CDC Issues Alert On Deadly New Designer Drug, Acetyl Fentanyl



Forbes

I rarely use sensational headlines but this one deserves the term, “deadly.”

The U.S. Centers for Disease Control and Prevention (CDC) today issued an alert on a peculiar cluster of designer drug overdose deaths that will appear in tomorrow’s August 30th issue of Morbidity and Mortality Weekly Report (MMWR).

In March and early April this year, Rhode Island public health officials noted an unusually high number of drug overdose deaths, with 21 cases in one month relative to an average of nine. Ten deaths were associated with what was originally thought to be the prescription opioid drug, fentanyl.

Fentanyl is most often used in chronic pain management in the form of transdermal patches (Duragesic), “lollipops” (Actiq) or for intravenous, outpatient anesthesia owning to its short duration of action. As a recreational street drug, fentanyl is often called, “China White.”

However, subsequent detailed analysis by the CDC and Rhode Island public health officials revealed that the drug was a chemical relative called acetyl fentanyl. Four additional cases were identified later up through May 26th, bringing the acetyl fentanyl death total to 14. Katie Mulvaney of the Providence Journal reported earlier this week on the intended guilty plea of a 20-year-old man charged with distributing the fatal doses.

Authorities called these cases a “cluster” because all but one death occurred in the same small northern Rhode Island town with no cases in the state capital of Providence. Other drugs such as cocaine, other opioids, alcohol, and benzodiazepines were found in the majority of victims, but one person died solely from acetyl fentanyl.

While first identified in Rhode Island, the Pennsylvania Department of Drug and Alcohol Programs reported on June 27th that acetyl fentanyl was implicated in 50 fatal overdoses and five non-fatal overdoses across that state this year (PDF).

Most concerning to public health officials is that acetyl fentanyl is truly a new designer drug in that no previous reports exist documenting overdose deaths with this chemical. Even the internationally-known recreational drug information site Erowid.org does not currently have any entries on this chemical.

Acetyl fentanyl is not sold as a drug anywhere in the world and is only found as a very minor impurity (0.04%) in prescription fentanyl products. But it’s a highly potent drug with little room for dosing errors: Animal experiments indicate that it’s five times more potent than heroin.

The story continues: http://www.forbes.com/sites/davidkroll/2013/08/29/cdc-issues-alert-on-deadly-new-designer-drug-acetyl-fentanyl/

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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/document/1345188/department_of_drug_and_alcohol_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
 
News for Immediate Release
June 27, 2013

Department of Drug and Alcohol Programs Warns about Acetyl Fentanyl

Drug Caused at Least 50 Fatalities This Year in Pennsylvania

Harrisburg &#8211; The Department of Drug and Alcohol Programs issued a warning
today about fentanyl and its derivative, acetyl fentanyl, a deadly drug that
resembles heroin, but is much more potent and has caused 50 deaths in
Pennsylvania this year.

After recently confirming five overdoses, including one fatality, from the drug in
Lebanon County, the department last week called upon coroners and medical
examiners across Pennsylvania to screen for the drug on all apparent heroin and
other opioid deaths, in order to accurately track the extent of the problem.

As a result, the department determined that recreational use of both versions of the
drug has resulted in at least 50 confirmed fatalities and five non-fatal overdoses
statewide this year.

Overdoses have been confirmed in Allegheny, Beaver, Berks, Blair, Bradford, Bucks,
Butler, Cambria, Delaware, Erie, Lebanon, Lehigh, Philadelphia, Washington and
Westmoreland counties. The department is also awaiting toxicology reports from
several other counties.

The Centers for Disease Control and Prevention (CDC) recently reported in a health
alert that the drug has also caused 14 deaths in Rhode Island since early March.
The department has been in communication with CDC, seeking technical assistance
to address the issue in Pennsylvania.

Fentanyl is a prescription narcotic used to relieve severe or chronic pain, commonly
used for cancer patients or as a last-resort pain medication. It&#8217;s available as a skin
patch, lozenge, pill, shot, a film that dissolves in the mouth, or intravenously.

As a recreational drug, acetyl fentanyl can often resemble heroin, as it has the
same consistency, color and packaging. If a heroin user unknowingly mistakes
fentanyl for heroin and takes too much of the drug, the user is at high risk of a fatal
overdose. During the last major fentanyl overdose outbreak in 2006, there were
269 deaths in Philadelphia alone.

&#8220;This is an especially important time for those addicted to heroin to seek
treatment,&#8221; Department of Drug and Alcohol Programs Secretary Gary Tennis
urged. &#8220;Treatment works; these individuals, rather than risk death day after day,
can attain recovery and go on to live rich and rewarding lives.&#8221;

To view the CDC Health Alert, visit: http://emergency.cdc.gov/HAN/han00350.asp.

For further information about the drug, visit: http://www.drugabuse.gov/drugsabuse/
fentanyl.

To seek treatment for drug or alcohol addiction, visit www.ddap.pa.gov.

Media contact: Christine Cronkright, Governor&#8217;s Press Office, 717-783-1116

###
 
Unmentioned in these articles but definitely worth noting is that the drug is probably being sold on the street as heroin.
 
Man to plead guilty to selling deadly drug in R.I.

http://www.pressherald.com/news/RIman-to-plead-guilty-to-selling-deadly-drug.html

PROVIDENCE, R.I. &#8212; A Providence man has agreed to plead guilty to selling a deadly synthetic drug and threatening a witness, according to an agreement filed in U.S. District Court in Providence.

Victor Burgos, 20, agreed in papers filed Aug. 20 to plead guilty to charges he possessed and distributed acetyl fentanyl, a new kind of injected illegal opiate that resembles heroin, though it is much more potent. It has killed 14 people in Rhode Island this year and dozens more elsewhere, according to health officials.

Burgos also agreed to change his plea to guilty on a charge of tampering with a witness.

He is scheduled to change his plea during a hearing Sept. 6 before U.S. District Judge William Smith.

Burgos, who is known as "Fatboy," was arrested May 17, within days of when authorities have said he sold acetyl fentanyl to a confidential informant. Police thought the informant was buying heroin, but tests later showed that it was acetyl fentanyl. Burgos was charged with possessing and distribution of synthetic acetyl fentanyl and ordered released with an electronic monitoring system May 21.

The story continues: http://www.pressherald.com/news/RIman-to-plead-guilty-to-selling-deadly-drug.html
 
So basically someone has an underground lab to produce this stuff. Then is somehow putting it into the distribution stream for the northeast. And at one of those levels is being passed off as heroin.
 
During the last major fentanyl overdose outbreak in 2006, there were
269 deaths in Philadelphia alone.
I forget their names, but some of these people have threads in the BL Shrine. Not just from Philly but from all of the northern US and also much of Canada. Like thousands of people died the last time the cartels decided to put fentanyl in the US heroin supply.

p.s. I say the cartels because we had a thread about the fentanyl chemist, Ricardo Valdez, who synthesized the fent in Mexico:

http://www.bluelight.ru/vb/threads/322926-Fentanyl-A-Free-Press-Special-Report
 
Considering this stuff has already made the jump to pa im sure its floating around bmore somewhere. There is an article posted in the window of the mmt clinic from the ri state health board about fent ods but its super vague to say the least and there is no mention of analogs. Ive seen this stuff for sale by rc vendors and is also from what i understand sold in headshops in russia as like am001 or something, also gets called synthetic opium. Id def give it a try if i knew exactly the dose i had to be able to properly iv it. I know its not as potent as actual fent but thats also like saying a porsche isnt as fast as a ferarri when they are both pretty fast.
 
23536;11801511 said:
I forget their names, but some of these people have threads in the BL Shrine. Not just from Philly but from all of the northern US and also much of Canada. Like thousands of people died the last time the cartels decided to put fentanyl in the US heroin supply.

p.s. I say the cartels because we had a thread about the fentanyl chemist, Ricardo Valdez, who synthesized the fent in Mexico:

http://www.bluelight.ru/vb/threads/322926-Fentanyl-A-Free-Press-Special-Report
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
 
Is this "new"? I thought fentanyl analogues were all the rage in the '80s. (c.f. china white)

Cayman Chem suggests that based on the EC50, acetyl fentanyl is about 1/20th the potency of "proprionyl"-fentanyl. (EC50 of 676 nM for Ac-Fent vs 30 nM for Fent). This brings it out of the "chemical weapon" territory and into the "very potent opioid".

I seriously doubt the fentanyl was manufactured domestically. The precursors are locked down tighter than a gnat's asshole in a thunderstorm.
 
They didn't catch the chemist, though, just the guy selling it. The Mexican dude arrested in 2007 or whatever probably had nothing to do with a recent batch of acetyl-fent.
 
PurpleKush1;11801894 said:
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
I'm pretty sure desmethyl fentanyl and acetyl fentanyl are the same thing. There's only one primary carbon in fentanyl, and its removal turns the propyl amide into an acetyl amide.

But what's weird is desmethyl fentanyl was being purported to be 40 times as powerful as heroin (by cops):

http://www.cbc.ca/news/canada/montreal/story/2013/05/13/montreal-drug-seizure-fentanyl-bromadol-oxycodone.html

Maybe they're just pulling multiples out of their asses though. At least with this one, there's a little scientific data.
 
23536;11802120 said:
I'm pretty sure desmethyl fentanyl and acetyl fentanyl are the same thing. There's only one primary carbon in fentanyl, and its removal turns the propyl amide into an acetyl amide.

But what's weird is desmethyl fentanyl was being purported to be 40 times as powerful as heroin (by cops):

http://www.cbc.ca/news/canada/montreal/story/2013/05/13/montreal-drug-seizure-fentanyl-bromadol-oxycodone.html

Maybe they're just pulling multiples out of their asses though. At least with this one, there's a little scientific data.
I agree its probably just the media being stupid as usual and embeliishing and mistaking about drugs. If im not mistake regular fentanyl is 300 times stronger then morphine, so when they say in that articles desmethyl fent is 80 times stronger, i nfact its less potent then regular fent. But still, its pretty damn potent. Id like to try bromadol, but from what i read its hella strong. Its stupid they sell these utral potent opioids as heroin, instead they could be honest about what they are, im sure the clientele would still come to get some. Altough some people who have no self control shouldnt be allowed near chemicals of this potency. I dont know man
 
Anyone have any theories on why China hasn't gotten into the designer opiate business yet?
 
^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. also in the mid 90s iirc, mossad agents using fake passports tried to assasinate some middle eastern hamas leader and all got caught, their release was bought only after a dr was flown there to give an antidote. im guessing a very specialized antagonist. but the drug was supposedly levofentanyl. i know sufentanyl is the strongest analog for humans, then you have stuff like etorphine for humongous animals. so i could see if a country was pumping out insanely strong fent analogs they could be charged as conspiring to make chemical weapons? give me heroin anyday over that lab made super chemistry. fent is great for pain but recreationally it never did it for me. but from a price to yeild standpoint i can see how criminal organizations would be drooling over the idea of getting kilos of fent analog to sell in the heroin market.
 
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