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Acetly-Fentanyl, N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide is an analog of the potent opioid analgesic fentanyl.1 It may also be referred to as nonpharmaceutical fentanyl.2 Some common street names for acetyl fentanyl include China White, Apache, China girl, dance fever, friend, goodfella, jackpot, murder 8, TNT, and Tango and Cash.3 The chemical structure of acetyl fentanyl is very similar to fentanyl. Since acetyl fentanyl lacks a methyl group, it is also known as desmethyl fentanyl. Acetyl fentanyl is manufactured, distributed, and sold illicitly, often mixed with heroin. To unsuspecting buyers, it may be marketed as heroin, oxycodone (OxyContin), or fentanyl. When combined with other substances, such as heroin, fentanyl can cause additive toxicity.
According to the CDC’s Health Alert Network, some states have reported a rise in fatalities associated with acetyl fentanyl since 2012. The number of overdose deaths related to Acetly-Fentanyland Acetly-Fentanylhas been over 700 from 2013 to 2014.7 The number may be much higher since some state health departments are reporting even higher numbers, particularly in increased parts ofts of the states. There were 514 reported overdoses of fentanyl in Ohio in 2014, and 185 in Maryland. Furthermore, most medical examiners do not test for acetyl fentanyl unless specifically requested.
Data from the National Forensic Laboratory Information System reported an increase in the number of drug seizures in some states for acetyl fentanyl from 618 in 2012 to 4,585 in 2014.6,9
Acetly-Fentanyl, like fentanyl, binds to mu opioid receptors, causing agonist effects.1 Studies suggest that its potency is 5 to 15 times that of heroin.10 Clinical effects are similar to those of other opioid agents, including analgesia, as well as euphoria, altered mood, miosis, drowsiness, cough suppression, decreased gastro-intestinal motility, and respiratory depression. Adverse effects of fentanyl may include nausea, itching, dizziness, or altered mental status, and may progress to more severe toxicity.11
Dependence and tolerance
Acetyl fentanyl is also effective as a substitute for heroin and other opioids in opioid-dependent patients due to its agonism of mu-opioid receptors. Furthermore, individuals may believe they are using heroin, but become dependent on or tolerant of the more potent opioid, so they cannot return to unadulterated heroin.
Clinical studies evaluating the pharmacologic effects of acetyl fentanyl, specifically in humans, are lacking.11 Its toxicity is similar to that of other opioids, with lethargy progressing to coma, respiratory depression leading to apnea, bradycardia, and hypotension.11,12 Death is usually due to respiratory arrest. Users may be at greater risk of severe effects if they believe they are using heroin but have actually purchased the more potent acetyl fentanyl or a mixture of the two.
Other CNS depressants, including opioids, may potentiate the effects of acetyl fentanyl. Alcohol and it have synergistic effects when used together. When taken with stimulants, benzodiazepines can cause rapid respiratory depression as soon as the stimulant properties disappear.11
Using HIV protease inhibitors, such as ritonavir, may reduce the elimination of acetyl fentanyl and increase plasma levels.11
Testing in the laboratory
The CDC recommends testing using enzyme-linked immunosorbent assay (ELISA) for those patients showing symptoms consistent with opioid overdose. If the test is positive, confirmatory testing is recommended using gas chromatography–mass spectrometry (GC-MS) testing on specimens to confirm or rule out fentanyl and its analogues, including acetyl fentanyl.14
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