CDC Issues Alert On Deadly New Designer Drug, Acetyl Fentanyl

Notes from the Field: Acetyl Fentanyl Overdose Fatalities — Rhode Island, March–May 2013

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6234a5.htm

August 30, 2013 / 62(34);703-704

In May 2013, the Rhode Island State Health Laboratories noticed an unusual pattern of toxicology results among 10 overdose deaths of suspected illicit drug users that had occurred during March 7–April 11, 2013. An enzyme-linked immunosorbent assay (ELISA) for fentanyl in blood was positive for fentanyl in all 10 cases, but confirmatory gas chromatography/mass spectrometry (GC/MS) did not detect fentanyl. The mass spectrum was instead consistent with acetyl fentanyl, a fentanyl analog. Acetyl fentanyl, a synthetic opioid, has not been documented in illicit drug use or overdose deaths, and is not available as a prescription drug anywhere. Animal studies suggest that acetyl fentanyl is up to five times more potent than heroin as an analgesic (1).

During May 14–21, 2013, CDC and Rhode Island public health officials conducted a field investigation to determine whether this cluster of 10 deaths represented an increase in the typical number of overdose deaths and what role might have been played by acetyl fentanyl. Data on illicit drug (cocaine, heroin, synthetic cathinones [bath salts], gamma-hydroxybutyric acid, and methamphetamine) overdose deaths during March 1, 2012–March 31, 2013 were abstracted from the Rhode Island Office of State Medical Examiners database and examined using Poisson regression. Data also were abstracted from autopsy reports, toxicology results, and medical records relating to the 10 deaths that were preliminarily positive for acetyl fentanyl. The state health laboratories performed all toxicology testing for acetyl fentanyl.

Investigators found that the number of illicit drug overdose deaths in Rhode Island was significantly higher in March 2013 (21, including 10 attributed to acetyl fentanyl), compared with the monthly average during March 2012&#8211;February 2013 (8.9, p<0.001). During the field investigation, two additional acetyl fentanyl overdose deaths were confirmed (dates of death: March 20 and May 16, 2013), bringing the total number of acetyl fentanyl deaths to 12. Among the 12 acetyl fentanyl decedents, ages ranged from 19 to 57 years, and eight were male. All but one of the deaths occurred in northern Rhode Island: six occurred in the same small city and none in the capital city, Providence. Evidence suggested that acetyl fentanyl was administered intravenously in at least four (33%) of the deaths. The route of acetyl fentanyl administration was undetermined for the remaining eight decedents.

The GC/MS toxicology results for 10 of the 12 decedents showed, in addition to acetyl fentanyl, various mixtures of other drugs, including cocaine (58%), other opioids (33%), ethanol (25%), and benzodiazepines (17%). None of the decedents tested positive for fentanyl by GC/MS. Toxicology results for one decedent showed only acetyl fentanyl. Since completion of the field investigation, two persons using acetyl fentanyl together died on May 26, 2013, increasing the number of acetyl fentanyl deaths to 14.

Acetyl fentanyl overdose deaths have recently been confirmed in Pennsylvania (2). If states observe clusters or increases in illicit opioid-related overdoses above expected levels, acetyl fentanyl could be involved and confirmatory testing will be needed. CDC encourages public health officials and laboratories, when feasible, to use an ELISA test to screen specimens from suspected illicit, nonpharmaceutical opioid overdose deaths. If an ELISA test is positive for fentanyl, CDC recommends laboratories conduct confirmatory testing by GC/MS; if no fentanyl is detected by GC/MS, then fentanyl analogs should be suspected, and subsequent testing should be considered.

Naloxone is an opioid antagonist that can reverse potentially fatal opioid-induced respiratory depression and is used as part of the initial treatment of suspected opioid overdose. Because of the increased potency of acetyl fentanyl, larger doses of naloxone might be needed to achieve reversal (3); health-care providers who administer naloxone in emergencies might consider increasing the amount they keep on hand. In addition, expansion of community-based programs that provide opioid-overdose prevention services, including distribution of and training in the use of naloxone, might be an effective strategy to help reduce opioid-related overdose deaths (4).

Reported by:

Laurie Ogilvie, MS, Rhode Island State Health Laboratories; Christina Stanley, MD, Rhode Island Office of State Medical Examiners. Lauren Lewis, MD, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Molly Boyd, MD, Div of Toxicology and Human Health Sciences, Agency for Toxic Substances & Disease Registry; Matthew Lozier, PhD, EIS officer, CDC. Corresponding contributor: Matthew Lozier, [email protected], 770-488-0794.

References:

1. Higashikawa Y, Suzuki S. Studies on 1-(2-phenethyl)-4-(N-propionylanilino) peperidine (fentanyl) and its related compounds. VI. Structure-analgesic activity relationship for fentanyl, methyl-substituted fentanyls and other analogues. Forensic Toxicol 2008;26:1&#8211;5.
   
2. Pennsylvania Department of Drug and Alcohol Programs. Department of Drug and Alcohol Programs warns about acetyl fentanyl: drug caused at least 50 fatalities this year in Pennsylvania. Harrisburg, PA: Pennsylvania Department of Drug and Alcohol Programs; 2013. Available at http://www.pa.gov/portal/server.pt/..._programs_warns_about_acetyl_fentanylExternal Web Site Icon.
   
3. Schumann H, Erickson T, Thompson TM, Zautcke JL, Denton JS. Fentanyl epidemic in Chicago, Illinois and surrounding Cook County. Clin Toxicol 2008;46:501&#8211;6.
   
4. Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ 2013;346:f174.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6234a5.htm

 

this is crazy, all these new opioids, heroins not even the big bad boy of the game anymore. Now we have this and that krokadil shit they`re making over in russia out of otc codeine pills that rots users flesh to their bones. Scary stuff for the next generation of opiate addicts....

 

I recently moved to camden new jersey which is just across the river from philadelphia. There have been a few heroin overdoses here lately that police are attributing to very potent heroin, i wonder if some of this fentanyl analog was involved. Personally i haven't come across any extra potent batches, which is probably a good thing.

 

this is crazy, all these new opioids, heroins not even the big bad boy of the game anymore. Now we have this and that krokadil shit they`re making over in russia out of otc codeine pills that rots users flesh to their bones. Scary stuff for the next generation of opiate addicts....

New opioids besides desomorphine? Please tell me about these!!!!

Is it fucked up i want some of this stuff, bad? Though, when i tried plain fentanyl (cut open a patch and shot a pea sized gel ball after dissolving in water), i was bummed. i was getting the OP-OC40s for $no prices a piece then... and would have preferred one of those over the $no prices patch i bought with a friend. i've heard fentanyl is just no euphoria and all OD. Or have i been informed incorrectly and didn't prep that shot correct? i get 90 Oxymorphone 10mg IR pills a month and bang them, so my tolerance is kinda absurd.

Peace&Love,
~f.xy

Edit: Sorry about the prices, mods... I've been on a hiatus. What about a comparative price, i.e.- I could have had four Oxy for what I paid for the Fentanyl?

 

[QUOTE='medicine cabinet';11805039]^i thought china would def be a source for them, havnt read much in the way of proof....seizures, busts ect. i dont know where a country would draw the line between drug and chemical weapon. look at the theatre seize where a few gundred ppl died, all from apparent synthetic opi overdose.[/QUOTE]

Interesting idea, but what would the point be of killing off a bunch of illicit opiate users? Not exactly high-powered individuals there. Just seems like that would cut off demand, in more ways than one.

 

No i mean since high potent fent analogs are used as chemical weapons, if a country was making one of them then cutting it down to a usable dose without causing overdose, i could see the us say its making chemical weapons. Most times too if someone is dropping dead from a specific batch of dope, ppl will actively go in search of it, something that most ppl think is insane, which i guess is.

 

this is crazy, all these new opioids, heroins not even the big bad boy of the game anymore. Now we have this and that krokadil shit they`re making over in russia out of otc codeine pills that rots users flesh to their bones. Scary stuff for the next generation of opiate addicts....

Desomoprhine in it's pure form is harmless. Additive, but harmless. Gives the same rush heroin does but the high lasts for a much shorter duration.

The problem with Desomorphine is that it's made in non-controlled settings with household chemicals and supplies which leave toxic impurities and adulterants. If you cook the stuff up properly and with pure forms of the chemicals you need in a controlled amateur UGL setting you are left with a very safe product. You also need to have common sense and some organic chemistry education. The typical addict lacks both.

 

Man this is so fucked up. Id definitly get me some fentanyl, but i think ti should be advertised as it is, not ''strong heroin''. The people responsible for this will have a special place in hell. I dont know if you remember but there this big drug bust in Montreal in Canada and they were all going crazy over ''desmethyl fentanyl'', i think in fact maybe it was acetly fentanyl? Anyways i hope this madness stops. RIP to all those who went away because of these irresponsible fucks actions

and the users weren't acting irresponsibly? heroin is not legal, meaning users should know that sometimes they get sold fentanyl or (this less potent) acetyl-fentanyl. if the users were acting responsible they would have tested each new set of bags before they were (most likely) injecting, or snorting it. if the users did practice harm reduction, its unlikely any or most of these people would have died (ignoring those who took alcohol/benzos with heroin, they knew what they were doing). but you and i both know thats not the name of the game, if you're addicted and wanna get high, you're not wasting any drops to test it. the dealers shouldn't bear the brunt of the responsibility because it's possible they dont even know they're selling fent not dope. the users acted in neglect of their health, and playing a dangerous game with fire you get burnt sticking your hand in the flame.


i know some of you will find this cruel and wrong, but im tired of all the bias exhibited by drug users on such topics as this. always quick to point the blame from the users themselves, when we are on a forum dedicated to the safe practice of drugs. if these users who overdosed practiced safe usage, its likely many of them would still be alive.

 

I guess krokodil is also desomorphine now that I look into it, it`s just the shit that they use to make it that makes this one even worse. The stuff is pretty big in Russia apparently. Apparently they use eyedrops containing the chemical tropicamide, and codiene, while producing other opiates like iodocodeine, I guess not unlike black tar containing many different opiates besides just the H. But it`s crazy because it`s about as easy to make as meth. Especially over there because codeine is otc.

 

I used to be prescribed fent patch. I wish I had it on hand, but there was a huge pamphlet that came with it. It had a chart that was supposed to be used to help determine what dose of fentanyl a patient should be on after switching from another opioid to fent. According to the chart, it is 100x more powerful than morphine. This is why the patches are in micrograms. MICROGRAMS. You can see why an OD is so easy.

 

and the users weren't acting irresponsibly? heroin is not legal, meaning users should know that sometimes they get sold fentanyl or (this less potent) acetyl-fentanyl. if the users were acting responsible they would have tested each new set of bags before they were (most likely) injecting, or snorting it. if the users did practice harm reduction, its unlikely any or most of these people would have died (ignoring those who took alcohol/benzos with heroin, they knew what they were doing). but you and i both know thats not the name of the game, if you're addicted and wanna get high, you're not wasting any drops to test it. the dealers shouldn't bear the brunt of the responsibility because it's possible they dont even know they're selling fent not dope. the users acted in neglect of their health, and playing a dangerous game with fire you get burnt sticking your hand in the flame.


i know some of you will find this cruel and wrong, but im tired of all the bias exhibited by drug users on such topics as this. always quick to point the blame from the users themselves, when we are on a forum dedicated to the safe practice of drugs. if these users who overdosed practiced safe usage, its likely many of them would still be alive.

Yeah you do have a point here. Alot of people who arei n the depths of addiction just go by the logic i shoot 3 bags each time so imma shoot 3 bags of this new batch must be the same shit. And then boom overdose. But its cowardly IMO to sell something as something else. I mean if i was going to get some H and the man told me it was fent id still get me some lol. Or atleast the dealers could tell the users be careful,more potent shit, laced with fent,etc.

Unless like you said they dont even know its fent. Thats the reason drugs should be legalised, shit like this wouldnt happen. I always do a threshold/small dose when i try a new batch of something, be it blow,H,meth. The only times i didnt follow this rule or didnt test my E pills i regreted it as fuck. I dont do this with pharm pills though because theyre consistent. Anyways on the article i think both the users and the dealers acted irresposnbly, but the blame goes in most part ot the people who laced /remplaced the dope with the fent.

 

Anyone have any theories on why China hasn't gotten into the designer opiate business yet?

Because the penalties are stiff in China - and N Korea would be the place

 

Im pretty sure this stuff has mde it to bmore. My sister was telling me bout a kid who had tiny lotto wraps like midwest style packaging, but a guy she was with is on 100mgs of methadone, took a small test shot and was nod city hard. And this kid apparently has a huge tolerance, i mean even most moderate users would die from 110mgs of zombie juice. She said it dissolved clean, were kinda speckles in the powder and looked kinda sandy. She doesnt shoot but the she was with does. She snorted half a 20 and was off her ass fucked up. The kid who has them i actually saved his life one night when he was oding so he loves me lol. These 2 stupid fat junkies bitches were just sitting there watching him on the floor after he fell backwards in it, instead of helping him they started going througb his pill, they were like come one he wont know, and i said yea but i will and thats bad karma. I told her stop being a junky scumbag and get me orange juic, ice and a little flashlight. He was barely responsive, but after a few good sternum rubs and the sugar from the orange juice and the ice bags under his arms he finally started to come through. Had i not showed up they probably would have let him die and just have told the police he must of oded while her and her whale of a lesbian gf were in the bathroom of their dirty ass place. Long story short he said you ever need anything call me, i told him i wasnt gona watch my sisters friend die on some dirty ass carpet. Junkie bitches at their finest, letting someone oding and then going through their stuff before they are even dead...pisses me off.

 

Man this is so fucked up. Id definitly get me some fentanyl, but i think ti should be advertised as it is, not ''strong heroin''. The people responsible for this will have a special place in hell. I dont know if you remember but there this big drug bust in Montreal in Canada and they were all going crazy over ''desmethyl fentanyl'', i think in fact maybe it was acetly fentanyl? Anyways i hope this madness stops. RIP to all those who went away because of these irresponsible fucks actions

Yep, the bust consisted of desmethyl fentanyl and an actual old opiate not used anymore called bro... something. I'm glad I got addicted to opiates (IV Dilaudid is kinda in the same league as heroin) without ever seeing heroin....with the prices I hear it goes around here anyway...eh...I guess their goal is to use it as cut and save on actual heroin, but if the cutting is done by idiots then...

 

^bromadol was never used medicinally. It's too potent. As potent as carfentanyl. 10,000 times morphine iirc. To my knowledge, there's only one other opiate more potent than that (who here can name it?)

p.s. Would that mean that a therapeutic dosage is 10 micrograms? What does 10 micrograms even look like?

 

^bromadol was never used medicinally. It's too potent. As potent as carfentanyl. 10,000 times morphine iirc. To my knowledge, there's only one other opiate more potent than that (who here can name it?)

p.s. Would that mean that a therapeutic dosage is 10 micrograms? What does 10 micrograms even look like?

Im not sure you could see 10 mics

 

It depends on density. 10 micrograms would surely not be a lot.

Using volumetric dosing one could measure to an arbitrary precision though. And 23536, there are several more potent compounds than bromadol. It's likely an isomer or derivative of ohmefentanyl, probably something like 4''-fluoro,4-carbomethoxy-ohmefentanil... maybe 30,000 to 50,000x morphine.

Scary!

 

I seriously doubt the fentanyl was manufactured domestically. The precursors are locked down tighter than a gnat's asshole in a thunderstorm.

Bingo, it's almost certainly being distributed by Mexican nationals via the same smuggling routes used to import meth et. al., possibly from the very same Mexican labs and supplied by the same precursor chains.

 

^bromadol was never used medicinally. It's too potent. As potent as carfentanyl. 10,000 times morphine iirc. To my knowledge, there's only one other opiate more potent than that (who here can name it?)

p.s. Would that mean that a therapeutic dosage is 10 micrograms? What does 10 micrograms even look like?

Thanks, I thought I read on wiki it was in use in china for surgery only, but it might be one of the "related articles" at the bottom.

 

i haven't bought for over 2 years. But right on the pipeline and everyone and their cousin is slingin. The dudes selling almost never failed to give a heads up if a batch ever kicked harder el morta el morta . Didn't care to lose their customer vase. Very informative 23 and yes Sekio, very intelligent

 

Bingo, it's almost certainly being distributed by Mexican nationals via the same smuggling routes used to import meth et. al., possibly from the very same Mexican labs and supplied by the same precursor chains.

The Lab here in Montreal probably made their own precursors.