The dozen packages were shipped from China to mail centers and residences in Southern California. One box was labeled as a “Hole Puncher.”

In fact, it was a quarter-ton pill press, which federal investigators allege was destined for a suburban Los Angeles drug lab. The other packages, shipped throughout January and February, contained materials for manufacturing fentanyl, an opioid so potent that in some forms it can be deadly if touched.

When it comes to the illegal sale of fentanyl, most of the attention has focused on Mexican cartels that are adding the drug to heroin smuggled into the United States. But Chinese suppliers are providing both raw fentanyl and the machinery necessary for the assembly-line production of the drug powering a terrifying and rapid rise of fatal overdoses across the United States and Canada, according to drug investigators and court documents.

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“We have seen an influx of fentanyl directly from China,” said Carole Rendon, the acting US attorney for the northern district of Ohio in Cleveland. “It’s being shipped by carrier. It’s hugely concerning because fentanyl is so incredibly deadly.”

The China connection is allowing local drug dealers in North America to mass produce fentanyl in pill form, in some cases producing tablets that look identical to an oft-abused version of the prescription painkiller OxyContin. It also has been added to Xanax pills. And last week, fentanyl pills made to resemble the painkiller hydrocodone were blamed for a wave of overdoses in the Sacramento area, including nine deaths.

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The fentanyl pills are often disguised as other painkillers because those drugs fetch a higher price on the street, even though they are less potent, according to police.

The Southern California lab was just one of four dismantled by law enforcement in the United States and Canada in March.

Packaged fentanyl seized in Calgary, Alberta. Calgary Police Service

In British Columbia, police took down a lab at a custom car business that was allegedly shipping 100,000 fentanyl pills a month to nearby Calgary, Alberta where 90 people overdosed on the drug last year. The investigation began when border authorities intercepted a package in December containing pharmaceutical equipment. Police would not describe the equipment but told STAT it came from China.

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Federal agents shut down a Seattle lab set up in the bedroom of a home in a residential neighborhood. Similarly, investigators last week raided a suburban Syracuse, N.Y. residence that police charged was a “Fentanyl Processing Mill.” Investigators found six people inside the home mixing and packaging the drug and seized enough fentanyl to make 5,866 doses. As they entered the home, police reportedly were warned by the alleged dealers not to touch the fentanyl without gloves because of its potency.

The emergence of decentralized drug labs using materials obtained from China — and often ordered over the Internet — makes it more difficult to combat the illicit use of the drug.

“We had a spike in 2007” of fentanyl-related deaths, said Russell Baer, a spokesman for the federal Drug Enforcement Administration. “We traced it to a single production lab in Mexico and the deaths went away. Now, it is not restricted to one site.”

Fentanyl is legally used to treat people with severe pain, often after surgery, but this prescription fentanyl is not the source of most of the illegal trade.

People who unknowingly take fentanyl — either in pill form or when cut into heroin — can easily overdose because it is up to 100 times more potent than morphine and many times that of heroin, according to the Centers for Disease Control and Prevention. It works quickly, and multiple doses of the antidote naloxone are often required to reverse an overdose.

US health and law enforcement officials began warning of a spike in fentanyl deaths last year, a trend that has continued into this year. Fentanyl has surpassed heroin as a killer in several locales. A recent report by the CDC identified 998 fatal fentanyl overdoses in Ohio in 2014 and the first five months of 2015. Last month, federal prosecutors in Cleveland charged a local man with selling blue pills that appeared to be 30 milligram doses of the milder painkiller oxycodone. When tested, the 925 pills in his possession turned out to be fentanyl.

“One of the truly terrifying things is the pills are pressed and dyed to look like oxycodone,” said Rendon. “If you are using oxycodone and take fentanyl not knowing it is fentanyl, that is an overdose waiting to happen. Each of those pills is a potential overdose death.”

In Calgary, the fentanyl pills were produced to look similar to a version of OxyContin that was easily abused before it was replaced in 2012 by a tamper-resistant form, according to police. The pills are the same shade of green as OxyContin and are marked “80”, which was a frequently abused dosage of the drug. On the street, the fentanyl pills are called “shady 80s,” said Calgary Police Sergeant. Martin Schiavetta. They are sold for about $20 a pill, and some addicts take 15 to 20 pills a day.

“We have tracked the import from China,” Schiavetta said of fentanyl sold in the Canadian city. “The dealers ask for fentanyl powder and there are websites that guarantee delivery. If it is stopped at the border, they will send you a new one.” He said the packages are labeled as different products, such as car parts.

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In Edmonton, Alberta, police inspector Dwayne Lakusta said fentanyl and pill presses are coming from China. “It is getting worse,” he said of that city’s fentanyl problem. “We will be battling this every day moving forward.”

Federal agents in Southern California became aware of the fentanyl operation there when a US Customs and Border Protection agent discovered a commercial pill press being sent from China to Gary Resnik, a Long Beach, Calif., man who has since been charged in the drug ring along with three other men.

Resnik allegedly set up a company called “Beyond Your Dreams” to order the machine, which was shipped through Los Angeles International Airport by a Chinese company called Capsulcn International, according to court records. Those records allege the Chinese company has a history of shipping pill presses to customers in the United States using fake shipping labels. Attempts to identify a specific location of the company and contact information were unsuccessful.

Pill press seized in British Columbia in March. RCMP

Federal agents eventually seized six pill presses they allege were used by the Southern California dealers. Each machine could produce thousands of pills an hour.

The dealers allegedly operated one lab out of a single-story home they rented in Baldwin Park, Calif. Investigators believe none of the men arrested actually lived there. DEA agents and technicians wearing bright-yellow hazardous material suits shut down the lab on March 15.

A storage unit was rented to house supplies and equipment. Agents also discovered handwritten notes listing ingredients and mixtures necessary to manufacture the fentanyl pills, according to court records.

The drug allegedly sold by the Los Angeles dealers was a fentanyl analog, called acetyl fentanyl, which has a slightly different chemical composition. Federal investigators have identified a dozen analogs of fentanyl produced in clandestine labs, all of which act similarly in the body to heroin, with the exception of being more potent.

China last year made it illegal to export acetyl fentanyl, a move that drew praise from US officials. However, several police agencies in North America say the drug continues to stream out of the country.

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A report this month from the Department of State’s Bureau for International Narcotics and Law Enforcement Affairs found China remains a major producer and exporter of drugs like fentanyl for illicit international markets. The country’s vast chemical and pharmaceutical industries — combined with lax regulation, low production costs, and government corruption — make China an “ideal source” for the export of materials needed in illicit drug production, according to the report.

In an affidavit, DEA agent Lindsey Bellomy said that based on wire transfers and other evidence, she “strongly believes” the Southern California group acquired its fentanyl from China. The affidavit lists a dozen deliveries from China to members of the group in January and February.

When police stopped one customer after he allegedly purchased fentanyl from the group, he was found to have “several thousand pills” later determined to be acetyl fentanyl by lab technicians. The customer told police he purchased drugs from the group every couple of days, and that he, in turn, sold his buyers a minimum of 1,000 pills, a quantity known as “a boat.”