. Landmark settlements since 2021 have set compensation at a total of more than $50 billion nationwide.
Biden is also due to meet with Mexican President Andres Manuel Lopez Obrador in San Francisco. Mexican Foreign Minister Alicia Barcena said talks would include how to better control the arrival from Asia of precursors used to make fentanyl.
In San Francisco, state and local officials have tried to clean up drugs from the city's streets, with limited success. The crisis has drawn sharp criticism from residents in the city, where drug-fuelled crime has forced some businesses to leave.
San Francisco's new district attorney, Brooke Jenkins, has made prosecuting drug dealers a cornerstone of her agenda. The city recently formed a law enforcement task force to investigate opioid-linked deaths and poisonings.
The city's Mayor London Breed has pushed to prioritize treatment for drug users, talked of police action as a way to solve the problem, and has called on the federal government to boost its drug trafficking enforcement.
"We know San Francisco - and cities across the United States - will benefit from more targeting of the trafficking and production of fentanyl worldwide," a spokesperson for Breed said in a statement.
