If enacted, the legislation would enable the Department of Health and Human Services to use Title 42 expulsion procedures and the Remain in Mexico policy to help combat the smuggling of fentanyl into the United States.

In the 117th Congress, the bill was blocked by president pro tempore Patty Murray, on grounds related to the expiration of Title 42 expulsion procedures.

The bill, akin to its name, modifies Title 18 of the United States Code, specifically sections 1111, to give capital punishment or life imprisonment to individuals who knowingly distribute fentanyl that causes a death.

Rubio and Gonzales further argued that the Biden administration should do more to prevent illegal narcotics from entering the country, especially those which can tie their origins to the People's Republic of China.

[18] The Justice Against Sponsors of Illicit Fentanyl Act of 2023 was introduced by Republican Senator John Thune of South Dakota.

The bill, referred to the House committees on the Judiciary as well as on Energy and Commerce, would permanently designate fentanyl as a Schedule 1 narcotic under the Controlled Substances Act.

The bill has received opposition from some organizations for criminalizing chemically similar substances that potentially can be used for legitimate medical purposes or therapies; such backers of this argument include the American Civil Liberties Union and Human Rights Watch.

[23][24] The legislation specifically sanctions, at the direction of the president, key figures in drug cartels and fentanyl trafficking operations, and additionally enables the executive branch to use proceeds from seized fentanyl-trafficking assets for further enforcement of the legislation, and authorizes the Department of the Treasury to utilize special measures to combat money laundering in relation to fentanyl.

[25] The FEND Off Fentanyl Act, though not advancing beyond the Senate as an individual bill, was signed into law as part of Public Law 118-50, a package of emergency spending legislation, which included emergency spending for Ukraine, Israel and Taiwan, as well as the Protecting Americans from Foreign Adversary Controlled Applications Act itself colloquially known as the "TikTok ban.