Purpose of Review <p>The rapid proliferation of synthetic opioids, particularly fentanyl and its analogues, has intensified the opioid crisis, highlighted the limitations of fragmented approaches to opioid use disorder (OUD), and heightened tensions between the United States and China. This narrative review compares public health policy responses in the United States and China across four key domains: demand reduction, harm reduction, supply control, and governance coordination, to evaluate how integrated governance can improve outcomes. </p> Recent Findings <p>In the United States, there has been substantial progress in expanding opioid agonist treatment, naloxone distribution, and low-threshold services. However, persistent fragmentation across healthcare, public health, criminal justice, and social services continues to limit long-term recovery. In China, sustained declines in registered drug users over seven consecutive years and improvements in community-based rehabilitation reflect a more coordinated system linking treatment, rehabilitation, and social reintegration, although new challenges have emerged from the rising non-medical use of prescription medicines, veterinary anesthetics, and new psychoactive substances. Regulatory control of supply chains, upstream targeted interdiction,expanded treatment access, and harm reduction strategies may contribute collectively to recent reductions in drug overdose deaths in the United States.</p> Summary <p>An effective response to synthetic opioids requires aligning demand reduction, harm reduction, and supply control strategies within a unified public health framework. Public health can serve as a practical bridge across differing policy systems and provide a foundation for sustained international cooperation in the synthetic opioid era.</p>