Fentanyl has become popular onthe black market in part because it's synthetic, and because it isso potent, it can be mailed around the world in tiny, concealablepackages. (Photo: Shutterstock)

America's opioid crisis has shifted. As Congress and theWhite House have dawdled, the overdose death toll has continued its steadyclimb — reaching more than 49,000 in 2017, an increase of nearly7,000 over the previous year, itself a record-breaker. But theprimary agent of death is no longer ordinary prescription painkillers. It's illicitfentanyl, often mixed with heroin or some other street drug.

This change calls for an equally drastic shift in the effort toprevent opioid deaths. Tighter controls on prescriptions foroxycodone and hydrocodone are no longer enough to limit supply. TheU.S. needs a comprehensive and multi-targeted strategy to restrictthe importation of illicit fentanyl, and a broader, better-fundedpush to reduce its demand.

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