Journal of Medical Toxicology

, Volume 11, Issue 2, pp 208–217 | Cite as

Acetyl Fentanyl, a Novel Fentanyl Analog, Causes 14 Overdose Deaths in Rhode Island, March–May 2013

  • Matthew J. Lozier
  • Molly Boyd
  • Christina Stanley
  • Laurie Ogilvie
  • Ewa King
  • Colleen Martin
  • Lauren Lewis
CDC Toxicology Report


Fentanyl Naloxone Heroin MDMA Confirmatory Testing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Funding Source

This study is part of the regular duties of the Centers for Disease Control and Prevention.

Conflict of Interest



  1. 1.
    Centers for Disease Control and Prevention NCHS. Underlying cause of death 1999–2011 on CDC WONDER online database, released 2014. Data are from the Multiple Cause of Death Files, 1999–2011, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. 2011.Google Scholar
  2. 2.
    Levi J, Segal L, Fuchs Miller A. Prescription drug abuse: strategies to stop the epidemic 2013; 2013:64.Google Scholar
  3. 3.
    Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. J Am Med Assoc. 2013;309(7):657–9. doi: 10.1001/jama.2013.272.CrossRefGoogle Scholar
  4. 4.
    SAMHSA. Results from the 2012 National Survey on Drug Use and Health: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration 2013 Contract No.: HHS Publication No. (SMA) 13-4795.Google Scholar
  5. 5.
    Centers for Disease Control and Prevention. Rates of drug poisoning deaths involving heroin,* by selected age and racial/ethnic groups—United States, 2002 and 2011. MMWR Morb Mortal Wkly Rep. 2014;63(27):595.Google Scholar
  6. 6.
    Rhode Island Department of Health. Fatal drug overdoses.
  7. 7.
    Ayres WA, Starsiak MJ, Sokolay P. The bogus drug: three methyl & alpha methyl fentanyl sold as “China White”. J Psychoactive Drugs. 1981;13(1):91–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Higashikawa Y, Suzuki S. Studies on 1-(2-phenethyl)-4-(N-propionylanilino)piperidine (fentanyl) and its related compounds. VI. Structure-analgesic activity relationship for fentanyl, methyl-substituted fentanyls and other analogues. Forensic Toxicol. 2008;26(1):1–5. doi: 10.1007/s11419-007-0039-1.CrossRefGoogle Scholar
  9. 9.
    Baum RM. New variety of street drugs poses growing problem. Chem Eng News. 1985;63(36):7–16. doi: 10.1021/cen-v063n036.p007.CrossRefGoogle Scholar
  10. 10.
    Stogner JM. The potential threat of acetyl fentanyl: legal issues, contaminated heroin, and acetyl fentanyl “disguised” as other opioids. Ann Emerg Med. 2014;64(6):637–9. doi: 10.1016/j.annemergmed.2014.07.017.PubMedCrossRefGoogle Scholar
  11. 11.
    Kram TC, Cooper DA, Allen AC. Behind the identification of China White. Anal Chem. 1981;53(12):1379A–86.PubMedCrossRefGoogle Scholar
  12. 12.
    Hibbs J, Perper J, Winek CL. An outbreak of designer drug-related deaths in Pennsylvania. J Am Med Assoc. 1991;265(8):1011–3.CrossRefGoogle Scholar
  13. 13.
    Martin M, Hecker J, Clark R, Frye J, Jehle D, Lucid EJ, et al. China White epidemic: an eastern United States emergency department experience. Ann Emerg Med. 1991;20(2):158–64.PubMedCrossRefGoogle Scholar
  14. 14.
    Nieves E. Toxic heroin has killed 12, officials say. The New York Times. 1991 February 4, 1991.Google Scholar
  15. 15.
    Centers for Disease Control and Prevention. Nonpharmaceutical fentanyl-related deaths—multiple states, April 2005–March 2007. MMWR Morb Mortal Wkly Rep. 2008;57(29):793–6.Google Scholar
  16. 16.
    Foerster EH, Mason MF. Preliminary studies on the use of n-butyl chloride as an extractant in a drug screening procedure. J Forensic Sci. 1974;19(1):155–62.PubMedGoogle Scholar
  17. 17.
    Rhode Island Department of Health. Agencies licensed to provide substance abuse treatment services. 2014. Accessed 8 Aug 2014.
  18. 18.
    Patton AL, Seely KA, Pulla S, Rusch NJ, Moran CL, Fantegrossi WE, et al. Quantitative measurement of acetyl fentanyl and acetyl norfentanyl in human urine by LC-MS/MS. Anal Chem. 2014;86(3):1760–6. doi: 10.1021/ac4036197.PubMedCrossRefGoogle Scholar
  19. 19.
    Pennsylvania Department of Drug and Alcohol Programs. Department of Drug and Alcohol Programs warns about acetyl fentanyl. 2013.Google Scholar
  20. 20.
    Robin N. New street drug kills 5 in Jefferson Parish. 2013.Google Scholar
  21. 21.
    McDonald T. NC health officials warn of new street drug that killed 3 this year. News Observer 2014.Google Scholar
  22. 22.
    Manchikanti L, Helm 2nd S, Fellows B, Janata JW, Pampati V, Grider JS, et al. Opioid epidemic in the United States. Pain Phys. 2012;15(3 Suppl):ES9–38.Google Scholar
  23. 23.
    Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999–2006. NCHS data brief. 2009. 22:1–8.Google Scholar
  24. 24.
    Centers for Disease Control and Prevention. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep. 2011;60(43):1487–92.Google Scholar
  25. 25.
    Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers—United States, 2002–2004 and 2008–2010. Drug Alcohol Depend. 2013;132(1–2):95–100. doi: 10.1016/j.drugalcdep.2013.01.007.PubMedCrossRefGoogle Scholar
  26. 26.
    Owens D. Deadly heroin-fentanyl mix on streets prompts police warnings. The Courant 2014.Google Scholar
  27. 27.
    Press A. Md. has 37 deaths from heroin, fentanyl overdoses. 2014.Google Scholar
  28. 28.
    Conlon LFK. Cancer painkiller mixed with heroin blamed for 22 Pennsylvania deaths. 2014.Google Scholar
  29. 29.
    Freyer FJ. RI overdose deaths rise to 69 for 2014; illicit drugs and fentanyl key factors. Providence J. 2014.Google Scholar
  30. 30.
    Soine WH. Clandestine drug synthesis. Med Res Rev. 1986;6(1):41–74.PubMedCrossRefGoogle Scholar
  31. 31.
    Centers for Disease Control and Prevention. Acetyl fentanyl overdose fatalities—Rhode Island, March–May 2013. MMWR Morb Mortal Wkly Rep. 2013;62(34):703–4.Google Scholar
  32. 32.
    Fernando D. Fentanyl-laced heroin. J Am Med Assoc. 1991;265(22):2962.CrossRefGoogle Scholar
  33. 33.
    Preble ECJ. Taking care of business: the heroin users life on the street. Int J Addict. 1969;4:1–24.Google Scholar
  34. 34.
    Rhode Island Department of Health. HEALTH Investigating New Synthetic Drug. 2013.
  35. 35.
    Rhode Island Department of Health. HEALTH identifies new synthetic drug as acetyl fentanyl. online 2013.Google Scholar
  36. 36.
    Seal KH, Thawley R, Gee L, Bamberger J, Kral AH, Ciccarone D, et al. Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a pilot intervention study. J Urban Health Bull N Y Acad Med. 2005;82(2):303–11. doi: 10.1093/jurban/jti053.CrossRefGoogle Scholar
  37. 37.
    Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174. doi: 10.1136/bmj.f174.PubMedCrossRefGoogle Scholar
  38. 38.
    Green TC, Heimer R, Grau LE. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction. 2008;103(6):979–89. doi: 10.1111/j.1360-0443.2008.02182.x.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Yokell MA, Green TC, Bowman S, McKenzie M, Rich JD. Opioid overdose prevention and naloxone distribution in Rhode Island. Med Health Rhode Island. 2011;94(8):240–2.Google Scholar
  40. 40.
    Davis C. Legal interventions to reduce overdose mortality: naloxone access and overdose good samaritan laws: The Network for Public Health Law2014 December 2014.Google Scholar
  41. 41.
    Niedowski E. Rhode Island takes emergency steps on overdoses. 2014.Google Scholar
  42. 42.
    Wood P. Arundel police officers to carry drug to counteract heroin overdose. The Baltimore Sun 2014.Google Scholar
  43. 43.
    Tobin KE, Davey MA, Latkin CA. Calling emergency medical services during drug overdose: an examination of individual, social and setting correlates. Addiction. 2005;100(3):397–404. doi: 10.1111/j.1360-0443.2005.00975.x.PubMedCrossRefGoogle Scholar
  44. 44.
    Tracy M, Piper TM, Ompad D, Bucciarelli A, Coffin PO, Vlahov D, et al. Circumstances of witnessed drug overdose in New York City: implications for intervention. Drug Alcohol Depend. 2005;79(2):181–90. doi: 10.1016/j.drugalcdep.2005.01.010.PubMedCrossRefGoogle Scholar

Copyright information

© American College of Medical Toxicology (outside the USA) 2015

Authors and Affiliations

  • Matthew J. Lozier
    • 1
    • 2
  • Molly Boyd
    • 3
  • Christina Stanley
    • 4
  • Laurie Ogilvie
    • 5
  • Ewa King
    • 5
  • Colleen Martin
    • 6
  • Lauren Lewis
    • 6
  1. 1.Epidemic Intelligence ServiceCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Centers for Environmental HealthCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Environmental Medicine Branch, Division of Toxicology and Human Health SciencesAgency for Toxic Substances and Disease RegistryAtlantaUSA
  4. 4.Office of State Medical ExaminersState of Rhode Island Department of HealthProvidenceUSA
  5. 5.State Health LaboratoriesState of Rhode Island Department of HealthProvidenceUSA
  6. 6.Health Studies Branch, Division of Environmental Hazards and Health Effects, National Centers for Environmental HealthCenters for Disease Control and PreventionAtlantaUSA

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