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At the G-20 summit in Buenos Aires in December, U.S. President Donald Trump announced that his Chinese counterpart, Xi Jinping, had agreed to tighten China’s controls over manufacturing fentanyl, a powerful synthetic opioid that is orders of magnitude stronger than heroin.

First synthesized in 1960, fentanyl is regularly used as a fast-acting general anesthetic in surgeries. Yet over the past four years, illicit fentanyl, much of it produced in China and mailed to U.S. buyers, has emerged as the major driver of fatal overdoses in the United States. In 2013, the National Forensic Laboratory Information System, which collects information on drugs seized and identified by U.S. law enforcement, had only 934 reports of fentanyl. The next year, it had more than 5,000 reports of fentanyl and in 2017, nearly 59,000. Over the same time period, the number of fatal drug overdoses in the United States rose from around 44,000 to 70,237. Of those, the number involving synthetic opioids other than methadone—a category dominated by fentanyl and its analogs—rose from 3,105 to 28,466, an increase of more than 800 percent. Synthetic opioids now account for more fatal overdoses than any other drug category. In 2017, more than half of overdoses for either cocaine or heroin also involved

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