Acetyl Fentanyl Deaths Spread To The Southeast

Posted: Feb 19 2014, 8:11pm CST | by , Updated: Feb 19 2014, 8:28pm CST, in News | Misc

Acetyl Fentanyl Deaths Spread To The Southeast
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The North Carolina Department of Health and Human Services issued a health advisory today after conclusively linking three drug overdose deaths with acetyl fentanyl, a designer opioid drug. While acetyl fentanyl is not an approved drug, its chemical structure is closely related to the prescription pain killing opioid, fentanyl.

The danger of acetyl fentanyl is that it is five times more potent than heroin, and 16 times more potent than morphine.* If a drug user injects themselves or snorts a dose of what they think is heroin and it’s all acetyl fentanyl instead, that’s like getting five doses of heroin in one fell swoop. The prescription drug, fentanyl, is actually even more potent, but it can be safely used as an analgesic and anesthetic when used therapeutically in small, pharmaceutically-controlled dosage forms.

Last October, we wrote about an acetyl fentanyl warning from the U.S. Centers for Disease Control and Prevention following the drug’s association with 14 overdose deaths in Rhode Island between March and May, 2013. At the time, the distribution of this drug seemed clustered around Providence.

But in late June, Pennsylvania public health officials announced that acetyl fentanyl was responsible for 50 overdose deaths there, as well as five non-fatal overdoses. By November, the drug appeared to spread to Louisiana when two more deaths from acetyl fentanyl were identified by the Jefferson Parish coroner’s office in the New Orleans suburb of Metairie.

North Carolina officials report that the state’s three January deaths were spread about as far across the state as one could be – 340 miles (the cases were from in Sampson, Person, and Transylvania counties). The brief advisory from the NC DHHS doesn’t say whether coroners had access to the material the decedents had used, so it’s not clear if the users purchased heroin laced with acetyl fentanyl or whether the drug was sold as acetyl fentanyl.

Because acetyl fentanyl is so potent, it’s difficult for analytical forensic chemists to detect it in body fluids because it takes so little to cause a fatal overdose. Having access to the drug the person used makes the association with a death considerably easier.

Continued challenges of designer drugs of abuse

In the book and PBS American Experience film, The Poisoner’s Handbook, author Deborah Blum tells vivid stories of jazz-age New York murderers who tried to to stay one step ahead of toxicologists and medical examiners by using poisons that couldn’t yet be detected by methodology of the time. A similar challenge today is presented by and other designer drugs such as the chemicals in so-called synthetic marijuana or bath salts. But the challenge is being met by swift and creative analytical chemists. A paper published last month from Arkansas and New York public health and crime laboratories showed that the drug is metabolized to another chemical (norfentanyl) that behaves quite differently during analysis.

Although a bit technical, the introduction to that paper presents one of the major obstacles:

When faced with an unsuspected acetyl fentanyl death, forensic toxicology laboratories may be perplexed when enzyme-linked immunosorbent assay (ELISA) screens are positive for fentanyl, yet confirmatory gas chromatography−mass spectrometry (GC-MS) and/or liquid chromatography−mass spectrometry (LC-MS) analyses yield no fentanyl result. Thus, development of a validated testing procedure to quantify acetyl fentanyl and acetyl norfentanyl in human samples is critical to accurately diagnosing human morbidity and mortality from this deadly emerging drug of abuse.

Hence, acetyl fentanyl is very easy to miss in drug overdose cases unless the samples are tested in laboratories with experienced personnel with time to develop brand new methods, and do so with highly-sensitive (read: remarkably expensive) instrumentation.

The Arkansas and New York research team also benefited from a collaboration with two researchers from Cayman Chemical Company in Ann Arbor, Michigan, who provided authentic samples of the drugs for identification (often called reference standards). The well-respected forensic science unit of this biotechnology company is constantly developing new products to keep up with the pace of illicit designer drugs showing up in street products and forensic crime laboratories.

My point in belaboring this issue is that in these real-life, medical detective scenarios, Abby from NCIS doesn’t just inject a sample into a machine that magically prints out the chemical name five minutes later (with apologies to actress Pauley Perrette).

While the U.S. Drug Enforcement Agency hasn’t yet reported on just how widespread acetyl fentanyl use is across the country, their Drug and Chemical Evaluation section released this one-page informational PDF in December.

One final note: for public health officials and people addicted to drugs like heroin or prescription opioids is that the opioid antidote naloxone would also temporarily reduce risk of death following an overdose. Interested readers can learn more about the expansion of community naloxone distribution programs in an article we presented last week.

*The current Wikipedia entry for acetyl fentanyl erroneously overstates the potency of the drug using an outdated reference from 1968.

Source: Forbes

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