A report released by the Mexican government Friday says the country is facing a dire shortage of fentanyl for medical use, even as Mexican cartels pump out tons of the illicit narcotic.

The paradox was reported in a study by Mexico’s National Commission on Mental Health and Addictions. The study did not give a reason for the shortage of the synthetic opioid, which is needed for anesthesia in hospitals, but claimed it was a worldwide problem.

The commission said fentanyl had to be imported, and that imports fell by more than 50% between 2022 and 2023.

Nonetheless, Mexican cartels appear to be having no problem importing tons of precursor chemicals and making their own fentanyl, which they smuggle into the United States. The report says Mexican seizures of illicit fentanyl rose 1.24 tons in 2020 to 1.85 tons in 2023.