YICHANG, China — Behind a large glass wall, a worker in full protective gear watches as hundreds of tiny bottles pass by every minute, being sterilized, filled and packaged by a ballet of robotic arms.
Inside each ampoule is the substance that lies at the heart of the geopolitical conflict between the United States and China: fentanyl, the deadly opioid that is set to be high on the agenda when Presidents Donald Trump and Xi Jinping meet on Thursday.
NBC News was given exclusive access to the headquarters of Yichang Humanwell Pharmaceutical, the largest producer of the drug in China, and indeed Asia, at its sprawling complex in the central city of Yichang.
Humanwell says it provides fentanyl for hospital use only, and that it does not export any of the drug to the United States, Mexico or Canada. In 51 years of business, “We have never had a single drug go missing, never a single dose gone missing,” the company’s president, Du Wentao, said in an interview inside his factory, which is surrounded by high fences wrapped in razor wire and electrical sensors.
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Humanwell Healthcare is one of only five companies in China licensed to produce fentanyl for use in hospitals, and produces about 100 million doses of fentanyl variants each year.
After a rigorous registration process to pass through the main gate, all visitors and employees alike – including the CEO – are required to wear blue hospital hats, shoe covers and lab coats to ensure they do not contaminate the work space.
Most production lines are automated to limit human contact, with vials washed, sterilized and then filled with fentanyl using long rubber tubing.
The operation was supervised by two workers wearing protective clothing, with an alarm sounding every 10 minutes to remind them to spray their hands with disinfectants. The vials are then scanned using flashes of light, sealed, boxed and shipped through the warehouse.
Trump says fentanyl will be the subject of his “first question” when he meets with Xi in South Korea, the final stop of his three-nation Asian tour.
U.S. officials say the Chinese government has not done enough to stop the illicit international flow of fentanyl precursor chemicals, which are then processed into a highly addictive opioid in Mexican laboratories and smuggled across the border into the United States. Although deaths appear to be declining in the United States, fentanyl and other synthetic opioids have killed hundreds of thousands of Americans in recent years, according to the Centers for Disease Control and Prevention.
Trump, who has cited fentanyl as a reason for imposing his first 20% tariffs on China since regaining office in January, said Wednesday that he believes China “will help us put the fentanyl in” and the tariffs will be reduced accordingly.
China defended its efforts to combat fentanyl, saying that the continued American demand for the drug was the cause of the crisis.
but State Department report to Congress last month He accused the ruling Chinese Communist Party of continuing to “support and incentivize companies based in China to export synthetic drug precursors, including through tax rebates, grants, cash prizes and official site visits.” It accused companies controlled by the Communist Party of being “complicit in this illegal trade.”
Under pressure from Trump, China made fentanyl a controlled substance in 2019, banning its use outside of prescriptions. This has slowed the flow of Chinese fentanyl into the United States, but “heavy exports of precursor chemicals and other illicit drugs remain,” the State Department report said.
Chinese officials reject this account.
“China expresses its sympathy to the American people who are suffering from the fentanyl crisis,” Foreign Ministry spokesman Guo Jiaqun told reporters in Beijing on Wednesday.
But he added, “China is the most assertive country in the fight against drugs, with the most comprehensive policies and the best record. It is also one of the countries with the largest number of controlled substances and the strictest regulations in the world.”
Doe, president of Humanwell Healthcare, which produces 100 million doses a year of fentanyl-based products, says the clean, automated and closely monitored process noted by NBC News was not a facade.
“China’s fentanyl drug management is among the strictest in the world,” he said. “There is absolutely no possibility of any dose from our company flowing into the United States. I can say that with complete confidence and certainty – there is no problem at all.”
He mocked “the many statements in the United States claiming that the fentanyl crisis originated in China,” saying that was impossible “given how stringent our controls are.”
In addition to the visit to Humanwell, NBC News gained exclusive access to the National Drug Intelligence Center in Beijing, which Washington imposed sanctions on in 2020 but whose measures were lifted three years later during the Biden administration as the two countries agreed to resume cooperation on fentanyl.
There, Chinese security officials said the two sides were again exchanging information on how smugglers had changed their ways.
Fentanyl precursors “are actually one of our main interests because drug manufacturing technologies and methods are constantly evolving,” lab director Hua Zhendong told NBC News.
“We have not found such factories locally,” he said, so “most of the relevant information comes from technical exchanges with American counterparts.”
The latest chemicals identified by the United States “have been added to our watch list so that we can enhance our interest in these substances,” Hua said.
He said banning all fentanyl products outside of medical use in 2019 had “effectively curbed illegal production and trafficking.”
US officials say this is not the case. The extent to which Washington and Beijing can find common ground on the issue is likely to influence the outcome of Trump and Xi’s meeting this week, although experts say stopping the illicit flow of fentanyl components is easier said than done.
“I think there’s an assumption here that if the Chinese really wanted to stop these precursors, they could do it,” said Michael Swain, a senior research fellow in the East Asia Program at the Quincy Institute for Responsible Statecraft, a Washington-based think tank.
The problem, he said, is that there is “no set number” of fentanyl precursors.
“You don’t have a clear list of specific items that you can easily prevent,” Swain said. “A lot of them, of course, are very dual-use items.”
So, while there may be a “token effort” to deal with the fentanyl issue at the Trump-Xi meeting, he said, “I don’t think this will completely go away.”