Tox Tuesday: Acetyl fentanyl

dreamstime_xs_19621261A cluster of overdoses linked to a synthetic analog of a commonly abused painkiller is causing concern among public health officials.

Acetyl fentanyl is a synthetic opioid chemically similar to the more commonly known fentanyl. However, acetyl fentanyl may be up to five times stronger than heroin, according to the U.S. Centers for Disease Control and Prevention (CDC). So far, at least a dozen fatal overdoses have been linked with acetyl fentanyl, most in northern Rhode Island. Prior to these cases, the drug has not been documented for illicit use or linked to fatal overdoses, CDC reports.

In May, the Rhode Island health department began an investigation after seeing an unusually high number of drug overdoses for one month at 21 (the average is about nine). Of those 21, 10 were associated with acetyl fentanyl. Officials later confirmed four more deaths were attributed to acetyl fentanyl, bringing the total to 14. In at least four of the deaths in the Rhode Island cluster, which occurred in March and April of this year, the drug was administered intravenously. In 10 of the 12 initial Rhode Island cases, officials found other drugs including cocaine and other opioids.

Last month, the Rhode Island Department of Health State health lab (HEALTH) identified acetyl fentanyl in pill form and released a warning that the pills resemble oxycodone (the warning did not apply to those who receive oxycodone from a pharmacy). Acetyl fentanyl is not U.S. Food and Drug Administration (FDA)-approved, nor is it prescribed by doctors or commercially available in any way, HEALTH notes.

“Earlier this year, we identified this lethal, illicit street drug in an injectable form. We now know that it is still in Rhode Island, yet in the form of a pill that has been packaged to look like oxycodone,” said Michael Fine, M.D., director of HEALTH, in a statement. “With an average of four people dying per week due to drug overdoses, we need the people of Rhode Island to know what dangers are out on our streets. People who may think they are buying oxycodone on the street could actually be buying something that we know has already taken the lives of 14 people in Rhode Island.”

This summer, Pennsylvania issued a call to medical examiners and coroners to screen for fentanyl and acetyl fentanyl. At least 50 deaths in that state had been linked to the drugs by June.

The CDC has recommended states that experience clusters or increases in opioid-related deaths specifically screen for acetyl fentanyl.

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