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On March 28, 2019, the U.S. Department of State released the 2019 edition of the annual International Narcotics Control Strategy Report (INCSR) to Congress. This two-volume, Congressionally-mandated report assesses foreign governments’ efforts to reduce illicit drug production, trafficking, and use, as well as their work to counter drug trafficking-related money laundering. The INCSR was first published in 1986, and this edition covers calendar year 2018. This year’s INCSR stresses that the synthetic opioid-fueled drug crisis still gripping the United States represents a crisis across the globe. It also points to the continued growth in overseas production of cocaine as a problem that requires urgent international action. The report highlights not only increases in trafficking and abuse of fentanyl and other deadly synthetic ethamphetamine, but rampant heroin production in Afghanistan as well.